El cuidado de niños y adolescentes negros con problemas de salud mental en la interseccionalidad entre género y raza / The care provided to black-skinned children and adolescents with mental health problems in the intersection between gender and race / O cuidado de crianças e adolescentes negros com problemas de saúde mental na interseccionalidade entre gênero e raça

Objetivo: caracterizar el perfil sociofamiliar de niños y adolescentes negros con problemas de salud mental y describir desde un enfoque interseccional quién es responsable de su cuidado. Método: estudio exploratorio descriptivo de enfoque cualitativo, llevado a cabo en un Centro de Atención Psicosocial Infantil y Juvenil de la región norte del municipio de São Paulo. La recolección de datos se realizó con 47 familiares de niños y adolescentes negros, con el soporte de un guion con variables predefinidas, sometidas a análisis estadístico. Resultados: se realizaron 49 entrevistas, 95,5% con mujeres, con edad promedio de 39 años, 88,6% madres, 85,7% negras. La renta familiar procede del salario para el 100% de los cuidadores hombres y el 59% de las mujeres. Entre las cuidadoras negras, 25% tienen casa propia y, entre las pardas, 46,2%. Del total de cuidadores, el 10% vive en casas ocupadas, el 20% vive en viviendas cedidas, el 35% tiene casa propia y el 35% alquila. La red de contención social es mayor entre los blancos (16,7%), seguidos por los pardos (3,8%) y está ausente entre los negros (0%). Conclusión: las responsables por el cuidado de niños y e adolescentes negros atendidos en el CAPSij, son, casi en su totalidad mujeres, "madres o abuelas" negras (o mulatas), con acceso desigual a educación, trabajo y vivienda, derechos sociales constitucionales en Brasil.

Objective: to characterize the sociofamily profile of black-skinned children and adolescents with mental health problems and to intersectionally describe who assumes responsibility for their care. Method: a descriptive and exploratory study with a quantitative approach, developed in the Psychosocial Care Center for Children and Adolescents from the North region of the municipality of São Paulo. The data were collected from 47 family members of black-skinned children and adolescents, using a script with predefined variables submitted to statistical analysis. Results: a total of 49 interviews were conducted: 95.5% women with a mean age of 39 years old, 88.6% mothers and 85.7% black-skinned. Family income comes from wages for all the male caregivers and for 59% of the women. Among the black-skinned female caregivers, 25% live in their own house, whereas this percentage is 46.2% among the brown-skinned ones. Of all the caregivers, 10% have a job, 20% live in transferred properties, 35% in houses of their own and 35% in rented places. The social support network is larger among white-skinned people (16.7%), followed by brown-skinned (3.8%), and absent among black-skinned individuals (0%). Conclusion: those responsible for the care of black-skinned children and adolescents monitored by the CAPS-IJ are almost entirely women, black-skinned (black or brown) "mothers or grandmothers", with unequal access to education, work and housing, constitutional social rights in Brazil.

Objetivo: caracterizar o perfil sociofamiliar de crianças e adolescentes negros com problemas de saúde mental e descrever interseccionalmente quem se responsabiliza por seus cuidados. Método: estudo descritivo exploratório de abordagem quantitativa, desenvolvido em um Centro de Atenção Psicossocial Infantojuvenil da região norte do município de São Paulo. Os dados foram coletados com 47 familiares de crianças e adolescentes negros, utilizando um roteiro com variáveis pré-definidas, submetidas à análise estatística. Resultados: foram realizadas 49 entrevistas, sendo 95,5% com mulheres, média de idade de 39 anos, 88,6% mães, 85,7% negras. A renda familiar é proveniente de salário, para 100% dos cuidadores homens e para 59% das mulheres. Dentre as cuidadoras pretas, 25% possuem casa própria, sendo que, dentre as pardas, 46,2%. Do total de cuidadores, 10% vivem em condições de ocupação, 20% habitam moradias cedidas, 35% casas próprias e 35% alugadas. A rede social de suporte é maior entre os brancos (16,7%), seguido pelos pardos (3,8%) e ausente entre os pretos (0%). Conclusão: as responsáveis pelo cuidado de crianças e adolescentes negros acompanhados pelo CAPSij, são na quase totalidade mulheres, "mães ou avós" negras (pretas ou pardas), com acesso desigual à educação, trabalho e moradia, direitos sociais constitucionais no Brasil.

Correlation between the implementation of Psychosocial Care Centers and the rates of psychiatric hospitalizations and suicide in Porto Alegre-RS from 2008 to 2018

Abstract Introduction The Brazilian psychiatric reform has revolutionized the way that mental health care is provided all over the country, introducing the Psychosocial Care Centers (CAPS) and encouraging care at liberty. The CAPS have been assigned many objectives, such as prevention of hospitalizations and intervention in crises or suicide. This paper aims to describe the correlation between the implementation of CAPS and the rates of psychiatric hospitalizations and suicides from 2008 to 2018. Methods This study has an ecological time series design and included residents of the city of Porto Alegre, RS, Brazil, who were hospitalized through the Sistema Único de Saúde (SUS). The data were obtained from official databases (DATASUS, CNES, and IBGE) and indicators were calculated (CAPS coverage, hospitalization rate, and suicide rate). Associations between the indicators were tested using Pearson's correlation coefficients. Results We found a negative correlation between provision of CAPS and psychiatric hospitalizations (r = -0.607 p = 0.048). Conclusion These results support the hypothesis that there is a negative correlation between implementation of the CAPS and psychiatric hospitalizations. This reinforces the importance of implementing policies related to improving psychiatric reform.

Concepções de profissionais dos Centros de Atenção Psicossocial sobre promoção da cidadania / Conceptions of workers of Community Mental Health Centers about citizenship promotion / Concepciones de trabajadores de los Centros de Atención Psicosocial sobre la promoción de la ciudadanía

INTRODUÇÃO: Não obstante os avanços do movimento de Reforma Psiquiátrica Brasileira, a luta pela efetivação dos direitos de cidadania, no campo dos cuidados em saúde mental, ainda permanece como um grande desafio. A própria noção de "cidadania", embora de uso muito frequente, carece de uma análise mais detalhada, de modo que é possível indagar o que pensam os profissionais dos Centros de Atenção Psicossocial sobre a promoção da cidadania dos usuários de serviços de saúde mental. OBJETIVO: Descrever e analisar as concepções de profissionais dos CAPS sobre a promoção da cidadania em sua prática cotidiana. MÉTODO: Foram realizadas entrevistas semiestruturadas com 11 profissionais da equipe técnica dos cinco CAPS do município de Feira de Santana. Os dados foram submetidos à análise temática inferencial à luz da literatura especializada. RESULTADOS: Foram identificadas cinco categorias relativas às concepções de promoção da cidadania nos CAPS: 1) promoção de cidadania como inserção social; 2) promoção da cidadania entre a política pública e a motivação pessoal; 3) práticas de promoção de cidadania no cotidiano do CAPS; 4) dificuldades vivenciadas na promoção da cidadania; e 5) Nova política de Saúde Mental (pós-2016) e a promoção da cidadania. CONSIDERAÇÕES FINAIS: Os resultados mostraram diferentes concepções de promoção da cidadania no cotidiano dos CAPS, indicando fragilidades formativas e aspectos de discricionariedade de profissionais técnicos da ponta dos serviços. Argumenta-se que a efetivação da lógica dos direitos deve estar acompanhada de práticas que reconheçam os usuários como protagonistas de suas vidas e sujeitos de direitos.

INTRODUCTION: Although the advances of the Brazilian Psychiatric Reform, the struggle to guarantee citizenship rights in mental health care remains a great challenge. The very notion of "citizenship", although very frequently used, lacks a more detailed analysis. In this study, we ask what professionals at Brazilian Community Mental Health Centers (CAPS) think about promoting citizenship for users of mental health services. OBJECTIVE: We aim to describe and analyze the concepts of promoting citizenship in the work of professionals of CAPS. METHOD: Was delineated and conducted semi-structured interviews with 11 workers from five CAPS in the city of Feira de Santana, Bahia, Brazil. The data were submitted to inferential thematic analysis in the light of recent specialized literature. RESULTS: Five categories emerged related to the conceptions of citizenship promotion in CAPS: 1) citizenship promotion as social insertion; 2) promotion of citizenship between public policy and personal motivation; 3) citizenship promotion practices in the daily life of CAPS; 4) difficulties experienced in promoting citizenship, and 5) Recent Brazilian Mental Health Policy (post-2016) associated the promotion of citizenship. FINAL CONSIDERATIONS: The results showed different conceptions of citizenship promotion in the daily life of CAPS, indicating formative lacks and aspects of discretion of technical professionals at the edge of services. We argued that to be effective the logic of rights must be followed by practices that recognize users both as protagonists of their lives and as subjects of rights.

INTRODUCCIÓN: No obstante, los avances del movimiento de la Reforma Psiquiátrica Brasileña, la lucha por la observancia de los derechos de la ciudadanía, en el campo de los cuidados con la salud mental, sigue siendo un gran reto. La noción misma de "ciudadanía", aunque de uso muy frecuente, carece de un análisis más detallado, por lo que es posible preguntar qué piensan los trabajadores de los Centros de Atención Psicosocial (CAPS) sobre la promoción de la ciudadanía de los usuarios de los servicios de salud mental. OBJECTIVO: Se plantea describir y analizar las concepciones de los trabajadores de los CAPS respecto la promoción de la ciudadanía en su práctica diaria. MÉTODO: Fueran realizadas entrevistas semiestructuradas con 11 trabajadores del equipo técnico de los cinco CAPS del municipio Feira de Santana, Brasil. Los datos fueran sometidos al análisis temático inferencial a la luz de la literatura especializada. RESULTADOS: Se identificaron cinco categorías relacionadas con los conceptos de ciudadanía en los CAPS: 1) promoción de ciudadanía como inserción social; 2) promoción de la ciudadanía entre la política de gobierno y la motivación personal; 3) prácticas de promoción de la ciudadanía en el cotidiano de los CAPS; 4) dificultades de la promoción de la ciudadanía; y 5) Nueva Política Brasileña de Salud Mental (post-2016) y la promoción de la ciudadanía. CONSIDERACIONES FINALES: Los resultados mostraran diferentes conceptos de promoción de ciudadanía en el quehacer diario de los CAPS, señalando debilidades en la formación y aspectos de discrecionalidad de los trabajadores de los servicios. Se argumenta entonces que la implementación de la lógica de los derechos debe ir acompañada de práctica que reconozcan a los usuarios como protagonistas de sus vidas y sujetos de derechos.

The race/color question in the care process in a psychosocial care center for children and adolescents / La cuestión raza/color en el proceso de cuidado en centro de atención psicosocial infantojuvenil / O quesito raça/cor no processo de cuidado em centro de atenção psicossocial infantojuvenil

ABSTRACT Objective: To recognize the actions related to race/color developed in the care process of the black child and adolescent population of a Psychosocial Care Center for children and adolescents in Brazil. Method: This is a study with a qualitative approach focusing on the three-dimensional racism framework. Data were collected through active medical records and interviews with reference professionals. The results were categorized and thematized through content analysis and the following themes were found: typology of child violence, identification of racism, the school, access to black culture and representativeness. This study obtained ethical approval. Results: The race/color question in the face of violation of fundamental rights of black children/adolescents contributes to the understanding of racism as a social determinant of mental health. Actions to empower the black population include the insertion of the race-color question as an analytical and procedural category in the Singular Therapeutic Projects, as an integral practice of multiprofessional teams work process. Conclusion: It is necessary to invest persistently in the identification and qualification of actions and systematic discussions to face the psychosocial effects of racism.

RESUMEN Objetivo: Reconocer las acciones relacionadas a la cuestión raza/color desarrolladas en el proceso de cuidado de la población infantojuvenil negra de un Centro de Atención Psicosocial infantojuvenil en Brasil (CAPSij). Método: Investigación de abordaje cualitativo con enfoque en el referencial del racismo tridimensional. Los datos fueron recolectados a través de los historiales activos y entrevistas con profesionales de referencia. Los resultados fueron categorizados y tematizados por medio de análisis de contenido y se hallaron los siguientes temas: tipología de la violencia infantil, identificación del racismo, la escuela, acceso a la cultura negra y representatividad. Este estudio obtuvo aprobación ética. Resultados: La cuestión raza/color frente a la violación de derechos fundamentales del niño/adolescente negro contribuye para la comprensión del racismo como determinante social de salud mental. Las acciones de empoderamiento de la población negra abarcan la inserción de la cuestión raza/color como categoría analítica y procesual en los Proyectos Terapéuticos Singulares, como práctica integrante del proceso de trabajo de los equipos multiprofesionales. Conclusión: Es necesario invertir persistentemente en la identificación y en la cualificación de acciones y debates sistemáticos para enfrentar los efectos psicosociales del racismo.

RESUMO Objetivo: Reconhecer as ações relacionadas ao quesito raça/cor desenvolvidas no processo de cuidado da população infantojuvenil negra de um Centro de Atenção Psicossocial infantojuvenil no Brasil. Método: Pesquisa de abordagem qualitativa com enfoque no referencial do racismo tridimensional. Os dados foram coletados por meio dos prontuários ativos e entrevistas com profissionais de referência. Os resultados foram categorizados e tematizados por meio de análise de conteúdo e encontraram-se os seguintes temas: tipologia da violência infantil, identificação do racismo, a escola, acesso à cultura negra e representatividade. Este estudo obteve aprovação ética. Resultados: O quesito raça/cor frente à violação de direitos fundamentais da criança/adolescente negro contribui para a compreensão do racismo enquanto determinante social de saúde mental. As ações de empoderamento da população negra perpassam pela inserção do quesito raça-cor como categoria analítica e processual nos Projetos Terapêuticos Singulares, como prática integrante do processo de trabalho das equipes multiprofissionais. Conclusão: É preciso investir persistentemente na identificação e na qualificação de ações e discussões sistemáticas para enfrentar os efeitos psicossociais do racismo.

Mental health assistance: identification of nursing diagnoses in a community mental health service / Asistencia en salud mental: identificación de diagnósticos de enfermería en un servicio comunitario de salud mental / Assistência à saúde mental: identificação de diagnósticos de enfermagem em serviço comunitário de saúde mental

ABSTRACT Objective: to map and identify nursing diagnoses targeted at night care users in a Psychosocial Care Center according to NANDA-I Taxonomy. Method: this is a descriptive-exploratory study, of documentary research type of 319 records in medical records. It was held in a Psychosocial Care Center III in Goiás, from 2014-2018. Nursing diagnoses and records were extracted with non-standardized language. Results: 813 records of nursing diagnoses identified in 53 different titles, in 10 domains, were identified. The most frequent diagnosis was risk for self-extermination. The domain with the highest number of diagnostic records was activity/rest. There was a predominance of diagnoses focused on the problem. Final considerations: mapping contributes to the planning of evidence-based nursing interventions and to the strengthening of professional identity in mental health. It is evident the need for practices that go beyond the symptoms in a preventive perspective, with a view to comprehensiveness.

RESUMEN Objetivo: mapear e identificar los diagnósticos de enfermería dirigidos a los usuarios que reciben atención nocturna en un Centro de Atención Psicosocial según la Taxonomía NANDA-I. Método: estudio descriptivo-exploratorio, del tipo investigación documental de 319 registros en historias clínicas. Realizado en un Centro de Atención Psicosocial III en el estado de Goiás, en el período 2014-2018. Los diagnósticos y registros de enfermería se extrajeron con lenguaje no estandarizado. Resultados: se identificaron 813 registros de diagnósticos de enfermería identificados en 53 títulos diferentes, en 10 dominios. El diagnóstico más frecuente fue el riesgo de autoexterminación. El dominio con mayor número de registros diagnósticos fue actividad y reposo. Predominó los diagnósticos centrados en el problema. Consideraciones finales: el mapeo contribuye a la planificación de intervenciones de enfermería basadas en evidencia y al fortalecimiento de la identidad profesional en salud mental. Se necesitan prácticas que vayan más allá de los síntomas en una perspectiva preventiva, con miras a la integralidad.

RESUMO Objetivo: mapear e identificar os diagnósticos de enfermagem direcionados para usuários em acolhimento noturno em Centro de Atenção Psicossocial segundo a Taxonomia NANDA-I. Método: estudo descritivo-exploratório, do tipo pesquisa documental de 319 registros em prontuários. Realizado em um Centro de Atenção Psicossocial III no estado de Goiás, no período 2014-2018. Extraíram-se diagnósticos e registros de enfermagem com linguagem não padronizada. Resultados: identificaram-se 813 registros de diagnósticos de enfermagem contemplados em 53 diferentes títulos, em 10 domínios. O diagnóstico mais frequente foi risco de autoextermínio. O domínio com maior número de registros de diagnósticos foi o de atividade/repouso. Houve predominância de diagnósticos com foco no problema. Considerações finais: o mapeamento contribui para o planejamento das intervenções de enfermagem baseadas em evidência e para o fortalecimento da identidade profissional na saúde mental. Evidencia-se a necessidade de práticas que ultrapassem o sintomatológico em uma perspectiva preventiva, com vistas à integralidade.

Ética del cuidado y atención pública en salud mental: un estudio de caso en Barcelona / Ethics of care and public mental health care: a case study in Barcelona

RESUMEN El presente artículo tiene como objetivo analizar, desde la perspectiva de género, los servicios de atención pública en salud mental en la ciudad de Barcelona, a través de un estudio de caso: el servicio de salud mental de personas adultas en el contexto de la última reforma en salud mental de orientación comunitaria y transdisciplinaria. Desde un abordaje cualitativo, estudiamos los diferentes discursos que las y los profesionales en salud mental elaboran sobre cómo abordan la relación terapéutica entre profesional y persona usuaria y, de forma específica, la vulnerabilidad y las propuestas de respuesta. Entre noviembre de 2018 y abril de 2019, se realizaron tres grupos de discusión con profesionales y un grupo conformado por mujeres usuarias. Sobre los datos obtenidos se realizó análisis de contenido categorial. Los resultados muestran una tendencia a entender y abordar la vulnerabilidad desde la ética del cuidado a partir de un modelo de atención comunitaria, que diferencia los discursos entre los hombres y las mujeres que han participado en la investigación. Concluimos que el modelo comunitario, al basarse en la interdependencia, promueve la recuperación de la ciudadanía de las personas usuarias, contraponiéndose al modelo hospitalario.

ABSTRACT This article aims to analyze public mental health services in the city of Barcelona from a gender-based perspective. We do so through a case study of mental health services for adults in the context of recent community-oriented and transdisciplinary mental health care reforms. Employing a qualitative methodology, we look at the discourses of mental health professionals regarding the ways in which they approach the therapeutic relationship between professional and user, specifically with reference to vulnerability and proposals for addressing it. Between November 2018 and April 2019 we conducted three discussion groups with professionals and another with a group of female users. Data analysis was guided by a categorical content analysis model. The results show a tendency to understand and address vulnerability from an ethics of care based on a community care model, with differences in the discourses of men and women who participated in the research. We conclude that the community-based model promotes the recovery of users' citizenship, as it is based on a notion of interdependence, in contrast to the hospital-based mental health model.

Gastos com internações psiquiátricas no estado de São Paulo: estudo ecológico descritivo, 2014 e 2019 / Gasto en hospitalizaciones psiquiátricas en el estado de São Paulo, Brasil: estudio ecológico descriptivo, 2014 y 2019 / Expenditure on psychiatric hospitalizations in the State of São Paulo, Brazil: a descriptive ecological study, 2014 and 2019

Objetivo: Analisar os gastos com internações psiquiátricas no estado de São Paulo, Brasil, nos anos de 2014 e 2019. Métodos: Estudo ecológico descritivo, com análise de dados das internações hospitalares psiquiátricas no estado, obtidos do Sistema de Informações Hospitalares do Sistema Único de Saúde. Resultados: Foram analisadas 115.652 internações ocorridas em 2014, e 79.355 em 2019 (redução de 31,38%). Observaram-se reduções nos valores gastos com internações psiquiátricas (-42,94%), destacando-se as internações de caráter de urgência, de pessoas do sexo feminino (-46,46%), nas idades de 15 a 49 (-36,85%) e mais de 50 anos (-51,54%). Conclusão: As reduções de frequência e de valores gastos com internações psiquiátricas fornecem elementos para a avaliação e alocação de recursos destinados à atenção da saúde mental, no âmbito das internações hospitalares e da utilização de serviços de base comunitária.

Objetivo: Analizar el gasto en hospitalizaciones psiquiátricas en el Estado de São Paulo, Brasil, en los años 2014 y 2019. Métodos: Estudio ecológico descriptivo, con análisis de datos de ingresos hospitalarios psiquiátricos en el Estado de São Paulo, obtenidos del Sistema de Información Hospitalaria del Sistema Único de Salud. Resultados: Se analizaron 115,652 hospitalizaciones ocurridas en 2014 y 79,355 ocurridas en 2019 (reducción del 31.38%). Hubo reducciones en los montos gastados en hospitalizaciones psiquiátricas (-42,94%), con énfasis en hospitalizaciones de urgencia, de pacientes del sexo femenino (-46,46%), en los grupos de edad de 15 a 49 años (-36,85%) y mayores de 50 años (-51,54%). Conclusión: Las reducciones en la frecuencia y los montos gastados en hospitalizaciones psiquiátricas proporcionan elementos para la evaluación y asignación de recursos para la atención de la salud mental, dentro del alcance de las admisiones hospitalarias y el uso de servicios comunitarios.

Objective: To analyze expenditure on psychiatric hospitalizations in the State of São Paulo in 2014 and 2019. Methods: This was a descriptive ecological study, with analysis of data on psychiatric hospital admissions in the State of São Paulo, retrieved from the Hospital Information System. Results: 115,652 hospitalizations that occurred in 2014 and 79,355 that occurred in 2019 were analyzed (reduction of 31.38%). There were reductions in the amounts spent on psychiatric hospitalizations (-42.94%), in particular expenditure on urgency hospitalizations, on female patients (-46.46%), on people aged 15-49 years (-36.85%) and on those aged over 50 years (-51.54%). Conclusion: The reduction in expenditure on psychiatric hospitalizations and the reduction in their frequency provide elements for the assessment and allocation of resources for mental health care, within the scope of hospital admissions and use of community-based services.

¿Qué hace un centro de atención psicosocial infanto-juvenil 24 horas en la ciudad de Curitiba, Brasil? / What does a 24-hour child and adolescent psychosocial care center do in the city of Curitiba, Brazil?

RESUMEN La política nacional de salud mental de la niñez y la adolescencia aún está mal estructurada en Brasil. En términos generales, se trata de una copia de su equivalente para adultos, lo que dificulta su vinculación con la red. El objetivo de esta investigación fue analizar y caracterizar las acciones desarrolladas en un Centro de Atención Psicosocial Infanto-Juvenil con camas, que atiende las 24 horas del día en la ciudad de Curitiba, Brasil. Se trata de un estudio descriptivo, de análisis de historias clínicas y datos de productividad del año 2016, que fueron provistos por el Departamento de Informática del Sistema Único de Salud (DATASUS). Los resultados muestran que el servicio realizó 29.449 procedimientos, atendió a 112 niñas, niños y adolescentes en la recepción de 24 horas. Las historias clínicas indican el amplio uso del servicio por parte de la red. El 52% de la demanda provino de la atención primaria, pero la otra mitad de una amplia variedad de servicios. Esa variedad de acciones sugiere una clínica más flexible, que reemplaza el hospital psiquiátrico clásico por los principios de la clínica ampliada. Además, la existencia de camas facilitó la administración de la crisis de forma más vinculada al territorio

ABSTRACT The National Policy on Mental Health for Children and Adolescents is still poorly structured in Brazil. In general, it replicates the policy aimed at adults, which creates problems for its articulation with networks. The objective of this study was to analyze and describe the actions carried out at a 24-hour Child and Adolescent Psychosocial Care Center (CAPSi) with beds in the city of Curitiba, Brazil. This is a descriptive study based on the analysis of medical record data and productivity data between 2016-2017, provided by the Department of Informatics at the Unified Health System (DATASUS). Results show that the center performed 29,449 procedures and attended to 112 children and adolescents through its 24-hour service. Medical records indicate extensive use of the service by the network. Primary care accounted for 52% of demand, while the other half could be attributed to a wide range of services. The variety of actions carried out suggests a high degree of flexibility at the clinic, replacing the classic model of the psychiatric hospital with the principles of the expanded clinic. Furthermore, the existence of beds made it easier to manage crises in a manner more closely linked to the community.

Caracterización del intento suicida en adolescentes desde un centro comunitario de salud mental / Characterization of the suicidal attempt in adolescents from a community center of mental health

RESUMEN Fundamento: el intento suicida en adolescentes es un elemento esencial en el trabajo asistencial actual desde los propios profesionales de la salud. Objetivo: caracterizar el intento suicida en adolescentes de un centro comunitario de salud mental. Métodos: se realizó un estudio descriptivo, transversal en un área de salud mental, de una población de 80 adolescentes quedó una muestra de 41 con intento suicida pertenecientes al policlínico José Ramón León Acosta de Santa Clara. Se empleó: métodos empíricos, entrevista abierta, revisión de las historias clínicas individuales y de salud familiar. Resultados: predominó el sexo masculino, el 82,8 % de los adolescentes con edades comprendidas entre los 12 y 15 años de edad, el 78 % de estos comenzaron a realizar intento suicida, las causas más frecuentes de por qué comenzaron fueron los conflictos familiares y la presencia de imitación, se demostró que los adolescentes emplean diversos métodos que entre ellos están las sustancias tóxicas para un total de un 39,0 % y seguido del ahorcamiento lo cual representa un 24,4 %. Conclusiones: las dificultades están relacionadas con las actitudes inadecuadas de los padres y la presión psicosocial en grupos por adolescentes que obedece a un código de camaradería.

assistance work from the own professionals of the health. Objective: to characterize the suicidal attempt in adolescents of a community center of mental health. Methods: a descriptive, traverse study was carried out in an area of mental health, with a population of 80 adolescents which left a sample of 41 with suicidal attempts belonging to the polyclinic José Ramón León Acosta in Santa Clara. It was used empiric methods; open interviews, revision of the individual clinical histories and of family health. Results: it prevailed the masculine sex, 82.8 % of the adolescents with ages between the 12 and 15 years old, the 78 % of them began to attempt against their lives. The most frequent causes why they began were the family conflicts and the presence of imitation, it was demonstrated that the adolescents use diverse methods such as toxic substances for a total of 39.0 % and followed by the hanging which represents 24.4 %. Conclusions: the difficulties are related with the inadequate attitudes of the parents and the psychosocial pressure in groups by adolescents that obey a code of companionship.

Estrutura e funcionamento de uma equipe de saúde mental de Trieste na perspectiva de seus integrantes: um estudo qualitativo / Structure and functioning of a mental health team of Trieste in its members perspective:: a qualitative study

O Modelo de Atenção Psicossocial vigente no Brasil requer práticas interdisciplinares e intersetoriais que produzam autonomia e cidadania. Esse modelo teve forte inspiração no modelo italiano. Este estudo teve por objetivo investigar a estrutura e funcionamento de uma equipe de saúde mental de Trieste, Itália, referência internacional na área, na perspectiva de seus integrantes. Entrevistas semiestruturadas foram realizadas com nove profissionais. As entrevistas audiogravadas foram transcritas e analisadas qualitativamente. Os resultados apontam que a cobertura populacional do serviço, número de profissionais, organização das práticas, frequência e qualidade de reuniões são recursos essenciais. O eixo central do trabalho é a existência de múltiplos espaços de discussão para a equipe e usuários, que potencializam práticas centradas na pessoa e no território. O processo de reflexão contínua é pautado em ações não-especialísticas e na discussão sobre as práticas cotidianas.

The Psychosocial Care Model, public policy on mental health in Brazil requires interdisciplinary and intersectoral practices producing autonomy and citizenship. This model had strong inspiration in the Italian model. This study aimed to investigate the structure and functioning of a mental health team of Trieste, Italy, whose network services is considered an international reference. Semi-structured interviews were conducted with nine professionals. The audio-recorded interviews were transcribed and qualitatively analyzed. Results pointed out that the population coverage of the service, number of professionals, territorial and service actions organization, frequency and quality of the meetings are essential resources. The central axis of the work is the existence of multiple discussion spaces for staff and users, which enhance practices centered on the person and in the territory. The process of continuous reflection is based on non-specialistic actions and the discussion about everyday practices.

Comparison of Baseline Characteristics between Community-based and Hospital-based Suicidal Ideators and Its Implications for Tailoring Strategies for Suicide Prevention: Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior

In this cross-sectional study, we aimed to identify distinguishing factors between populations with suicidal ideation recruited from hospitals and communities to make an efficient allocation of limited anti-suicidal resources according to group differences. We analyzed the baseline data from 120 individuals in a community-based cohort (CC) and 137 individuals in a hospital-based cohort (HC) with suicidal ideation obtained from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS) study. First, their sociodemographic factors, histories of medical and psychiatric illnesses, and suicidal behaviors were compared. Second, diagnosis by the Korean version of the Mini International Neuropsychiatric Interview, scores of psychometric scales were used to assess differences in clinical severity between the groups. The results revealed that the HC had more severe clinical features: more psychiatric diagnosis including current and recurrent major depressive episodes (odds ratio [OR], 4.054; P < 0.001 and OR, 11.432; P < 0.001, respectively), current suicide risk (OR, 4.817; P < 0.001), past manic episodes (OR, 9.500; P < 0.001), past hypomanic episodes (OR, 4.108; P = 0.008), current alcohol abuse (OR, 3.566; P = 0.020), and current mood disorder with psychotic features (OR, 20.342; P < 0.001) besides significantly higher scores in depression, anxiety, alcohol problems, impulsivity, and stress. By comparison, old age, single households, and low socioeconomic status were significantly associated with the CC. These findings indicate the necessity of more clinically oriented support for hospital visitors and more socioeconomic aid for community-dwellers with suicidality.

A vivência do portador de transtorno mental no uso de psicofármacos na perspectiva do pensamento complexo / La vivencia del portador de trastorno mental en el uso de psicofármacos en la perspectiva del pensamiento complejo / The experience of mental disorder patients using psychotropic medication under the perspective of complex thinking

RESUMO Objetivo: conhecer como o portador de transtorno mental vivencia o uso de psicofármacos. Método: pesquisa qualitativa, exploratória e descritiva que utilizou como referencial teórico o pensamento complexo de Edgar Morin. Os dados foram coletados por entrevista semiestruturada, aplicada a 26 portadores de transtorno mental com prescrição médica de psicofármacos, e submetidos à análise categorial temática. Resultados: foi identificada uma categoria central: "A vivência complexa do portador de transtorno mental no uso de psicofármacos", que mostra as inter-relações entre as categorias temáticas: vivenciando os efeitos dos psicofármacos; utilizando os psicofármacos de modo irregular; identificando facilidades e dificuldades no uso de psicofármacos; e desenvolvendo estratégias para manutenção do uso regular de psicofármacos. Conclusão: a vivência do portador de transtorno mental no uso de psicofármacos é um processo dinâmico e complexo que engloba a multidimensionalidade, envolvendo o ser humano e seu tratamento.

RESUMEN Objetivo: conocer como el portador de trastorno mental vivencia el uso de psicofármacos. Método: investigación cualitativa, exploratoria y descriptiva que utilizó como referencial teórico el pensamiento complejo de Edgar Morin. Datos fueron recolectados por entrevista semiestructurada aplicada a 26 portadores de trastorno mental con la prescripción de psicofármacos y fueron sometidos al análisis categorial temático. Resultados: emergió una categoría central: "La vivencia compleja del portador de trastorno mental en el uso de psicofármacos", que muestra las interrelaciones entre las categorías temáticas: vivenciando los efectos de los psicofármacos; utilizando los psicofármacos de modo irregular; identificando facilidades y dificultades en el uso de psicofármacos; y desarrollando estrategias para mantenimiento del uso regular de psicofármacos. Conclusion: que la vivencia del portador de trastorno mental en el uso de psicofármacos es un proceso dinámico y complejo que engloba la multidimensionalidad que envuelve el ser humano y su tratamiento.

ABSTRACT Objective: to understand how mental disorder patients experience the use of psychotropic medications. Method: a qualitative, exploratory and descriptive research, which used Edgar Morin's complex thinking as theoretical reference. The data were collected through a semi-structured interview applied to 26 mental disorder patients with psychotropic medical prescription and who were subjected to theme category-based analysis. Results: a central category emerged "The complex experience of mental disorder patients in the use of psychotropic medication". This category shows the interrelations between thematic categories, such as: experiencing the effects of psychotropic medications; using psychotropic medication irregularly; identifying the advantages and difficulties of using psychotropic medication; and developing strategies to maintain the regular use of psychotropic medication. Conclusions: the experiences of mental disorder patients use of psychotropic medications is a dynamic and complex process that encompasses the multidimensionality involving human beings and their treatment.

Psicologia e práticas psicossociais: narrativas e concepções de psicólogos de Centros de Atenção Psicossocial / Psychology and psychosocial practices: narratives and conceptions of psychologists from the psychosocial care / Psicologia y práticas psicosociales: narrativas y concepciones de psicólogos de centros de atención psicosocial

A atenção psicossocial, modelo de cuidado em saúde mental vigente no Brasil, preconiza o trabalho interdisciplinar, intersetorial e territorial. Este trabalho tem como objetivo apresentar concepções de psicólogos dos Centros de Atenção Psicossocial de uma cidade paranaense sobre as práticas psicossociais desenvolvidas em seu cotidiano. Foram realizadas entrevistas individuais semiestruturadas e encontros grupais, utilizando-se a técnica de Grupo Operativo de Pichón-Rivière. As entrevistas e os grupos foram gravados, transcritos na íntegra e analisados qualitativamente. Os resultados apontam a dicotomia entre o fazer clínico e o fazer psicossocial e a identidade profissional dos participantes atrelada ao modelo clínico tradicional da psicologia. Algumas práticas psicossociais estão gradualmente sendo reconhecidas pelos profissionais como práticas legítimas da Psicologia, e poderiam ser consideradas clínica ampliada dentro da área. Conclui-se que para a efetivação de práticas psicossociais, é imprescindível a transformação nos cursos de formação e a criação de estratégias de educação permanente para os profissionais (AU).

The psychosocial care, current care model in mental health in Brazil, emphasizes interdisciplinary, inter-sectoral and territorial actions. This paper aims to present conceptions of psychologists from the Centers for Psychosocial Care of a city on Parana state, about the psychosocial practices developed in their daily actions. Semistructured individual interviews and group meetings were conducted, using the technique of Operating Group of Pichón-Rivière. The interviews and groups were recorded, transcribed and qualitatively analyzed. Results point the dichotomy between clinical and psychosocial practices in psychology and the professional identity of the participants tied to traditional clinical psychology model. Some psychosocial practices are gradually being recognized by professionals as legitimate practice of psychology, and could be considered amplified clinic in psychology. It is concluded that for the effectiveness of psychosocial practices, it is essential to improve graduation courses and permanent education strategies for mental health professionals (AU).

La atención psicosocial, modelo de cuidado en salud mental del Brasil, preconiza el trabajo interdisciplinar, intersocial y territorial. Este trabajo tiene como objetivo presentar concepciones de psicólogos de los Centros de Atención Psicosocial de una ciudad paranaense sobre las prácticas psicosociales desarrolladas en su cotidiano. Se realizaron entrevistas individuales semiestructuradas y encuentros grupales, utilizando la técnica de Grupo Operativo de Pichòn-Rivière, que fueron grabados, transcritos y analizados cualitativamente. Los resultados señalan la dicotomía entre hacer clínico y hacer psicosocial y la identidad profesional de los participantes nel modelo clínico tradicional de la psicología. Algunas prácticas psicosociales están gradualmente siendo reconocidas por los profesionales como prácticas legítimas de la Psicología, y podrían ser consideradas clínica ampliada dentro del área. Se concluye que para que se vuelvan efectivas las prácticas psicosociales, es imprescindible la transformación de los cursos de formación y la creación de estrategias de educación permanente para los profesionales (AU)

The Distribution of Depressive Symptoms among the Community-Dwelling Elderly

OBJECTIVES: This study was to understand the characteristics of depressive symptoms among the community-dwelling elderly. METHODS: Through a community mental health mass screening program in senior society, 197 elderly were evaluated for depressive symptoms with Korean version of Short form Geriatric Depression Scale (SGDS-K). The subjects were grouped into normal or caution groups with a cut-off score of 6. The response rate and odds ratio were calculated and compared within each question. RESULTS: Although they had low total score, many subjects in normal group have the symptoms of the question 2, 13, 5, 10, 7, 4 (in order). Question 12, 6, 8, 4, 14, 3 (in order) showed higher odds ratio in caution group than normal group. Questions belonged to a factor 'general depressive mood' scored much higher odds ratio than the other. CONCLUSION: Even the elderly with low score in SGDS-K might complain of symptoms such as decreased level of energy, activities, interests, and memory. However the subjects with high score tend to report feeling more worthless, afraid, helpless, bored, hopeless, and empty. It can be helpful to know the distribution of depressive symptoms for providing careful mental health service to the elderly dwelling in the communities.

The Psychosocial Adaptation Process of Psychiatric Nurses Working in Community Mental Health Centers

PURPOSE: The aim of this study was to verify psychosocial issues faced by psychiatric and community mental health nurse practitioners (PCMHNP) working in community mental health centers, and to identify the adaptation processes used to resolve the issues. METHODS: Data were collected through in-depth interviews between December 2013 and August 2014. Participants were 11 PCMHNP working in community mental health centers. Analysis was done using the grounded theory methodology. The first question was "How did you start working at a community mental health center; what were the difficulties you faced during your employment and how did you resolve them?" RESULTS: The core category was 'regulating within relationships.' The adaptation process was categorized into three sequential stages: 'nesting,' 'hanging around the nest,' and 'settling into the nest.' Various action/interaction strategies were employed in these stages. The adaptation results from using these strategies were 'psychiatric nursing within life' and 'a long way to go.' CONCLUSION: The results of this study are significant as they aid in understanding the psychosocial adaptation processes of PCMHNP working in community mental health centers, and indicate areas to be addressed in the future in order for PCMHNP to fulfill their professional role in the local community.

Refletindo sobre os centros de atençãopsicossocial / Reflating on psychosocial attention centers

Introdução: O processo de Reforma Psiquiátrica, em curso no Brasil, aponta para a construção e incorporação de novas práticasem saúde mental, como a implantação dos Centros de AtençãoPsicossocial (CAPS). O Ministério da Saúdeincorporou esse dispositivo como a principal estratégia de enfrentamento do modelo assistencial tradicional. Objetivos: Este artigo tem como objetivo refletir sobre a importância dos CAPS como projeto político-social na produção de novos sentidos para a doença mental. Metodologia: Trata-se de um estudo de revisão de literatura de abordagem qualitativa. Resultados: Percebeu-se que a dificuldade de inserçãodesses serviços, de maneira mais ampla, no territórioconstitui-se empecilho para a promoção de novos sentidos para a loucura. Como também, que o projeto de promover uma transformação cultural acerca de loucura ainda é incipiente. Conclusão: Faz-se necessário que os CAPS se inscrevam de maneira mais ampla no território, aumentando sua projeção frente às políticas sociais.

Background: The Psychiatric Reform process currently underway in Brazil points to the construction and adoption of new mental health practices, among which is the implementation of Psychosocial Attention Centers (PAC). The Brazilian Health Ministry adopted this device as the main strategy for coping with the traditional welfare model. Objectives: This article aims to perform reflection on the importance of psychosocial, political and social project in the production of new directions for mental illness. Methodology: This is a study of literature review of qualitative approach. Results: It was felt that the difficulty of inserting these services more widely in the territory constitutes a hindrance to the promotion of new directions for the madness. Furthermore, the project of promoting a cultural change about madness is still incipient. Conclusion: It is necessary that the PAC expand more broadly into the territory, increasing its projection in the face of social policies.

Introducción: El proceso de la Reforma Psiquiátrica en curso en Brasil apunta a la construcción e incorporación de nuevas prácticas de salud mental, como la implementación de los Centros de Atención Psicosociales (CAPS). El Ministerio de Sanidad de Brasil incorporó este dispositivo como la principal estrategia para hacer frente al tradicional modelo asistencial. Objetivos: Este artículo pretende reflexionar sobre la importancia de los CAPS como proeyecto político y social en la producción de nuevos sentidos para la enfermedad mental. Metodología: Se trata de un estudio de revisión de la literatura de abordaje cualitativo. Resultados: Se observó que la dificultad de inserción de estos servicios, más ampliamente en el territorio, constituye un factor que impide la promoción de nuevos sentidos a la locura. Además, el proyecto de promover una transformación cultural en relación con la locura es todavía incipiente. Conclusión: Es necesario que los CAPS se registren de manera más amplia en el territorio, incrementando su proyección frente las políticas sociales.

Work Stress and Job Satisfaction of Community Mental Health Nurses in South Korea: A Qualitative Content Analysis / 정신간호학회지

PURPOSE: The purpose of this study was to describe work stress and job satisfaction of community mental health nurses working in community mental health centers. METHODS: Data were collected using open-ended questions from 37 mental health nurses working in the 16 centers. Qualitative descriptive methods and qualitative content analysis were used. RESULTS: For work stress there were 148 statements and job satisfaction, 107. Work stress had 5 domains (work environment, policy, work load, operations, compensation and welfare), 14 categories (bureaucratic and unsafe environment, communication, social awareness, lack of support, absurd evaluation, inconsistent policy, excessive work, unrealistic service range, inefficient business means, unreasonable system and budget, job insecurity, low compensation) and 26 subcategories. Job satisfaction had 5 domains (business, client, organization, social awareness and compensation), 8 categories (performance, recognition for the job importance and expertise, business potential, client recovery, team work, improve social awareness, direct compensation), and 14 subcategories. CONCLUSION: Results of this study suggest the following: a) further research on identifying sources affecting and improving retention of mental health nurses, b) implementing positive factors and supporting identification of sources of work stress as central to development of strategies to encourage nurses' morale and improve personnel policies.

The Preference Survey for Long-Acting Injectable Antipsychotics of Community-Dwelling Patients with Schizophrenia and their Caregivers / 대한정신분열병학회지

OBJECTIVE: The prescription rates of long-acting injectable (LAI) antipsychotics are very low around 1% in Korea. This study was aimed to explore the preference of LAIs in patients with schizophrenia, who are currently living in community, and their caregivers. METHODS: The patients, diagnosed with schizophrenia by DSM-IV TR and were registered in the 31 mental health centers of Gyeonggi province and their caregivers were inquired the knowledge of the LAIs. The questionnaires contained information such as demographic characteristics, history of psychiatric treatment, and so on. RESULTS: About 5,318 were registered in 31 community mental health centers of Gyeonggi province in February 2012. The questionnaires of 614 patients and 365 caregivers were gathered from 20 community mental health centers. The mean ages (+/-SD) of patients and caregivers were 41.9 (+/-10.2) and 62.2 (+/-13.4) years old, respectively. 272 patients (44.6%) had experienced the discontinuation of medications without doctor's consent. 217 patients (35.9%) and 97 caregivers (27.1%) knew about the LAIs. The preference rates for LAIs were 35.2% and 46.8% for the patients and caregivers, respectively. CONCLUSION: There is still huge discrepancy between the preference and the real prescriptions of LAIs in community-dwelling patients and their caregivers, much higher than in those of hospital settings. This study suggests that both patients and caregivers registered in the community mental health centers have a strong commitment to live in the community. The obstacles against the benefits of LAIs need to be resolved.

Job Satisfaction of Psychiatric and Community Mental Health Nurses in Community Mental Health Centers / 산업간호학회지

PURPOSE: The purpose of this study was to investigate the relationship of psychiatric and community mental health nurses' job satisfaction. METHODS: This was a descriptive and correlational study in which 151 psychiatric and community mental health nurses (PCMHNs) took part between September and October 2009. RESULTS: The mean score for job satisfaction of the participants was 3.25. In job satisfaction, there were significant differences between psychiatric and community mental health nurse practitioner (PCMHNP) and nurse in community mental health center. All variables except role conflict were positively correlated with job satisfaction. As a result, factors influencing job satisfaction were reward system (beta=.46, p<.001), self-esteem (beta=.35, p<.001), leadership (beta=.27, p<.001), career as a PCMHNP (beta=-.12, p<.007), job-related characteristics (beta=.11, p<.24), and career as a nurse in community mental health center (beta=.09. p<.045). These factors explained 70.3% of the total variance. CONCLUSION: The results indicated that the comprehensive understanding of job satisfaction to the independent variables could suggest the way how to increase the job satisfaction for psychiatric and community mental health nurse who are a catalysts promoting mental health in community mental health center.

Job Satisfaction of Psychiatric and Community Mental Health Nurses in Community Mental Health Centers / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to investigate the relationship of psychiatric and community mental health nurses' job satisfaction. METHODS: This was a descriptive and correlational study in which 151 psychiatric and community mental health nurses (PCMHNs) took part between September and October 2009. RESULTS: The mean score for job satisfaction of the participants was 3.25. In job satisfaction, there were significant differences between psychiatric and community mental health nurse practitioner (PCMHNP) and nurse in community mental health center. All variables except role conflict were positively correlated with job satisfaction. As a result, factors influencing job satisfaction were reward system (beta=.46, p<.001), self-esteem (beta=.35, p<.001), leadership (beta=.27, p<.001), career as a PCMHNP (beta=-.12, p<.007), job-related characteristics (beta=.11, p<.24), and career as a nurse in community mental health center (beta=.09. p<.045). These factors explained 70.3% of the total variance. CONCLUSION: The results indicated that the comprehensive understanding of job satisfaction to the independent variables could suggest the way how to increase the job satisfaction for psychiatric and community mental health nurse who are a catalysts promoting mental health in community mental health center.