Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil

OBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41% (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5% of the budget in 1995 and 49% in 2005, and the expenses with community services and medication have increased 15% each. As a whole, the expenses in mental health decreased by 26.7% (2.66 to 1.95 US$ per capita). CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged.

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Preventing Suicide in Prisons, Part II

Crisis ◽

10.1027/0227-5910.28.3.122 ◽

2007 ◽

Vol 28 (3) ◽

pp. 122-130 ◽

Cited By ~ 27

Author(s):

Marc S. Daigle ◽

Anasseril E. Daniel ◽

Greg E. Dear ◽

Patrick Frottier ◽

Lindsay M. Hayes ◽

...

Keyword(s):

Mental Health ◽

Suicide Prevention ◽

Mental Health Professionals ◽

Task Force ◽

International Association ◽

Correctional Officers ◽

Community Services ◽

Correctional Systems ◽

Prevention Activities ◽

Prison Systems

Abstract. The International Association for Suicide Prevention created a Task Force on Suicide in Prisons to better disseminate the information in this domain. One of its objectives was to summarize suicide-prevention activities in the prison systems. This study of the Task Force uncovered many differences between countries, although mental health professionals remain central in all suicide prevention activities. Inmate peer-support and correctional officers also play critical roles in suicide prevention but there is great variation in the involvement of outside community workers. These differences could be explained by the availability of resources, by the structure of the correctional and community services, but mainly by the different paradigms about suicide prevention. While there is a common and traditional paradigm that suicide prevention services are mainly offered to individuals by mental health services, correctional systems differ in the way they include (or not) other partners of suicide prevention: correctional officers, other employees, peer inmates, chaplains/priests, and community workers. Circumstances, history, and national cultures may explain such diversity but they might also depend on the basic way we think about suicide prevention at both individual and environmental levels.

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Resources and Workforce in Top-Tier Psychiatric Hospitals in China: A Nationwide Survey

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.573333 ◽

2021 ◽

Vol 12 ◽

Author(s):

Lei Xia ◽

Feng Jiang ◽

Jeffrey Rakofsky ◽

Yulong Zhang ◽

Yudong Shi ◽

...

Keyword(s):

Mental Health ◽

Social Workers ◽

Lower Limit ◽

Mental Health Professionals ◽

Health Resources ◽

Psychiatric Hospitals ◽

Outpatient Services ◽

The Past ◽

Psychiatric Staff ◽

Psychiatric Beds

Objectives: Mental healthcare has gained momentum and significant attention in China over the past three decades. However, many challenges still exist. This survey aimed to investigate mental health resources and the psychiatric workforce in representative top-tier psychiatric hospitals in China.Methods: A total of 41 top-tier psychiatric hospitals from 29 provinces participated, providing data about numbers and types of psychiatric beds, numbers of mental health professionals, outpatient services and hospitalization information covering the past 3 years, as well as teaching and training program affiliation.Results: Significant variations were found among participating hospitals and across different regions. Most of these hospitals were large, with a median number of psychiatric beds of 660 (range, 169-2,141). Child and geriatric beds accounted for 3.3 and 12.6% of all beds, respectively, and many hospitals had no specialized child or geriatric units. The overall ratios of psychiatrists, psychiatric nurses, and psychologists per bed were 0.16, 0.34, and 0.03, respectively. More than 40% of the hospitals had no clinical social workers. Based on the government's staffing guidelines, less than one third (31.7%) of the hospitals reached the lower limit of the psychiatric staff per bed ratio, and 43.9% of them reached the lower limit of the nurse per bed ratio.Conclusion: Although some progress has been made, mental health resources and the psychiatric workforce in China are still relatively insufficient with uneven geographical distribution and an acute shortage of psychiatric beds for children and elderly patients. In the meantime, the staffing composition needs to be optimized and more psychologists and social workers are needed. While addressing these shortages of mental health resources and the workforce is important, diversifying the psychiatric workforce, promoting community mental health care, and decentralizing mental health services may be equally important.

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The COVID-19 Pandemic and Italian Public Mental Health Services: Experience and Future Directions

Journal of Patient Experience ◽

10.1177/2374373520956857 ◽

2020 ◽

Vol 7 (5) ◽

pp. 642-644

Author(s):

Lorenzo Pelizza ◽

Simona Pupo

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Public Mental Health ◽

Community Services ◽

Point Of View ◽

Future Directions ◽

Public Health Policies ◽

Public Mental Health Service ◽

Public Mental Health Services ◽

Health Service Organization

The COVID-19 pandemic has crosses every health care area (from primary care to specialist ones), leading to a review of all public health policies. The use of smart working allows important technological innovations, but it must be accompanied by a review of hospital and residential programs and locations. Since many institution are talking about economic investments for mental health (a crucial area for a full recovery of the society), specific funds are needed in mental health professionals (eg, psychologists), skills, and innovation of locations and technology, such as the conversion of psychiatric wards to community services that carefully must consider the patient experience and clinician’s point of view. Some considerations on the COVID-19 experience in Italy are reported, and suggestions on future directions for public mental health service organization are hypothesized.

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Psychiatric Reform based on the Practices of Mental Health Professionals at CAPS Ad: Between the Nosocomial and Psychosocial Models

International Journal of Advanced Engineering Research and Science ◽

10.22161/ijaers.75.25 ◽

2020 ◽

Vol 7 (5) ◽

pp. 189-212

Author(s):

José Carlos Barboza da Silva ◽

Bruna Botelho Costa Rocha dos Santos ◽

Leonardo Severo da Luz Neto ◽

Helio Franklin Rodrigues de Almeida ◽

Fatima Maia Queiroga ◽

...

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Health Professionals ◽

Psychiatric Reform ◽

Psychosocial Models

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Innovations in Mental Health Care Delivery

The British Journal of Psychiatry ◽

10.1192/bjp.160.5.589 ◽

1992 ◽

Vol 160 (5) ◽

pp. 589-597 ◽

Cited By ~ 31

Author(s):

Isaac Marks

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Community Care ◽

Clinical Audit ◽

Care Delivery ◽

Severe Depression ◽

Cost Effective ◽

Community Services ◽

Self Help ◽

Anxiety Depression

In serious mental illness (SMI) even good community care does not usually make a major impact on clinical or social function, but patients and relatives prefer community to hospital care, and it tends to be cheaper. Any gains are lost if the required community services are not resourced, coordinated, and maintained indefinitely. A few SMI patients continue to need asylum under one roof. CPNs see more anxiety/depression than SMI. Their patients come increasingly from GPs, and they tend to work in practices with less need. Their cost-effectiveness is uncertain, although nurse behaviour therapists are cost-effective in anxiety disorders in primary care. Such research is also needed into the work of other mental health professionals. Despite their effectiveness, there is a dearth of behaviour therapists among nurses and psychiatrists. Problem-orientated training is lacking for most professionals with most patients. Behavioural self-treatments have improved phobic disorders and non-severe depression in controlled studies. Gains were as great when self-treatment was guided by a computer or by a manual as by a clinician. Self-help can extend care delivery, with therapists acting as consultants. Computers can also aid clinical audit.

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Professionals’ perspectives on factors within primary mental health services that can affect pathways to involuntary psychiatric admissions

International Journal of Mental Health Systems ◽

10.1186/s13033-020-00417-z ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Irene Wormdahl ◽

Tonje Lossius Husum ◽

Jorun Rugkåsa ◽

Marit B. Rise

Keyword(s):

Mental Health ◽

Health Care ◽

Primary Health Care ◽

Health Services ◽

Mental Health Professionals ◽

Health Professionals ◽

Care Level ◽

Psychiatric Admissions ◽

Primary Health ◽

Primary Mental Health Care

Abstract Background Reducing involuntary psychiatric admissions has been on the international human rights and health policy agenda for years. Despite the last decades’ shift towards more services for adults with severe mental illness being provided in the community, most research on how to reduce involuntary admissions has been conducted at secondary health care level. Research from the primary health care level is largely lacking. The aim of this study was to explore mental health professionals’ experiences with factors within primary mental health services that might increase the risk of involuntary psychiatric admissions of adults, and their views on how such admissions might be avoided. Methods Qualitative semi-structured interviews with thirty-two mental health professionals from five Norwegian municipalities. Data were analysed according to the Systematic Text Condensation method. Results Within primary mental health care professionals experienced that a number of factors could increase the risk of involuntary psychiatric admissions. Insufficient time and flexibility in long-term follow-up, limited resources, none or arbitrary use of crisis plans, lack of tailored housing, few employment opportunities, little diversity in activities offered, limited opportunities for voluntary admissions, inadequate collaboration between services and lack of competence were some of the factors mentioned to increase the risk of involuntary psychiatric admissions. Several suggestions on how involuntary psychiatric admissions might be avoided were put forward. Conclusions Mental health professionals within primary mental health care experienced that their services might play an active part in preventing the use of involuntary psychiatric admissions, suggesting potential to facilitate a reduction by intervening at this service level. Health authorities’ incentives to reduce involuntary psychiatric admissions should to a greater extent incorporate the primary health care level. Further research is needed on effective interventions and comprehensive models adapted for this care level.

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Psychiatric Patients Boarding at the Emergency Department: Length of Stay and Consequences

Medical & Clinical Research ◽

10.33140/mcr.04.04.01 ◽

2019 ◽

Vol 4 (4) ◽

Keyword(s):

Mental Health ◽

Length Of Stay ◽

Emergency Room ◽

Psychiatric Patients ◽

Community Services ◽

The State ◽

Government Hospital ◽

Health Strategy ◽

National Mental Health ◽

Psychiatric Beds

Objectives: In this research audit we look at the length of stay for psychiatric patents boarding at the emergency room at Hamad General Hospital which is the largest government hospital in the state of Qatar. We also looked at other parameters like, the number of psychiatric patients who leave the ER against medical advice of their own will, whether they return afterwards within a week or not, and also, how many of the boarding patents were treated and discharged without being transferred to the psychiatry hospital. Significant Findings: It was found that out of the 357 boarding patents, only 95 (26.6%) spent less than 12 hours in the ED, and a cumulative of 115 patents spent more than 24 hours in the ED. What was also found was that from the 65 patents discharged y the psychiatry liaison team only 3 returned to the ED within 1 week. Principal Recommendations: To find a safer alternative to patients boarding in the emergency room, in the form of increased in patent beds in Psychiatry, increased flow to community services in additon to adequuate staffing and ER resources including staff and doctors to care for the boarding patents. Conclusion: After reviewing the national mental health strategy, as mentioned in the introduction as well, it is deemed that a need of 319 psychiatric beds is present in the state of Qatar currently. The mental health strategy also highlights plans for expansion of psychiatric services in all the various disciplines like community and home care as well, in order to reduce the number of patents boarding in the ER which goes in line with the recommendations that are produced through this audit.

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