ABSTRACT
O fenômeno da reinternação em hospital psiquiátrico, conhecido na literatura como "revolving door", é de altíssima incidência na maioria das instituições, indicando a relevância de conhecer suas causas e pensar estratégias que o evitem. Objetivou-se avaliar as reinternações no Hospital Dr. João Machado (HJM), em Natal, RN, bem como identificar os efeitos da proposta de alta assistida desse hospital. Realizaram-se leituras dos prontuários de usuários que passaram pela alta assistida do HJM e entrevistas abertas com profissionais, além de uma revisão bibliográfica acerca da reinternação psiquiátrica, a fim de elucidar o que a literatura tem encontrado. Constatou-se que o projeto enfrenta alguns entraves e que a estratégia de dar assistência após a alta hospitalar, garantindo uma atenção continuada e inserida no meio social e familiar, é fundamental na tentativa de evitar a reinternação.
The phenomenon of rehospitalization in a psychiatric hospital, known in the literature as "revolving door", has a high incidence in the majority of the institutions. Knowing the causes of that phenomenon and thinking about strategies to enable its rupture are pertinent worries. On this path, the present research was developed, seeking to evaluate the "revolving door" on a psychiatric hospital - the Dr. João Machado Hospital (HJM), in the city of Natal, Rio Grande do Norte, Brazil - and the effects of the proposal of a assisted discharge in this hospital. The handbook of the patients who were submitted to the assisted discharge was read and interviews with professionals were carried out. In addition, it was made a literature review about the psychiatric rehospitalization to elucidate what the literature has found. In the end, it was possible to detect problems that evolve this follow-up and it was verified that the strategy of assisting the patient on the after-discharge, giving him/her appropriate and continuing attention in the social and familiar environment is fundamental to avoid the "revolving door".
Subject(s)
Humans , Mental HealthABSTRACT
El propósito del siguiente escrito es dar a conocer el trabajo realizado desde hace ya 9 años en el Programa de Rehabilitación y Externación Asistida (P.R.E.A.) en el Hospital Estevez", de Temperley, Provincia de Buenos Aires. Se intenta dar cuenta del contexto histórico-político que dio origen al surgimiento de este programa, así como de las distintas actividades que el mismo realiza a través de sus dispositivos para lograr el objetivo primordial del P.R.E.A.: la externación y reinserción social de personé con años de internación, cronificadas en la institución neuropsiquiátrica. Es el relato de una experiencia que, junto con otras ya consolidadas en nuestro país y en el mundo, demuestran a las claras que existen alternativas prácticas y sustentables a la manicomialización y al encierro en el tratamiento del padecimiento mental severo y la cronicidad. Y que eso es posible en las condiciones concretas de nuestra provincia y nuestro sistema público de salud.
The purpose of the following article is show the work that has been going on for the past nine years in the Assisted Discharge and Rehabilitation Program (PREA, from its Spanish initials), at the Estevez Hospital, Temperley, Province of Buenos Aires, Argentina. Our aim is to describe the historical and political context that gave rise to this program as well as the different activities carried out through its mechanisms to achieve the program's main objective: institutional discharge and resocialization of long-term patients with high chronicity in the psychiatric facility. This is the account of an experiment which, together with other similar ones already carried out in our country and elsewhere in the world, proves clearly that there are practical al sustainable alternatives to institutionalization and confinement for the treatment of serious mental disorders and chronicity and that this is feasible within our province's current situation and our public health system.
Subject(s)
Humans , Patient Discharge , Deinstitutionalization , Rehabilitation , Socialization , Argentina , Personal Autonomy , Patient Advocacy , Community Psychiatry , Health SystemsABSTRACT
A Alta-Assistida/AA e o Acompanhamento Terapêutico/AT são práticas que se inserem no contexto atual da atenção à saúde mental em concordância com as diretrizes que norteiam a Reforma Psiquiátrica. Atualmente, vive-se o desafio da reintegração social de sujeitos portadores de transtornos mentais, uma vez que ainda não se dispõe de uma rede ágil, flexível e resolutiva para atendê-los. A proposta de uma saída do hospital planejada e assistida é, pois, uma estratégia fundamental no processo de desinstitucionalização. Este trabalho objetiva apresentar uma experiência de AT realizada junto a um paciente do Hospital Dr. João Machado, em Natal, e discutir os efeitos e resultados desta forma de atenção na proposta de alta-assistida aí implementada.
Assisted Discharge/AD and Therapeutic Accompaniment/TA are practices that are inserted in the present context of attention to mental health in accordance with the directives that guide Psychiatric Reforms. Nowadays, people with a mental upset live the challenge of social reintegration, since there isn't available a flexible, agile and firm network capable of helping them. The proposal of a planned and watched exit of the hospital is, therefore, a primary strategy in the process of de-institutionalization. This work intends to present an experience of TA carried out with a patient from the Dr. João Machado Hospital, in the city of Natal, and discuss the effects and results of this form of attention in the proposal of assisted discharge that was applied.
Subject(s)
Humans , Male , Female , Continuity of Patient Care , Health Care Reform , Mental Health , Social Adjustment , Social Work, PsychiatricABSTRACT
Um dos obstáculos atuais à Reforma Psiquiátrica é a ausência de uma rede assistencial ágil, flexível e resolutiva. A proposta de saída dos usuários do hospital de forma planejada e assistida é uma estratégia fundamental no processo de desinstitucionalização, no sentido de evitar o tão acentuado fenômeno da reinternação. Tal situação está relacionada à falta de uma rede de atenção extra-hospitalar, bem como de suporte e acompanhamento do usuário por parte da equipe técnica em parceria com as famílias. Com base nisso, realizou-se uma investigação em um hospital psiquiátrico do município de Natal, visando a avaliar o processo de implantação e o funcionamento do Projeto de Alta-Assistida atualmente em curso nessa instituição. Este trabalho objetiva discutir os resultados dessa investigação.
One of the current obstacles to the psychiatric reform is the absence of an agile, flexible and problem-solving welfare network. The proposed removal of users from the hospital in a planned and assisted is a key strategy in the process of deinstitutionalization, in order to avoid the phenomenon of so marked rehospitalization. This situation is related to the lack of a network of care outside hospitals, as well as supporting and monitoring of the user by the technical team in partnership with families. On this basis, there was an investigation into a psychiatric hospital in the city of Natal, to evaluate the process of deployment and operation of the Project for Assisted Discharge currently in progress at that institution. This work discusses the results of this research.