Arranjos assistenciais em uma rede atenção psicossocial no sul do Brasil / Arreglos asistenciales en una red de apoyo psicosocial en sur de Brasil / Care arrangements on a psychosocial care network in southern Brazil

RESUMO. A implementação da reforma psiquiátrica é tema de recorrentes discussões no campo da saúde mental. Essa implementação não é padrão para todas as localidades brasileiras, uma vez que depende dos recursos materiais, humanos e aspectos culturais de cada região. A esta singularidade retoma-se a noção de arranjo assistencial. Este trabalho se propôs a conhecer a implementação numa regional de saúde da região Sul. Foi realizado um mapeamento descritivo, seguindo método empírico-fenomenológico. Descrevem-se serviços que acolhem todos os públicos, mas que encontram dificuldades no trabalho com a população usuária de álcool e outras drogas. Foram elencados sete dispositivos assistenciais: acolhimento, grupos terapêuticos, oficinas, atendimentos individuais, uso da medicação, encaminhamentos e reuniões de equipe. Expõe-se a ideia de que a estrutura de um serviço de saúde mental não pode ser estanque. Os arranjos assistenciais estão relacionados às vivências e soluções criativas e humanas como também práticas irrefletidas e normatizadoras na atenção do sofrimento mental.

RESUMEN. La implementación de la reforma psiquiátrica no se encuentra estandarizada para todas las regiones brasileras, una vez que eso depende de recursos materiales, humanos y de aspectos culturales. Por cuenta de esta singularidad, se retoma la noción de arreglo asistencial. En este trabajo se propone conocer la implementación en una regional de salud de sur de Brasil. Se realizó un mapeo descriptivo, siguiendo el método empírico-fenomenológico. Se describen servicios que acogen a todos los públicos, pero que encuentran dificultades en el trabajo con usuarios de alcohol y drogas. Fueran enumerados siete dispositivos asistenciales: Acogimiento, grupos terapéuticos, talleres, atendimientos individuales, uso de medicación, encaminamientos y reuniones de equipo. Se expone la idea de que la estructura de un servicio de Salud Mental no puede ser hermética. Los arreglos asistenciales están relacionados con las vivencias y soluciones creativas y humanas como también prácticas irreflexivas y normalizadoras en la atención del sufrimiento mental.

ABSTRACT. The psychiatric reform is not standard in all Brazilian places, as it depends on different factors such as material, human and cultural aspects of each region. As for its singularity, it is seen as a care arrangement. This article aims to study the psychosocial care network on a regional health department in south Brazil. A descriptive mapping has been performed, following the empirical-phenomenological method. The services described welcome the entire community, people from all walks of life, but when it comes Drug and Alcohol addicted, the approach becomes more challenging. There have been seven care services listed: Hosting, Therapeutic Groups, Workshops, Individual Treatment, Medication usage, Referrals and Support Group Meetings. The approach for care arrangement is related to the creative experiences and human solutions as well as thoughtless and normative practices in the attention of mental suffering.

Psychological-behavioral health services and its outcome based on World Health Organization health-promoting school framework: a systematic review of systematic reviews / 中国康复理论与实践

ObjectiveTo review the effect of school-based psychological and behavioral health services based on the World Health Organization (WHO) health-promoting school (HPS) framework on the psychological and behavioral health of children and adolescents. MethodsSystematic reviews on school-based psychological and behavioral health services based on WHO HPS framework and the health outcome, published from 2013 to June, 2023, were searched from Medline, EBSCO, PubMed, Web of Science. A systematic review of the systematic reviews was conducted. ResultsSeven articles were included, involving 261 studies, from six countries, from the journals in the fields of children's psychological health, HPS and school health, published mainly from 2013 to 2022. School-based psychological and behavioral health services involved school health education curriculum and school health services. School health education curriculum included psychological health courses and health education provided by trained teachers. School health services involved various services provided by professionals in school settings, including psychological screening, preventive interventions for psychological and behavioral health issues, clinical assessment, management services, promotion, and supportive services. The health benefits of school-based psychological and behavioral health services included relieving symptoms and incidence of anxiety and depression, alleviating the negative impact of stress, decreasing negative mood, enhancing positive attitudes and resilience, increasing happiness, improving positive psychological well-being, enhancing cognitive functions (such as sustained attention, fluid intelligence, information processing speed and executive functions), fostering correct attitudes and awareness of psychological health, helping students develop interest in learning, enhancing psychological health literacy, knowledge of psychological disorders, awareness of prevention, ability to recognize signs and symptoms, eliminating stigma related to psychological health, promoting social interaction, and improving help-seeking behaviors for psychological health issues. ConclusionThe school-based psychological and behavioral health services based on the WHO HPS framework mainly encompass school health education curriculum and school health services. The health benefits of school-based psychological and behavioral health services are reflected in psychological and behavioral health, overall psychological well-being, and quality of life, as well as social behavior and academic performance.

Mental health services for children with intellectual and developmental disabilities: a WHO-FICs-based study / 中国康复理论与实践

ObjectiveTo systematically analyze the typical mental health conditions and psychological disorders of children with intellectual and developmental disabilities (IDD), to construct a mental health service system and psychological interventions to these mental health conditions of children with IDD . MethodsBased on the framework of the World Health Organization Family International Classifications (WHO-FICs), the mental health conditions and related functioning were analyzed, and the mental health service framework and proposed mental health interventions were constructed.There were six main categories of mental health conditions for children with IDDConclusionThis study systematically analyzed the typical mental health status and related psychological functional impairments of children with IDD. Based on the World Health Organization health service system, a mental health service framework for children with IDD was constructed. Referring to the WHO's continuum of health services, a system of psychological intervention methods for children with IDD was established. Furthermore, the WHO-FICs were used to describe and code the functions of children with IDD, and the ICHI-β3 was applied to code and analyze the related psychological interventions. Resultsmood disorders (anxiety and depression), behavioral disorders (disruptive disorders and challenging behaviors, aggressive behaviors), traumatic disorders (post-traumatic stress disorder), mental disorders (schizophrenia), suicide and self-harm, and learning disabilities (developmental learning disabilities, attention deficit hyperactivity disorder). Mental health services for children with IDD involved in six dimensions: leadership and governance, fundraising, human resources, service delivery, mental health technologies, and information and research. Mental health services went through the continuum of health services from prevention, treatment, rehabilitation to health promotion. We delivered mental health services for children with IDD in three aspects: identifying and diagnosing mental health problems or conditions, analyzing the main factors caused mental health problems, and analyzing the environmental factors. Mental health service interventions mainly covered five categories: antidepressants, psychotherapy, stress management training, physical exercise training, healthy lifestyle education, consultation and support. Children with IDD may obtain the mental health services in hospitals, rehabilitation institutions, community and school settings.

Perspectivas para o uso da telemedicina no atendimento de saúde mental na atenção primária / Perspectives for the use of telemedicine in mental health care in primary care / Perspectivas para el uso de la telemedicina en la atención de salud mental en atención primaria

Objetivo: Identificar na literatura o uso da Telemedicina como recurso na promoção a assistência em saúde mental na Atenção Primária à Saúde. Métodos: Trata-se de uma revisão integrativa, baseada no protocolo Prisma. Realizou-se a coleta de dados na Biblioteca Virtual em Saúde e na Literatura Internacional em Ciências da Saúde. Os dados foram operacionalizados pelo software Iramuteq®. Resultados: Contemplaram a revisão, 27 artigos, a convergência entre a organização do software e a análise das obras dera origem a quatro classes: Ligações telefônicas na promoção do cuidado em saúde mental; Recursos tecnológicos como aliados para o atendimento em saúde mental para crianças e adolescentes; A Telemedicina como ferramenta para minimizar barreiras na assistência à saúde mental; e Perspectivas para o uso da Telemedicina no atendimento de Saúde Mental na Atenção Primária à Saúde. Conclusão: Pode-se identificar que telemedicina favorece o fortalecimento da Atenção Primária à Saúde, suscitando a promoção da saúde e como ferramenta para educação permanente. (AU)

Objective: To identify in the literature the use of Telemedicine as a resource in promoting mental health care in Primary Health Care. Methods: This is an integrative review, based on the Prisma protocol. Data were collected in the Virtual Health Library and in the International Health Sciences Literature. The data were operationalized by the Iramuteq® software. Results: The review, 27 articles, the convergence between the organization of the software and the analysis of the works had resulted in four classes: Telephone calls in the promotion of mental health care; Technological resources as allies for mental health care for children and adolescents; Telemedicine as a tool to minimize barriers in mental health care; and Perspectives for the use of Telemedicine in Mental Health care in Primary Health Care. Conclusion: The results demonstrate relevant aspects about the use of Telemedicine as a tool to promote mental health assistance in Primary Health Care. (AU)

Objetivo: Identificar en la literatura el uso de la telemedicina como recurso para promover la atención de la salud mental en la Atención Primaria de Salud. Métodos: Esta es una revisión integradora, basada en el protocolo Prisma. Los datos fueron recolectados en la Biblioteca Virtual de Salud y en la Literatura Internacional en Ciencias de la Salud, los cuales fueron operacionalizados por el software Iramuteq®. Resultados: La revisión, 27 artículos, la convergencia entre la organización del software y el análisis de las obras, dio lugar a cuatro clases: llamadas telefónicas en la promoción de la atención de la salud mental; Recursos tecnológicos como aliados para el cuidado de la salud mental de niños y adolescentes; La telemedicina como herramienta para minimizar las barreras en la atención de la salud mental; y Perspectivas para el uso de la telemedicina en la atención de salud mental en Atención Primaria de Salud. Conclusión: Los resultados demuestran aspectos relevantes sobre el uso de la telemedicina como herramienta para promover la asistencia de salud mental en Atención Primaria de Salud. (AU)

Abertura de possíveis no cuidado em saúde mental, em momentos de crise / Opening up possibilities in mental health care, in times of crisis

RESUMO O objetivo deste artigo é apontar possíveis ações em saúde mental, em momentos de crise, a partir da Rede de Atenção Psicossocial. Utilizou-se de cena ilustrativa para fundamentar a análise, a partir de diferentes concepções sobre o fenômeno. Evidencia-se que concepções hegemônicas e simplificadoras da crise psíquica são centralizadas em sinais e sintomas, e apagam os sentidos do episódio, gerando ações de violência para os envolvidos. Defende-se a busca por respostas complexas, a fim de ampliar possibilidades de entendimento e ação, envolvendo diferentes atores, que estão implicados na produção da cena da crise. Sugere-se uma abordagem amparada em diferentes pontos da rede psicossocial, visto que a manutenção dos laços comunitários é imperiosa e pode se transformar em espaços facilitadores para a aproximação ou manutenção da pessoa na comunidade. Conclui-se que as aberturas possíveis para o acolhimento e as ações em rede encontram limites nas concepções simplificadoras e contraditórias às necessidades das pessoas. Para lidar com a complexidade da crise, necessita-se de outro paradigma, outros olhares, práticas e saberes, que considerem que a pessoa que encarna a crise produz um significado, constrói um saber sobre a vida e sobre a própria crise, e não deve ser colocada no lugar de objeto de intervenção.

ABSTRACT The objective of this article is to point achievable actions in mental health, in times of crisis, from the Psychosocial Care Network. An illustrative scene was used to support this analysis, from different conceptions about this phenomenon. It is evident that the hegemonic and simplifying conceptions of the psychiatric crisis are centered on signs and symptoms that erase the senses of the episode, and generate acts of violence for everyone involved. The search for complex answers is defended, in order to expand possibilities of understanding and action, involving different actors, that are involved in the production of the crisis's scene. It is suggested an approach supported by different points of the psychosocial network, since the maintenance of the community bonds is imperative and can turn into spaces facilitating the approach or maintenance of the person in the community. It is concluded that the possible openings for the reception and the actions in network find limits in the simplifying conceptions and contradictory to the needs of the people. In order to face the complexity of the crisis, another paradigm is needed, other perspectives, other practices and knowledge that consider that the person who embodies the crisis produces a meaning, builds some knowledge about your life and the own crisis, and should not be placed in the place of intervention object.

Satisfação de negros e não negros assistidos por Centros de Atenção Psicossocial em Álcool e Outras Drogas / Satisfaction of black and non-black individuals assisted at the Alcohol and Drugs Psychosocial Care Center

RESUMO Este artigo objetivou analisar comparativamente a satisfação de indivíduos negros e não negros assistidos por Centros de Atenção Psicossocial em Álcool e Outras Drogas de três estados brasileiros. É um estudo quantitativo, transversal e avaliativo, cujos dados foram coletados por meio de entrevistas seguidas de análise inferencial. Participaram do estudo 707 indivíduos, a maioria homens, autodeclarados negros, com média de idade de 44 anos. Os resultados mostraram que indivíduos negros e não negros estavam igualmente satisfeitos com a assistência ofertada, sobretudo com a competência e compreensão dos profissionais, acolhimento e ajuda recebida, o que contradiz a literatura tradicional que desvela racismo nos serviços de saúde. A avalição é a de que os Centros de Atenção Psicossocial em Álcool e Outras Drogas são locais potentes e diferenciados do sistema de saúde, mais acolhedores e inclusivos, para o cuidado de qualquer tipo de população com necessidades decorrentes do uso de substâncias. Esse resultado é coerente com a história desses dispositivos de saúde em nosso país, sendo serviços centrais da rede substitutiva aos cuidados hegemônicos e asilares.

ABSTRACT The paper aimed to compare the satisfaction of black and non-black individuals assisted by Psychosocial Care Centers for Alcohol and Drugs in three Brazilian states. This is a quantitative, cross-sectional and evaluative study, with inferential analysis of the data we collected through interviews. A total of 707 individuals participated in the study, mostly men, self-declared black, with an average age of 44 years. The results show that black and non-black individuals were equally satisfied with the assistance offered, especially with the competence and understanding of the professionals, embracement and help received. These results contradict the traditional literature that reveals racism in health services. We believe that the Psychosocial Care Centers on Alcohol and Drugs are powerful and differentiated services in the health system, more welcoming and inclusive of their. This result is consistent with the history of these health devices in our country, being central services in the network that is substitutive of hegemonic and asylum-centered psychiatric care.

Adolescentes usuários de serviço de saúde mental: avaliação da percepção de melhora com o tratamento / Adolescents users of mental health services: assessment of the perception of improvement with treatment Assessment of perceived improvement

OBJETIVO: Avaliar a mudança percebida pelos adolescentes usuários de um serviço ambulatorial especializado de saúde mental infantojuvenil. MÉTODOS: Estudo transversal com amostragem por conveniência. Foram realizadas entrevistas individuais com questionário que inclui questões demográficas e socioeconômicas, juntamente com a Escala de Mudança Percebida ­ versão paciente, validada no Brasil. Essa escala aborda mudanças percebidas em diversas dimensões da vida: ocupação, saúde física, aspectos psicobiológicos, sono, relacionamento e estabilidade emocional. O estudo foi realizado de agosto de 2017 a novembro de 2018, abrangendo 100 adolescentes de 12 a 18 anos em tratamento no serviço, no mínimo há 6 meses. RESULTADOS: A maioria foi do sexo feminino (64,0%), com idade entre 16 e 18 anos (48,0%), atendida há mais de um ano (84,0%). Os diagnósticos mais citados pelos adolescentes foram transtorno do déficit de atenção e hiperatividade (39%) e transtornos de ansiedade (36%). O resultado da avaliação global apontou o sentimento de melhora em 83% dos participantes; quanto à mudança percebida nos itens da escala relacionados à melhora, incluem-se: interesse em trabalhar (71,0%), convivência com a família (67,0%) e interesse pela vida (60,0%). CONCLUSÃO: A avaliação da assistência à saúde oferecida pelos serviços públicos de saúde mental é um importante indicador de qualidade e resolutividade das ações, possibilitando identificar os aspectos a serem aperfeiçoados ou reforçados nos processos de trabalho, a fim de favorecer melhores práticas de cuidado na infância e na adolescência.

OBJECTIVE: To evaluate the change perceived by adolescents, who are users of a specialized outpatient mental health service for children and adolescents. METHODS: Cross-sectional study with convenience sampling. Individual interviews were conducted with a questionnaire that includes demographic and socioeconomic questions, together with the Perceived Change Scale ­ patient version, validated in Brazil. This scale addresses perceived changes in several dimensions of life: occupation, physical health, psychobiological aspects, sleep, relationship and emotional stability. The study was conducted from August 2017 to November 2018, covering 100 adolescents between 12 and 18 years undergoing treatment in the service for at least 6 months. RESULTS: The majority were female (64.0%), aged between 16 and 18 years (48.0%), attended for more than one year (84.0%). The most cited diagnoses by teenagers were attention deficit hyperactivity disorder (39%) and anxiety disorders (36%). The result of the global evaluation showed the feeling of improvement in 83% of the participants; regarding the perceived change in the items of the scale related to improvement, they include: interest in working (71.0%), coexistence with family (67.0%) and interest in life (60.0%). CONCLUSION: The evaluation of health care offered by public mental health services is an important indicator of quality and resoluteness of actions, making it possible to identify the aspects to be improved or reinforced in work processes, in order to favor better care practices in childhood and adolescence.

Fronteiras permeáveis e suas implicações no cuidado em saúde mental: a experiência de um serviço aberto e territorial / Permeable Borders and their implications on mental health care: the experience of an open and territorial service / Fronteras permeables y sus implicaciones en el cuidado en salud mental: la experiencia de un servicio abierto y territorial

A partir de narrativas de cenas cotidianas e fragmentos de casos clínicos, discutimos as implicações da permeabilidade entre um Centro de Atenção Psicossocial III (Caps) e o território para a estruturação do cuidado, salientando aspectos que favorecem ou dificultam seu funcionamento como um serviço aberto. Verificamos que, apesar de algumas contradições, ocorre uma ruptura com a noção de fechamento no que concerne à espacialidade, à organização do trabalho e à produção das relações de cuidado. Nesse contexto, a interlocução com territórios marcados por precariedades materiais e violências estruturais interrogam a instituição, seus supostos saberes sobre a loucura e suas formas de tratamento e convidam os trabalhadores a sair de seus muros, buscando construir com os usuários saídas sempre singulares para o que os aflige em seus enlaçamentos com o mundo.

From the narratives of daily scenes and fragments of clinical cases, we discuss the implications of permeability between a Psychosocial Care Center III (Caps) and the territory for structuring care, highlighting aspects that favor or hinder its functioning as an open service. We find that, despite some contradictions, there is a rupture with the notion of closure regarding spatiality, the organization of work and the production of care relations. In this context, the interlocution with territories marked by material precarities and structural violence question the institution, its supposed knowledge about madness and its forms of treatment and invite workers to leave their walls, seeking to build with the users always unique outputs for what afflicts them in their entanglements with the world.

A partir de narrativas de escenas cotidianas y fragmentos de casos clínicos, discutimos las implicaciones de la permeabilidad entre un Centro de Atención Psicosocial III (Caps) y el territorio para la estructuración del cuidado, destacando aspectos que favorecen o dificultan su funcionamiento como un servicio abierto. Verificamos que, a pesar de algunas contradicciones, ocurre una ruptura con la noción de cierre en lo que concierne a la espacialidad, a la organización del trabajo ya la producción de las relaciones de cuidado. En este contexto, la interlocución con territorios marcados por precariedades materiales y violencias estructurales interroga a la institución, sus supuestos saberes sobre la locura y sus formas de tratamiento e invita a los trabajadores a salir de sus muros, buscando construir con los usuarios salidas siempre singulares para lo que los aflige en sus enlazados con el mundo.

Child and Adolescent Psychosocial Care Center service use profile in Brazil: 2008 to 2012

Objective: To describe the service use profile of Child and Adolescent Psychosocial Care Centers (Centro de Atenção Psicossocial Infanto-Juvenil [CAPSi]) in Brazil regarding diagnostic categories, sociodemographic aspects, and care modalities between 2008 and 2012. Methods: A descriptive, ecological study was performed using data from the Unified Health System regarding high-complexity procedure authorizations (Autorização de Procedimentos de Alta Complexidade [APAC]) for the period from 2008-2012. The variables sex, age, diagnosis (F00-F99 of ICD-10), and type of care provided were examined. The data were processed using TabWin and STATA version 12. Results: A total of 837,068 records were examined, each representing one visit to CAPSi. Most visits were by male users (68.8%). The most common diagnoses were hyperkinetic disorders (13%), pervasive developmental disorders (12.4%), and conduct disorders (8.4%). Conclusions: Behavioral and emotional disorders that usually appear during childhood or adolescence and psychological development disorders were frequent, with more than 50% of the latter comprising autism spectrum disorders. Regional differences were observed, with a higher presence of this diagnosis in the Southeast, while the North and Northeast had a high percentage of visits due to mental retardation.

Evaluation of the repertory of social skills of users of psychoactive substances under treatment / Avaliação do repertório de habilidades sociais de usuários de substâncias psicoativas em tratamento

Abstract Introduction: Mental and behavioral disorders due to the use of substances is a serious public health problem. Deficit in social skills can be considered a risk factor at the beginning or continuity of use. Objective: To evaluate the repertoire of social skills of users of multiple and varied psychoactive substances being treated at the Center for Psychosocial Care in Alcohol and Drugs. Method: The sample was composed of individuals diagnosed with Substance-related Disorder undergoing treatment at the Center for Psychosocial Care for Alcohol and Drug Users of a city in the inner state of of São Paulo. Two investigative instruments were used: sociodemographic characterization and use questionnaire and Social Skills Inventory (IHS). The analysis of sociodemographic data used descriptive statistics and IHS analysis performed by collaborating psychologist through the IHS computerized correction system. Results: A total of 35 users, all male, 42.8% aged 31-35 years, 51.4% single participated in this study. The general average classified them with good repertoire, but individual analysis pointed out 42.8% with repertoire below average. Among deficits, the most affected factors were Factors 1 and 3 related to coping skills and self-assertion with risk and difficulties in conversation and social skills. The number of users with social skill deficits is expressive, especially in coping skills and self-assertion with risk, fact that may be directly related to relapse and abandonment of treatment. Conclusion: It is important to evaluate the repertoire of HS at the beginning of treatment, in order to contribute to the elaboration and implementation of specific training interventions.

Resumo Introdução: O transtorno mental e de comportamento devido ao uso de substância é um grave problema de saúde pública. O déficit nas habilidades sociais pode ser considerado fator de risco ao início ou continuidade do uso. Objetivo: Avaliar o repertório de habilidades sociais de usuários de múltiplas e variadas substâncias psicoativas diagnosticados e em tratamento no Centro de Atenção Psicossocial em Álcool e outras Drogas II. Método: Amostra composta de indivíduos diagnosticados com transtorno decorrente do uso de substância em tratamento no Centro de Atenção Psicossocial para Usuários de Álcool e Drogas de uma cidade do interior paulista. Utilizaram-se dois instrumentos investigativos: questionário de caracterização sociodemográfica e uso e Inventário de Habilidades Sociais (IHS). Para a análise dos dados sociodemográficos, utilizaram-se cálculos de estatística descritiva e análise do IHS realizada por psicólogo colaborador pelo sistema de correção informatizada do IHS. Resultados: Participaram 35 usuários, todos do gênero masculino, 42,8% com idade entre 31 e 35 anos e 51,4% solteiros. A média geral classificou-os com bom repertório, porém uma análise individual apontou 42,8% com repertório abaixo da média. Dentre os déficits, os fatores mais comprometidos foram fatores 1 e 3 relacionados a habilidades de enfrentamento e autoafirmação com risco e dificuldades em conversação e desenvoltura social. É expressivo o número de usuários com déficit nas HS, principalmente em habilidades de enfrentamento e autoafirmação com risco, fato que pode estar diretamente relacionado a recaídas e abandono de tratamento. Conclusão: É importante a avaliação do repertório das HS no início do tratamento, a fim de contribuir na elaboração e implantação de intervenções específicas de treinamento.

Percepção de enfermeiros e demais membros da equipe multiprofissional sobre as ações do enfermeiro no cuidado em saúde mental / Perception of nurses and other members of the multiprofessional team about Nursing actions in Mental Health Care

Considerando as recomendações do modelo de cuidado pautado na atenção psicossocial e as dificuldades relacionadas ao núcleo de cada profissão no campo da saúde mental, neste estudo propôs-se analisar a percepção de enfermeiros e demais membros da equipe multiprofissional sobre as ações de enfermagem no cuidado em saúde mental. Como referencial teórico foram utilizadas as concepções de "campo" e "núcleo", propostas por Campos (2000), com a intenção de diferenciar o conjunto de saberes e práticas comuns de todos os profissionais da equipe daqueles específicos da enfermagem. Trata-se de estudo qualitativo, descritivo, transversal, sendo a população do estudo os profissionais de todos os Centros de Atenção Psicossocial e Ambulatório de Saúde Mental do município de Bauru, SP. Foram utilizadas três diferentes técnicas de coleta de dados, a saber, entrevista semiestruturada, questionário com perguntas fechadas e grupo focal. A entrevista foi realizada com todos os enfermeiros e analisada segundo procedimentos metodológicos da análise de conteúdo. O questionário foi aplicado a todos os profissionais das equipes e foi analisado utilizando estatística descritiva. E o grupo focal contou com pelo menos um participante de cada categoria profissional, exceto terapeuta ocupacional, médico e fonoaudiólogo.Os resultados foram divididos em dois grandes temas: atuação da equipe nos serviços de saúde mental e dificuldades do enfermeiro na execução das ações de saúde mental. Notou-se que a percepção de toda a equipe multiprofissional, inclusive a do enfermeiro, enfatizou proximidade com "o corpo físico" dos usuários e os procedimentos técnicos relacionados. Ações de campo foram mencionadas como atribuição do enfermeiro também, porém, desafios para tal desempenho foram ressaltados, entre eles: formação deficitária, dificuldades pessoais, estereótipos profissionais, infraestrutura do serviço e falta de delimitação do núcleo das profissões pelos próprios profissionais.O presente estudo pode subsidiar a construçãode processos de trabalho interdisciplinares e auxiliar na delimitação das ações específicas da enfermagem no cuidado em saúde mental, agregando contribuições singulares aos serviços e à identidade profissional dos enfermeiros

Considering the recommendations of the care model based on psychosocial care and the difficulties related to the core of each profession in the field of mental health, this study proposed to analyze the perception of nurses and other members of the multiprofessional team on the actions of nursing in mental health care. As a theoretical reference, the field and core conceptions proposed by Campos (2000) were used with the intention of differentiating the set of common knowledge and practices of all the professionals of the team from those specific to nursing. This is a qualitative, descriptive and transversal study, which subjects were the professionals of all Psychosocial Attention Centers and Mental Health Ambulatory of Bauru city, in São Paulo, Brazil. Three different data collection techniques were used: a semi-structured interview, a questionnaire with closed questions and a focus group. The interview was performed with all the nurses and analyzed according to the methods of content analysis. The questionnaire was applied to all the professionals of the teams and was analyzed using descriptive statistics. And the focus group had at least one participant from each professional category, except occupational therapist, doctor and speech therapist. The results were divided into two main themes: the team's performance in mental health services and the nurse's difficulties in performing mental health actions. It was noted that the perception of the entire multiprofessional team, including the nurse, emphasized proximity to the "physical body" of users and technical procedures associated. Field actions were also mentioned as a nursing attribution, but some challenges for such performance were highlighted, among them: lack of training, personal difficulties, professional stereotypes, infrastructure and lack of delimitation of the professions core by the professionals themselves. The present study may support the construction of interdisciplinary work processes and assist in the delimitation of specific actions of nursing in mental health care by adding singular contributions to services and the professional identity of nurses

A Preliminary Study to Determine Comprehensive Research and Development Plans for Promoting Mental Health Services

OBJECTIVES: The aim of this study was to analyze research and development projects in mental health services in Korea, using priority evaluation of mental health promotion policies to determine direction of the service. METHODS: An online survey was conducted that targeted experts in the mental health service regarding promotion of mental health in Korea in 2016. The survey was based on 32 policy projects that resulted from 12 strategies according to 4 policy objectives. RESULTS: Analysis of 32 mental health projects were assessed regarding the possibility of technology development success, magnitude of the ripple effect, and necessity of a national response. It was observed that 3 policy projects relevant to suicide, had a high relative priority. This was followed by policies for improvement of health insurance and the medical benefit cost system, and policies for reinforcement of crisis psychological support such as those for disaster victims. CONCLUSION: The prioritization of mental health services should place an emphasis on promotion of a healthy mental lifestyle, rehabilitation support for patients with serious mental illness, and reinforcement of social safety networks for suicide prevention.

Relationship between mental health service demand, loneliness, anxiety and depression of rural left-behind women / 中华行为医学与脑科学杂志

Objective To explore the correlation between psychological health service demand and loneliness and anxiety depression in rural left-behind women.Methods 260 left-behind wo nen in Hebei province were surveyed by psychological health service demand scale,UCLA loneliness scale,trait anxiety scale and the center for epidemiologic studies depression scale (CES-D).Results There were statistically significant differences between the only child and non-only child left-behind women in mental health service demand ((131.72±13.91) vs (122.94±14.76)),loneliness ((52.94±5.65) vs (49.864±5.90)) and anxiety ((50.97±6.38) vs (47.16±4.80)) (t=3.313,2.899,4.151,P＜0.01).The mental health service demand,loneliness,anxiety and depression of left-behind women were different in the age of marriage (F=6.196,9.441,5.257,4.221,all P＜0.01),husband go out time (F=2.761,27.020,4.550,2.830,all P＜0.05) and degree of farm work (F=12.142,6.403,4.115,5.366,all P＜0.001).The anxiety of left-behind women was positively correlated with service content,service demand and depression (r=0.138-0.221,P＜0.01).Depression was negatively correlated with mental health service demand and service teams (r=-0.352--0.223,P＜ 0.01).Loneliness was positively correlated with service content,anxiety and depression (r=0.177-0.262,P＜ 0.01).Multiple linear regression showed that husbands go out time (β=0.326),farm work in very heavy degree (β=-0.376) and relatively heavy degree (β=-0.281),depression (β=-0.194) had a predictive effect on mental health services.Conclusion The mental health service demand of left-behind women are affected by their age,whether the only child,the age of marriage,their husbands' go out time and the degree of heavy farm work.

A review of competencies of community mental health service providers of different professional backgrounds / 中国心理卫生杂志

To promote the development of the domestic community mental health services, this paper introduced several foreign studies on the competencies of community mental health service providers of different professional backgrounds. The studies examined by this article inquire into the core competencies of community mental health service providers working with people of psychiatric disabilities, the core competencies of psychiatrists providing integrated care in the community setting, the competencies of psychologists in community mental health service, and the competency level of community mental health service providers in intervention activities. Drawing on foreign experience and strengthening cooperation among community mental health service providers of different professional backgrounds, and achieving complementary advantages, will help to promote service effectiveness.

A cross-sectional study of supervision in Shanghai mental health service industry / 中国心理卫生杂志

Objective:To understand the status of supervision of mental health service industry in Shanghai, and to provide reference for further strengthening the construction of mental health service system in Shanghai. Methods: In Shanghai, 107 mental health service agencies (including psychiatric institutions, non-specialist medical institutions, non-specialist enterprise and public institutions, social institutions) were selected from Shanghai psychological service industry association. The survey was conducted with the Questionnaire on Current Situation of Mental Health Professional Service Agencies in Shanghai (agency survey), including the "relevant information of agency" and the "management of the agency in the field of mental health services"(whether the agency had supervision requirements on the mental health service personnel, whether the agency organized supervision, the source of supervisors and payment method), and the Questionnaire on Current Situation of Mental Health Service Professionals in Shanghai (professional survey), including "basic information on demography "and" psychological professional work" (the number of hours of supervision in 2015, the cost of supervision, and the form of supervision and payment method). These two parts of questionnaire were selected and analyzed. Results: Agency survey results showed that 80％ of non-specialist enterprises had no supervision requirements for mental health service personnel, supervisor in non-specialist medical institutions were mainly from psychiatric institution (52.9％). The cost of supervision in most psychiatric institutions was paid by the agency (39.1％) and the cost of supervision in most public institutions was paid by professional (37％). The professional institutions under the jurisdiction of other departments within the unit required less supervision of the professional staff than the independent institutions (P ＜ 0.001). Professional survey results showed that the number of supervision hours of mental health service professional in social institutions was more than that in the other three types of institutions (P ＜0.001), of which 47.9％ chosen to pay the cost of supervision by themselves. The proportion of their own payment in social institutions was higher than that in the other three types of institutions (P ＜0.001). Conclusion:The social institutions in Shanghai have the best supervision of social institutions, followed by the supervision of the medical institutions. The supervision of non-medical enterprises and their personnel needs to be improved.

Apoio matricial na atenção à saúde mental em uma regional de saúde, Paraná, Brasil / Matrix support in mental health care at a health center in the state of Paraná, Brazil

Este estudo objetivou analisar os limites e possibilidades do apoio matricial em saúde mental na Atenção Básica, segundo a percepção de gestores e profissionais de saúde em uma regional de saúde, Paraná, Brasil. Trata-se de um recorte da pesquisa intitulada Componentes da Rede de Atenção à Saúde Mental: realidade da 4ª e 5ª Regional de Saúde do Estado do Paraná. Os dados foram coletados por grupo focal e submetido à análise de conteúdo, da qual emergiram duas categorias. Na primeira categoria discute-se a não realização do matriciamento por parte do NASF e CAPS e as contradições entre as políticas de saúde e sua efetivação. Na segunda, pontua-se a realização e as potencialidades do matriciamento em saúde mental. Ficou evidente que as equipes de apoio matricial precisam assumir a responsabilidade de suporte técnico à atenção básica principalmente no acolhimento às necessidades de saúde mental.

The limits and possibilities of matrix support in mental health within the basic health system are analyzed from the point of view of health managers and professional in a regional health center in the state of Paraná, Brazil. The paper is a section of a research titled Network Components in Mental Health Care at the 4th and 5th Regional Center of the state of Paraná. Data were collected by a focal group and submitted to content analysis from which two categories emerged. The first category discusses the non-occurrence of matrix by Nasf and Caps and the contradictions between health policies and their materialization. The second category underscores the performance and potentialities of matrix in mental health. It became evident that matrix support teams should bear the responsibility of technical support in Basic Care, especially in complying with mental health needs.

Percepção de profissionais da área de saúde mental sobre o acolhimento ao usuário de substância psicoativa em CAPSad / Mental health professional perception of the embracement towards psychoactive substance user in CAPSad

[{"text": "Introdução: A adesão ao tratamento da dependência química ainda consiste em um grande desafio não só\r\naos usuários, mas também aos profissionais da saúde. Atualmente, as políticas públicas apontam, como ferramenta auxiliar, o desenvolvimento de um modelo de tratamento humanizado, que preconiza a prática do acolhimento. Objetivo: Investigar a percepção dos profissionais de saúde mental sobre o acolhimento oferecido ao usuário de álcool e outras drogas em Centro de Atenção Psicossocial para usuários de álcool e outras drogas (CAPSad). Método: Trata-se de um estudo do tipo exploratório descritivo e qualitativo, realizado em CAPSad do interior paulista. Participaram do estudo, seis profissionais. Para coleta de dados, foi utilizado questionário semiestruturado com 27 perguntas de autopreenchimento, sendo 15 perguntas fechadas, analisadas através de estatística descritiva, e 12 abertas, analisadas pelo método de análise de conteúdo. Resultados: Participaram do estudo, seis profissionais com tempo médio de atuação de 14,3 anos e, destes, nenhum possui capacitação em relação à prática do acolhimento. Neste estudo, cinco responderam realizar acolhimento com presença de familiar, quatro sem a presença de familiar e um prefere deixar a critério do usuário (o mesmo participante poderia assinalar mais de uma resposta). Os resultados\r\ndemonstram ambiguidade da concepção de acolhimento, já que todos relataram que acolher restringe a recepção do usuário, a escuta qualificada, a orientação e a realização de encaminhamentos necessários. Conclusão: Evidenciou-se necessidade de criação de espaços formais para troca de saberes, discussão e encaminhamentos dos casos, bem como necessidade de incentivo à capacitação profissional, promovendo a identidade do acolhimento no serviço e favorecendo a adesão do usuário ao tratamento.", "_i": "pt"}, {"text": "Introduction: Adherence to chemical dependency treatment is still a great challenge for both, users and\r\nhealth care professionals. Currently, public healthcare policy is a tool to assist in the development of a humanized care model, which advocates for the practice of user inclusion. Objective: Investigate the perception of professionals who work in the mental health field, to understand the inclusion offered to users of psychoactive substances in Psychosocial Care Centers for alcohol and drug users (CAPSad). Method: A descriptive and exploratory study conducted at the CAPSad in São Paulo. Active professionals in the mental health field working at the CAPSad participated in the present study. For data collection a semi-structured questionnaire was used with 27 self-report questions, 15 closed questions, analyzed through statistics and 12 open questions, with speech analysis. Results: The questionnaires of\r\nsix professionals with a mean of 14.3 years working at the CAPSad, revealed that they had no prior training about inclusion. Five participants responded that they carried out inclusion in the presence of the family, four responded without the presence of family and just one responded according to user choice (each participant could choose more than one option). The results show ambiguity regarding the concept of user inclusion, as all reported that inclusion hampers user reception, qualified listening, guidance and making necessary referrals. Conclusion: The need to create formal spaces for knowledge exchange, case discussion, and encourage professional training, promoting the identity of the service and improving user adherence to treatment was highlighted.", "_i": "en"}]

Depresión y trauma temprano: hacia una caracterización clínica de perfiles de consulta en un servicio de salud secundario / Depression and early trauma: towards a characterization of clinical profiles of consultation in a secondary mental health service

Patients with depression maltreated during childhood differ from those depressive patients without this background. In patients with early trauma the disease emerges earlier, it is more severe and does not respond to the classical antidepressant therapy. Despite this evidence, research regarding the clinical conceptualization and approach to these patients is still limited. The above becomes relevant in Chile, considering the high prevalence of depression and history of adverse childhood events among Chilean depressive consulting health services. Based on the conceptualization of complex Post traumatic stress disorder (PTSD), the overall objective of this article is to propose a conceptualization to the clinical characteristics presented in depressive patients with early abuse, who consult in a mental health service. We propose that in all these patients it needs to inquire actively about history of early adverse events, patterns of interpersonal difficulties, psychiatric comorbidity with emphasis on PTSD features and presence of dissociative symptoms. According to which of the areas is the most important to understand the reason of consultation and considering the observation of 41 patients treated in the context of the Psychic Tauma Unit in the Curicó Hospital, we postulate the existence of the following profiles: depressive, posttraumatic and dissociative. The main clinical characteristics of each profile are presented with a therapeutic approach.

Existe suficiente evidencia que constata que los antecedentes de maltrato infantil se asocian al desarrollo de un subtipo depresivo en la vida adulta, de mayor severidad, cronicidad y peor respuesta a la terapia antidepresiva clásica. La conceptualización respecto a la clínica y al abordaje que requiere este subtipo ha sido poco sistematizada. En Chile, lo anterior adquiere relevancia dada la alta prevalencia de antecedentes de maltrato infantil en consultantes por depresión en los servicios de salud. Partiendo de la conceptualización que engloba la nosología de Estrés post-traumático (TEPT) complejo, el objetivo general de este artículo es proponer una posible caracterización de pacientes con depresión y trauma temprano en un servicio de salud secundario. Se plantea para el reconocimiento de esta clínica diferenciada, en el nivel secundario, que en la primera consulta en todos los pacientes depresivos, se indaguen activamente las siguientes variables: historia de eventos adversos tempranos, patrón de dificultades interpersonales, comorbilidad psiquiátrica con énfasis en la pesquisa activa de la clínica de cuadros ansiosos específicamente TEPT y presencia de síntomas o trastornos disociativos. Según cuál de las variables clínicas previamente expuestas, permite comprender mejor el motivo de consulta actual, y de acuerdo a la observación de 42 pacientes en la Unidad de Trauma del Hospital de Curicó postulamos la existencia de los siguientes perfiles de consulta en estos pacientes: depresivo, postraumático y disociativo. Se plantean las características clínicas centrales que pudiese caracterizar a cada uno de estos perfiles y el probable abordaje terapéutico

Study on the Utilization of the Child-Adolescent Functional Assessment Scale in Mental Health Service

OBJECTIVES: This study aims to supplement the limitations of the preliminary study and expand the use of the Child-Adolescent Functional Assessment Scale by providing standardized T-scores for measuring function in different areas, as well as guidelines for their interpretation. METHODS: The Child-Adolescent Functional Assessment Scale and Korean-Child Behavior Checklist were administered to a total of 623 individuals, including 467 parents of emotionally and behaviorally disturbed elementary school students, 45 parents of emotionally and behaviorally disturbed middle school adolescents and 111 parents of elementary school students with developmental disorders, as well as to a control group consisting of 186 parents of mainstream elementary school children in the Seoul metropolitan area. RESULTS: In contrast to the preliminary study, the emotional domain was disassociated into two factors, negative affect and emotion regulation, and the coefficient of determination for misconduct was increased significantly. Also, the overall reliability and validity of the Child-Adolescent Functional Assessment Scale were similar to those in the preliminary study, and the item structure was consistent. This study provides standardized T-scores of function in different areas based on the revised scale, and provides guidelines for their interpretation. CONCLUSION: The Child-Adolescent Functional Assessment Scale can assist the Child Global Assessment in Functioning in providing the information necessary for case management and treatment planning by comparing the impairment severity in each area of functioning, and also determining changes in behavior and function after treatment interventions. On the other hand, this scale has yet to clearly distinguish between rebellious behavior and misconduct. Further research is necessary to provide standards for more diverse age groups and for its utilization.

Impact of Internalized Stigma, Anger Expression Style, and Mental Health Service Satisfaction on Self-esteem in Inpatients with Schizophrenia / 정신간호학회지

PURPOSE: This study was performed to identify how internalized stigma, anger expression style, and mental health service satisfaction impact on the self-esteem of inpatients with schizophrenia. METHODS: For this descriptive correlational study, 191 inpatients with schizophrenia participated. They had been admitted to one of six mental hospitals in three areas of South Korea. Data were collected from August 1 to November 30, 2016 using self-report questionnaires and data were analyzed using t-test, one-way ANOVA, Pearson correlation coefficients, and stepwise multiple regression with IBM SPSS 22.0. RESULTS: The significant predictors of self-esteem in inpatients with schizophrenia were internalized stigma, anger expression style, and mental health service satisfaction, explaining 36% of the variance in self-esteem. The most significant predictor of self-esteem in inpatients with schizophrenia was internalized stigma. CONCLUSION: Study findings suggest that a significant reduction in the internalized stigma of inpatients with schizophrenia increases their self-esteem. It is also, necessary to improve adaptive anger expression style and mental health service satisfaction.