Mental Health Programme in India: Has the tide really turned?

Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India’s NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.

Practice and perceptions of pediatric residents in a Tertiary Government Hospital on mental healthcare as part of general practice

Objective@#This study aimed to describe mental health practice patterns, perceptions, perceived responsibility, confidence, barriers, and supports of pediatric residents in a tertiary government hospital to arrive at recommendations in enhancing their mental health competencies.@*Methodology@#As part of needs and baseline assessment within an existing collaboration, written self-administered questionnaires were distributed among pediatric residents of the hospital. Frequency of answers were tallied to see clustering and trends. RESULTS: Most of the 37 Pediatric residents had positive perceptions i.e. 78.83% - 83.78% and planned to incorporate all aspects mental healthcare in their future practice as consultants i.e. 89.19 %- 97.29 %. However, they did not get to practice or apply it as much during training. All respondents perceived that diagnosing the neurodevelopmental disorders of Autism Spectrum, Attention Deficit and Hyperactivity, Intellectual Disability and Learning was their responsibility. When it came to confidence in diagnosing other psychiatric disorders less than half to 3/5 (45.9%- 64/9%) were confident or very confident in doing so. Approximately three fifths (56.75% -67.56%) of them were confident in managing neurodevelopmental disorders. There was an even lower proportion i.e. one fourth (16.21% - 32.43%) of pediatric residents who were confident in managing other psychiatric disorders. Time was the most often perceived barrier while more exposure and training were the supportive factors for integrating mental healthcare into practice.@*Conclusion@#With such positive perceptions already in place, programs to improve knowledge and skills can be developed to increase confidence, focusing on diagnosing and managing psychiatric conditions. Target areas as guided by this research can be on how to use screening tools and psychotropics, diagnosing anxiety and behavioral addictions, and managing psychosis and trauma. These should be incorporated in a time-efficient manner into usual patient interviews. Training and added exposure can be utilized in the short-term as well as institutionalization of collaboration, liaison, and feedback systems in the future.

Adolescents' lived experiences of substance abuse in the Greater Giyani Municipality

Background: Adolescence is a unique and distinct stage of development that involves changes in the physical, psychological and social aspects of adolescents. It is a critical transition into adulthood whereby heightened risk-taking and sensation-seeking takes place, such as substance abuse. In a South African context, this transition sometimes occurs under economic stress, poverty, unemployment, high levels of crime and political instability. This can place adolescents at risk of substance abuse. Objectives: To explore and describe the lived experiences of adolescents abusing substances in the Greater Giyani Municipality in the Limpopo province, South Africa. Method: A qualitative, exploratory, descriptive and contextual research design with a phenomenological approach was used. Data were collected through individual, in-depth, phenomenological interviews and field notes. Thematic coding was utilised to analyse the collected data, and literature was reviewed to support the findings. Moreover, measures to ensure trustworthiness and ethical principles were applied throughout the research process. Results: Five themes were identified: substance abuse behaviour among adolescents, adolescents' motivation for continuing substance abuse, the effects of substance abuse on the lives of adolescents, factors affecting adolescents' discontinuation of substance abuse and a need to discontinue substance abuse. Conclusion: The study concluded that adolescents abusing substances in the Greater Giyani, Limpopo province, experience loss of control, broken relationships, poor academic performance, stigma attached to mental illness and negative emotions. The adolescents foresaw their future as uncertain and without direction. It is recommended that mental healthcare professionals introduce and implement interventions that will assist the adolescents who abuse substances in the Greater Giyani, Limpopo province. Contribution: The findings in this study could add knowledge in developing and implementing of strategies for psychiatric nurses to support adolescents abusing substances in the Greater Giyani, Limpopo province.

Ethical dilemmas encountered in suicide research and management: Experiences of young mental health professionals

This study aimed to explore ethical dilemmas and challenges faced by young mental healthcare researchers and professionals working with survivors of suicide (hereinafter suicide survivors). Two focus group discussions (FGDs) Researcher FGD (with those engaged in suicide research) and Clinician FGD (with those providing treatment to suicide survivors) – consisting of open-ended questions and lasting for 70-90 minutes were conducted and analysed using Thematic Analysis. Five themes were identified: i) struggling with the incongruity of harm within benefit, ii) difficulty in delineating boundaries, iii) self-doubt in one’s professional competence, iv) nature of suicide straining the limits of confidentiality, and v) working with structural limitations. The study helps to understand the obstacles and dilemmas encountered in adhering to ethical principles while working with vulnerable individuals.

Experiences of psychiatric nurses caring for mental healthcare users with a comorbid disorder

Background: Caring for mental healthcare users (MHCUs) with a comorbid disorder of human immunodeficiency virus (HIV) and schizophrenia has always been challenging and requires expertise, skill, intuition and empathy. Objectives: The objective of this study was to explore and describe the experiences of psychiatric nurses caring for MHCUs with a comorbid disorder of HIV and schizophrenia. Method: A qualitative, exploratory, descriptive and contextual research design was used. Eight participants were selected through purposive sampling for individual in-depth interviews to collect data. Thematic analysis was used to analyse data. Results: Three themes emerged from this study. The first theme is that the psychiatric nurses experienced deep frustration because they were capable but unable to manage MHCUs with HIV and schizophrenia because of poor infrastructure and other contributing barriers. The second theme identified that the psychiatric nurses experienced discrimination against MHCUs compromising their holistic recovery. Lastly, the psychiatric nurses identified the need for health care workers in general hospitals and communities and families of MHCUs with a comorbid disorder to be educated in mental health issues to ensure continuous medical care. Conclusion: The results of this study showed that psychiatric nurses became exhausted when trying to cope with difficult nursing situations. The challenges they faced had negative consequences for the mental health of the psychiatric nurses and compromised patient care. Contribution: This study adds knowledge to nursing practice, nursing education and nursing research by implementing recommendations to mitigate the challenges of psychiatric nurses caring for MHCUs with HIV and schizophrenia.

A contação de histórias no instagram como tecnologia leve em tempos pesados de pandemia / La narración de historias em instagram como tecnología ligera en tiempos de pandemia intensa / Storytelling on instagram as a light technology in heavy pandemic times

Resumo O artigo objetiva analisar as contribuições da contação de histórias para a saúde mental no contexto da pandemia de Covid-19. Trata-se de uma pesquisa-intervenção que posiciona o recurso das histórias como uma tecnologia leve em saúde, comprometida em reduzir distâncias, criar pontes entre as pessoas através do investimento na produção de vínculos e acolhimento. A contação de histórias articula literatura e psicologia, faz parte da caixa de ferramentas necessárias para a ativação de forças psíquicas expressivas dos afetos no cenário atual. O banco de dados da pesquisa pode ser designado como banco de histórias que passam por um processo de curadoria, sendo essa uma metodologia fundamental para o encadeamento de temas abordados nas histórias e a postagem das mesmas no Instagram do projeto. As histórias videogravadas foram analisadas a partir dos núcleos semânticos contexto-afeto-texto, com destaque para os conteúdos de memória e morte; e práticas de mutualidade em cuidado. A reação dos/as seguidores/as do Instagram expressam mensagens afetuosas aos/as contadores/as.

Resumen El artículo tiene como objetivo analizar las contribuciones de la narración a la salud mental en el contexto de la pandemia Covid-19. Se trata de una investigación-intervención que posiciona el recurso de las historias como una tecnología ligera en salud, comprometida con la reducción de distancias, creando puentes entre las personas a través de la inversión en la producción de vínculos y la acogida. La narración de cuenteros articula la literatura y la psicología, es parte de la caja de herramientas necesarias para la activación de las fuerzas psíquicas expresivas de los afectos en el escenario actual. La base de datos de investigación puede designarse como un banco de historias que se someten a un proceso curatorial, que es una metodología fundamental para vincular los temas tratados en las historias y publicarlos en el Instagram del proyecto. Se analizaron relatos videograbados a partir de los núcleos semánticos contexto-afecto-texto; con énfasis en los contenidos de la memoria y la muerte; y prácticas de cuidado mutuo en el cuidado. La reacción de los/las seguidores/as de Instagram expresan mensajes afectuosos a los/las cuenteros/as.

Abstract This article aims to analyze the contributions of the storytelling to mental health in the context of the Covid-19 pandemic. It is an intervention-research that places this story device as light health technology. It is committed to reduce distances, create bridges between people through investment in bonding and welcoming. Storytelling articulates literature and psychology, and is part of the toolbox that is necessary for the activation of expressive psychic forces of affections in the current scenario. The research database can be designated as a bank of stories that undergo a curatorial process, which is a fundamental methodology for linking topics covered in the stories and posting them on the project's Instagram. The videotaped stories were analyzed from mutual-care practices and the context-affection-text semantic nuclei, with emphasis on the contents of memory and death. The reactions of Instagram followers express affectionate messages to the storytellers.

The dilemma of using physical restraint in delirium tremens: a case report

Delirium tremens (DT) is a common presentation in tertiary care hospitals. Refractory DT, though not very common, is a dreaded presentation in any clinical setting. Usually, patients with DT respond to standard doses of benzodiazepines, but sometimes we encounter patients requiring higher than the usual dose. Also, due to the high level of agitation, confusion and hallucinatory behaviour, physical restraint is frequently used in these patients. We hereby report a case of refractory DT in whom the dilemma of using physical restraint and need for higher doses of Benzodiazepine has been highlighted.

Fatores intervenientes na adesão ao tratamento de usuários de drogas atendidos no Caps-Ad / The intervening factors on the treatment adherence of drug users assisted by a Caps-Ad / Factores intervenientes en la adhesión al tratamiento de usuarios de droga atendidos en el Caps-Ad

Objective: The study's purpose has been to recognize the interfering factors on the ambulatory treatment adherence by drug users. Methods: It is a descriptive study with a qualitative approach. Data were collected over the period from August to December 2015 through an interview process with seven users and following taken to thematic content analysis. Results: The first contact with drugs usually occurs by friends influence, while the search for treatment in the Psychosocial Care Center for Alcohol and other Drugs [Centros de Atenção Psicossocial Álcool e outras Drogas (CAPS-AD)] occurs by own person's will, considering that the family interferes positively in the initiation and also in the continuity of the treatment. The factors favoring adherence to treatment were as follows: the availability of health professionals to provide the care, which goes against the difficulty in accessing the service. Conclusion: The following was perceived as necessary in order to maintain the adherence to ambulatory treatment: the user's desire to stop using drugs, family support, personal bonds with the professionals, and easy access to the service in regard to the geography, financial and structural parameters

Objetivo: Conhecer os fatores que interferem na adesão de usuários de drogas ao tratamento ambulatorial. Métodos: Estudo descritivo, de natureza qualitativa, cujos dados foram coletados entre agosto e dezembro de 2015 por meio de entrevista com sete usuários e submetidos à análise de conteúdo temática. Resultados: O primeiro contato com as drogas normalmente ocorre por influência de amigos, enquanto a busca por tratamento no CAPS-ad ocorre por vontade própria, sendo que a família interfere positivamente no início e também na continuidade do tratamento. Os fatores que favorecem a adesão ao tratamento foram: disponibilidade dos profissionais de saúde no atendimento aos pacientes, o que se contrapõe à dificuldade de acesso ao serviço. Conclusão: Para manter a adesão ao tratamento no âmbito ambulatorial se faz necessário: desejo do usuário em parar de usar drogas, apoio familiar, vínculo com os profissionais e facilidade de acesso ao serviço, em termos geográfico, financeiro e estrutural

Objetivo: Conocer los factores que interfieren en la adhesión de usuarios de drogas al tratamiento ambulatorial. Métodos: Estudio descriptivo, de naturaleza cualitativa, cuyos datos fueron recolectados entre agosto y diciembre de 2015 por medio de una entrevista con siete usuarios y sometidos al análisis de contenido temático. Resultados: El primer contacto con las drogas normalmente ocurre por influencia de amigos, mientras que la búsqueda por tratamiento en el CAPS-ad ocurre por voluntad propia, siendo que la familia interfiere positivamente al inicio y también en la continuidad del tratamiento. Los factores que favorecen la adhesión al tratamiento fueron: disponibilidad de los profesionales de salud en la atención a los pacientes, lo que se contrapone a la dificultad de acceso al servicio. Conclusión: Para mantener la adhesión al tratamiento en el ámbito ambulatorio se hace necesario: deseo del usuario en dejar de usar drogas, apoyo familiar, vínculo con los profesionales y facilidad de acceso al servicio, en términos geográfico, financiero y estructural

Usage Status and Characteristics of Mobile Devices for the Geriatric Population

OBJECTIVE: This study aims to investigate the current usage status and identify the needs of mobile devices in the geriatric population, thus grasping the accessibility and possibility of mobile devices which can be positively used to allow them to obtain health information and manage their mental health. METHODS: All self-reported questionnaires, such as demographics, mobile phone usage, and several mental health-related scales, were completed by two elderly groups (14 males ; aged over 60, mean=73) who visited Seodaemun-gu center for dementia: 1) 54 feature phone and 2) 57 smartphone users. RESULTS: The results revealed that they have had the need to receive health information and healthcare particularly on psychiatric disorders such as dementia, geriatric depression, and anxiety. The relation between wireless calling plan and the two groups was significant. The two groups showed a significant difference only in the Short form of Geriatric Depression Scale (SGDS) score; The feature phone group had significantly higher SGDS score than the smartphone group did. CONCLUSION: As the elderly mobile phone users showed a high level of need for health information and healthcare via their own mobile phones, the data of this study are expected to serve as a foundation for the development of elderly-friendly mobile applications and programs.

Práticas integrativas e complementares em centros de atenção psicossocial como ampliação do cuidado em saúde / Integrative and Complementary Practices at Psychosocial Service Centers as Expanded Healthcare

Este artigo resulta de pesquisa implementada na Residência Integrada em Saúde do Grupo Hospitalar Conceição. A pesquisa teve como base um projeto investigativo realizado em serviços de saúde mental e de saúde da família. O objetivo central do estudo foi conhecer as Práticas Integrativas e Complementares realizadas nos Centros de Atenção Psicossocial vinculados ao Serviço de Saúde Comunitária do Grupo Hospitalar Conceição. Como objetivos específicos, intencionou identificar espaços potenciais para a realização de Práticas Integrativas e Complementares nos serviços; conhecer as percepções dos profissionais sobre as Práticas Integrativas e Complementares, e refletir sobre os fatores que influenciam esses profissionais a utilizarem ou não as práticas integrativas e complementares nos atendimentos. A metodologia do estudo contou com coleta de informações por meio de entrevistas individuais e aplicação de questionário. Como principais resultados destacam-se o reconhecimento das diferentes modalidades de Práticas Integrativas e Complementares utilizadas, e a ampliação do cuidado em saúde mental proporcionada pelas Práticas Integrativas e Complementares, na medida em que agregam outras maneiras de conceber o corpo nas suas dimensões emocionais, físicas e espirituais. (AU)

This article is the product of research conducted during an Integrated Healthcare Residency at Grupo Hospitalar Conceição. The research was based on an investigative project carried out in mental and family healthcare services. The core goal of the study was to learn about the Integrative and Complementary Practicesin place at Psychosocial Service Centers connected to Grupo Hospitalar Conceição's Community Healthcare Services. This study's specific goals included identifying potential opportunities for carrying out the Integrative and Complementary Practices in the services; learning about the professionals' opinions on the Integrative and Complementary Practices, and looking into the factors that lead these professionals to either use the integrative and complementary practices when seeing patients or not. The study methodology comprised collecting information via individual interviews and the application of a questionnaire. The main results included detecting the different types of Integrative and Complementary Practices used and the expanded mental healthcare provided by the Integrative and Complementary Practices, as they incorporate other ways of understanding the body in its emotional, physical, and spiritual aspects.(AU)

Sobrecarga do cuidado, solidariedade e estratégia de lida na experiência de familiares de Centros de Atenção Psicossocial / Family burden, support groups and coping style among family members of patients in Psychosocial Care Centers

Os familiares de usuários de serviços de saúde mental que assumem a tarefa do cuidado cotidiano são frequentemente submetidos a sobrecarga objetiva e subjetiva. Estratégias práticas de lidar com a tarefa do cuidado e ações de solidariedade entre familiares podem contribuir para a melhora da qualidade de vida de cuidadores e usuários. Este estudo descreve e analisa estratégia desenvolvida junto a serviços comunitários de saúde mental (CAPS), em colaboração com os familiares, de modo a conhecer melhor a experiência da sobrecarga e apoiar iniciativas de ajuda mútua, educação em saúde e promoção da autonomia. A coleta e análise dos dados utilizou metodologia qualitativa, como observação e grupos focais. Resultados preliminares identificam altos níveis de sobrecarga, boa resposta dos familiares à participação em grupos de ajuda mútua e atividades de educação em saúde, e a necessidade de aperfeiçoar e intensificar as ações desenvolvidas pelos CAPS para apoio e orientação dos familiares...

Family members of mental health service users who take everyday care are often subjected to objective and subjective burden. Practical strategies to deal with the task of care and solidarity actions between family members can help improve the quality of life of caregivers and users. This study describes and analyzes strategy developed with Psychosocial Care Centers (CAPS), in collaboration with the family, in order to better know the experience of overload and support self-help initiatives, health education and promotion of autonomy. The collection and analysis of data used qualitative methodology, such as observation and focus groups. Preliminary results identify high levels of overload, good response of family participation in self-help groups and health education activities, and the need to improve and intensify actions developed by CAPS for support and guidance of the family...

Servicios clínicos disponibles para niñas, niños y jóvenes con trastornos mentales en México / The clinical services available to children and young people with mental illnesses in México / Serviços clínicos disponíveis para crianças e jovens com perturbações mentais no México

En el ámbito de la salud, el bienestar físico y mental debería ser una prioridad. No obstante, en México existen limitantes importantes en la atención a la salud mental, como el estigma social que prevalece hacia las enfermedades mentales, la discriminación y violación a los derechos humanos de las personas afectadas por estos trastornos, el limitado número de servicios clínicos a los que se puede acceder, la falta de servicios de salud especializados, y la tendencia de los gobiernos a omitir esta realidad. En el presente artículo de tipo descriptivo pretendo hacer una breve revisión de los servicios clínicos disponibles para niñas, niños y jóvenes mexicanos que padecen trastornos mentales.

In the field of health, physical and mental well-being should be a priority. Nevertheless, in Mexico, the attention given to mental health has important limitations, such as the social stigma that prevails toward mental illnesses; the discrimination and violation of human rights of people affected by these disorders; the limited number of clinical services which can be accessed; the lack of specialized health services and the tendency of Governments to ignore this reality. This article aims to undertake a brief review of the clinical services available to Mexican children and young people that are affected by a mental disorder.

Na área da saúde, bem-estar físico e mental deveria ser uma prioridade. Porém no México na atenção de saúde mental existem restrições importantes, como o estigma social que prevalece nas doenças mentais, discriminação e violação dos direitos humanos das pessoas afetadas por estas perturbações, o número limitado de serviços clínicos que podem ser acessados , a falta de serviços especializados de saúde, e a tendência dos governos em ignorar esta realidade. Este artigo procura fazer uma breve revisão dos serviços clínicos disponíveis para crianças e jovens mexicanos que tenham alguma perturbação mental.

Acompanhamento terapêutico, clínica e atenção psicossocial: uma relação possível? Reflexão crítica segundo a hermenêutica dialética de Jügen Habermas / Therapeutic accompaniment, outpatient clinic and psychosocial care: a possible relationship? Critical reflection according to Jürgen Habermas hermeneutic dialectic

A reflexão sobre como se organiza a oferta terapêutica nos serviços extra-hospitalares da rede pública de saúde mental tem mostrado que a organização do trabalho coloca o saber médico-psicológico como componente privilegiado dos programas terapêuticos, impõe uma cisão teórico-prática entre o tratamento clínico-medicamentoso-psicológico e as estratégias de reabilitação psicossocial, e elegem os primeiros como dispositivo central de seus programas, em detrimento das ações psicossociais. À luz da Teoria da Ação Comunicativa de Jürgen Habermas situa-se o problema como consequência de extrema tecnificação das práticas terapêuticas, selecionadas, ideologicamente, segundo uma racionalidade instrumental, na qual as práticas respondem a imperativos técnicos, ignorando o elemento humano e social, provocando uma dicotomização entre a clínica e a atenção psicossocial, como se fossem práticas dissociadas nos projetos terapêuticos. Aponta-se para a prática do Acompanhamento Terapêutico como possibilidade concreta de reunião dessas esferas da ação dissociadas e de superação da dicotomização entre clínica e atenção psicossocial.

Reflections about the therapeutic offer is organized in extra-hospital services within the public mental healthcare network have shown the way work is organized puts forward medical-psychological knowledge as a privileged comonent of therapeutic programs, imposes a theoretical-practical split between clinical-medicationpsychological treatments and psychosocial rehabilitation strategies, and select the former as the central device of its programs, to the detriment of psychosocial actions. In the light of Jürgen Habermas' communication theory, the problem is established as a consequence of the extreme technification of therapeutic practices, ideologically selected in line with an instrumental rationality, in which the practices respond to technical imeratives, ignoring the human and social element, provoking a dichotomization between the clinic and psychosocial care, as if they were dissociated practices in therapeutic projects. Therapeutic Accompaniment is indicated as a concrete possibility of having these dissociated action spheres meet and of overcoming the dichotomization between outpatient clinic and psychosocial care.

As práticas dos psicólogos em ambulatórios de saúde mental / The practices of psychologists in mental health ambulatories

Os profissionais de psicologia têm sido importantes atores nos ambulatórios de saúde mental brasileiros desde a década de 1980. Todavia, tais serviços ainda representam um desafio à consolidação da reforma psiquiátrica. Soma-se a isso a forma vasta como são referidos em portarias ministeriais, o que propiciou uma diversidade de modelos implantados pelo Brasil. A presente pesquisa foi realizada com psicólogos dos ambulatórios de saúde mental de Aracaju-SE, a partir de entrevistas semi estruturadas e análise documental. Objetivou-se estudar as práticas dos psicólogos, bem como quais os limites e potencialidades da participação desses profissionais nos ambulatórios de saúde mental. Verificou-se a predominância da clínica tradicional com ajustes significativos na postura profissional e no trato com os usuários, além de poucas ações interdisciplinares. Os principais desafios apontados foram o fortalecimento do trabalho em rede, além da necessidade de responsabilização por parte de outras categorias profissionais pelo cuidado em saúde mental.

Psychology professionals have been playing important roles in the setting of Brazilian mental healthcare ambulatories since 1980s. However, the services offered by these centers still represent a challenge to the consolidation of psychiatric reform. Added to this, there is a wide form of treatment of these issues by Brazilian policy, which provide a variety of models between the ambulatories. This study was conducted with psychologists, workers of mental healthcare ambulatories in Aracaju-SE, and aimed investigate their practices, challenges and limits. It was done a documental analysis, and interviews with a semi-structured instrument. It was found a predominance of the traditional clinical settings, with pertinent adjustments in the professional posture for dealing with users of these services, and lack of interdisciplinary actions. The main challenges identified were the strengthening of professional networking, plus the need of sharing responsibility with other professional groups for mental health care.

Telepsiquiatría: innovación de la atención en salud mental. Una perspectiva general / Telepsychiatry: Innovating Mental Healthcare. A General Perspective

Introducción: El desarrollo y crecimiento de la era tecnológica demanda la exploración de nuevas oportunidades en la prestación de servicios en salud. La telepsiquiatría es un claro ejemplo del desarrollo en tecnología y constituye un valioso aporte a la solución de problemas específicos, como la prestación de servicios especializados en salud mental en regiones de difícil acceso. Objetivo: Describir las fortalezas y dificultades relacionadas con las nuevas tecnologías mpleadas, centrándose en aplicaciones de telepsiquiatría para la atención en salud mental, y posibles oportunidades de implementación y aplicación en nuestro escenario. Métodos: Revisión de literatura médica en MedLine, The Cochrane Library Controlled Trial Registry databases, Lilacs y SciELO (hasta enero del 2011) utilizando el término “telepsychiatry”. Se encontraron 244 referencias. Los artículos se seleccionaron manualmente por título y disponibilidad, dada su relevancia para la revisión. Desarrollo y Conclusiones: Los resultados publicados en la literatura indican que las intervenciones realizadas por telepsiquiatría son comparables con tratamientos de consulta cara a cara. De igual manera, se encontraron resultados positivos respecto a costos y acceso en regiones apartadas. En Colombia, el terreno legal y logístico está preparado para la generación de trabajos en esta área...

Introduction: Development and growth of the technological era require the exploration of new opportunities in health services. Telepsychiatry is a clear example of technology Implemented in the solution of a specific problem, such as the provision of specialized mental health services in remote areas. Objective: To describe strengths and barriers related to new technologies, focusing on the applications of telepsychiatry on mental healthcare, and possible opportunities for implementation and application in our scenario. Methods: Review of the medical literature in Medline, The Cochrane Library Controlled Trial Registry databases, Lilacs y Scielo (until January 2011), using the term “telepsychiatry”. A total of 244 articles were Identified. Articles were selected manually by title and availability if they discussed the Advantages and disadvantages of telepsychiatry specifically, or technology in general. Development and Conclusions: Published data indicate that telepsychiatry and face to Face treatments have comparable outcomes on different levels. Additionally, positive outcomes were found regarding costs and access in isolated places. In Colombia, there are legal and logistic opportunities to develop programs in this field...

Psychiatric care in the Brazilian context / O cuidado psiquiátrico no contexto brasileiro

This study seeks to present an updated discussion concerning psychiatric care in Brazil. It is based upon a historical review of psychiatric knowledge and practices within the Brazilian context and knowledge about the phenomenon of madness. It discusses the appearance of modern medical science as an area of knowledge designed for the treatment and comprehension of mental suffering. It also presents a discussion on psychiatric reform, stressing how it is a movement that seeks to redefine the significance of knowledge and practices about the phenomenon of madness, by concentrating on the application of such knowledge and practices in the psychiatric hospital. This paper concludes with a brief critical reflection on prevailing mental healthcare in Brazil, singling out the potential and the difficulties faced within the scope of health policies and the day-to-day working life of professionals of the area.

O presente estudo pretende fazer uma discussão atualizada acerca da assistência psiquiátrica no Brasil, tendo como base um resgate histórico dos saberes e práticas psiquiátricas no contexto brasileiro e a apropriação do fenômeno da loucura. Discute o surgimento da ciência médica moderna e da psiquiatria como área do conhecimento designada ao tratamento e à compreensão do sofrimento mental. Também apresenta discussões acerca da reforma psiquiátrica, ressaltandoa como um movimento que vem ao encontro da ressignificação de saberes e práticas de intervenção referentes ao fenômeno da loucura, a partir da concentração desses saberes e práticas no hospital psiquiátrico. No final, realiza uma breve reflexão crítica sobre a assistência em saúde mental no país na atualidade, constatando potencialidades e dificuldades enfrentadas no âmbito das políticas de saúde e do cotidiano do processo de trabalho dos profissionais da área.

Dimensões do objeto de trabalho em um Centro de Atenção Psicossocial / Dimensions of the scope of work in a Psychosocial Care Center

Este artigo apresenta resultados parciais de uma pesquisa avaliativa desenvolvida em um Centro de Atenção Psicossocial em Pelotas (RS) no ano de 2005. O estudo, de abordagem qualitativa, utiliza o referencial teórico-metodológico da Avaliação de Quarta Geração. A coleta de dados contém observação e entrevistas com usuários, familiares e profissionais do serviço. A análise se baseou no Método Comparativo Constante, possibilitando a delimitação de núcleos temáticos. Um deles se refere às dimensões do objeto de trabalho, desdobrando-se em questões relacionadas à integralidade; aos velhos e novos crônicos; aos atendimentos às crises e à inserção da família. Da avaliação, a partir da inclusão de grupos diretamente envolvidos com o cotidiano do serviço, emergiram questões relevantes em um contexto de mudança no modelo de atenção em saúde mental.

This article presents partial results of evaluative research conducted in 2005 at a Psychosocial Care Center in Pelotas, in the Southern Brazilian State of Rio Grande do Sul. The study adopts a qualitative approach and utilizes the theoretical and methodological referential of the Fourth Generation Evaluation. The data collected contains observation and interviews with users, family members and professionals of the care center. The analysis was based on the Constant Comparative Method that made the definition of the thematic nuclei possible. One of them refers to the dimensions of the scope of work broken down into issues related to integrality, to old and new chronicities, to dealing with crises and to family involvement. Considering the inclusion of groups directly involved with the daily routine services, relevant issues have emerged from the evaluation in a context of change in the model of mental healthcare.

A sustentabilidade da vida cotidiana: um estudo das redes sociais de usuários de serviço de saúde mental no município de Santo André (SP, Brasil) / The sustainability of day-to-day life: a study of the social networks of users of mental healthcare service in the municipality of Santo André (SP, Brazil)

Estudos sobre redes sociais demonstram que as relações têm impacto significativo na vida das pessoas. Quando associadas à população com transtorno mental, atuam como fator de proteção importante e gerenciador de recursos e suporte social. Entretanto, estudos apontam que pessoas com transtorno mental apresentam redes sociais empobrecidas e poucas relações significativas. Nesta perspectiva, esta pesquisa teve como objetivo caracterizar as redes sociais de usuários do NAPS II, em Santo André (SP). Realizada em 2006, a pesquisa qualitativa, orientada pela postura etnográfica, utilizou entrevistas por pautas, observação participante e caderno de campo. Os resultados apontaram que o grupo estudado possui rede social empobrecida; a trajetória de vida dos sujeitos está relacionada a esse empobrecimento, uma vez que as rupturas provocadas pelas situações de crise ou de institucionalização os retiram da rede de relações, colocando-os em situação de vulnerabilidade social. Buscou-se discutir a importância da intervenção nas relações e o papel dos serviços nesse processo.

Studies into social networks show that relationships have a significant impact on people's lives. When associated with the population suffering from mental disorders, they serve as an important protection factor and a manager of resources and social support. However, studies show that people with mental disorders have impoverished social networks and few significant relationships. In this perspective, this research sought to characterize the social networks of users of NAPS II in Santo André (SP, Brazil). Conducted in 2006, the qualitative research adopted an ethnographic approach and used interviews by topics, participant observation and field notes. The results revealed that the group studied had an impoverished social network; the life histories of the subjects is related to this impoverishment, since the disruptions caused by situations of crisis or institutionalization removed them from the network of relationships, placing them in a situation of social vulnerability. An attempt was made to address the importance of intervention in the relationships and the role of the services in this process.

Experiências psíquicas de mulheres frequentadoras da rede pública de saúde em Teresina (PI, Brasil) / Psychic experiences of women attended at public health centers in Teresina (PI, Brazil)

O objetivo deste artigo é discutir os significados das experiências psíquicas de mulheres frequentadoras da rede pública de saúde em nível de Atenção Básica na cidade de Teresina, Piauí, Brasil. Realizou-se uma pesquisa qualitativa com o objetivo de compreender experiências emocionais, sociais, familiares, sexuais e laborais na perspectiva de mulheres usuárias da Saúde da Família em Teresina. Para a coleta de dados, utilizaram-se entrevista semiestruturada e observação não sistemática, realizadas na própria Unidade Municipal de Saúde. As informações coletadas desvelaram sofrimento psíquico intrínseco às experiências cotidianas, na relação familiar, em situações de traição, separação, desemprego, violência e vivência da sexualidade. Percebeu-se a importância de articular saúde mental com atenção básica, instituindo um diálogo profícuo, com vistas à proximidade entre equipes, famílias e comunidades, que certamente serão beneficiadas no enfrentamento de entraves do cotidiano, permeado por situações de violência, abuso, maus-tratos e negligência. Propõe-se preparar profissionais de saúde e implementar a interface entre Saúde da Família e atenção psicossocial, propiciando ação integral voltada ao sujeito integral.

The scope of this article is to examine the findings of the psychic experiences of women attended at Primary Care level in public healthcare centers in Teresina, State of Piaui, Brazil. Qualitative research was conducted in order to assess emotional, social, family, sexual and workplace experiences from the standpoint of women who seek Family Healthcare services in Teresina. Semi-structured interviews and non-systematic observation carried out in the Municipal Health Unit itself were used to collect the data. The information gathered revealed psychic suffering that is intrinsic to everyday experiences, family relationships and situations involving betrayal, separation, unemployment, violence and sexual experiences. The importance of integrating mental healthcare and basic healthcare was identified, requiring in-depth dialogue, bringing together staff, family and communities that will undoubtedly benefit from this to tackle day-to-day problems permeated by violence, abuse, maltreatment and negligence. The proposal put forward is to train healthcare professionals and implement an interface between Family Healthcare and psychosocial treatment permitting integrated action geared to the individual as a whole.

Contextos, processos e memórias: narrativas sobre saúde mental nas décadas de sessenta a oitenta no Brasil / Contexts, processes and memory: narratives about mental-healthcare from the 1960's to the 1980's in Brazil

Este artigo relata resultados parciais de pesquisas que vem sendo desenvolvidas, na dimensão da História Social, acerca dos processos de instituição da Psicologia no Brasil. No presente texto, partimos de memórias sobre as práticas no campo da saúde mental e tecemos considerações acerca do contexto brasileiro nos anos sessenta, setenta e oitenta, especialmente no que se refere à práticas desenvolvidas no Rio Grande do Sul. Dentre as abordagens utilizadas para apoiar a realização do estudo ressalta-se a história oral com a coleta de narrativas. Essas foram associadas a outros documentos e materiais midiáticos. A partir desse corpus se efetivou a análise. Dentre os resultados obtidos destaca-se a influência da Psiquiatria Comunitária e a relevância de experiências prévias de saúde comunitária para a consecução de transformações nas concepções e práticas de saúde e, mais especificamente, nas políticas de saúde mental brasileiras.

This article reports partial results of researches that are being developed, in the Social History dimension, about the institutionalization processes of Psychology in Brazil. In this text, we discuss memories of the mental healthcare practices and build considerations about the Brazilian context of the 1960s, '70s and '80s, specially concerning the practices developed in Rio Grande do Sul state. Among the approaches utilized to sustain this study, oral history with narrative collection is preeminent. These narratives were associated with documents and mediatic material. From this corpus, the analysis of the narratives that were in the practices of mental healthcare in the period mentioned above were effectuated. Among the results obtained, are highlighted: the influence of Community Psychiatry and the relevance of previous community healthcare experiences for the attainment of changes in conceptions and practices of health and, more specifically, in the Brazilian mental healthcare policies.