Understanding and navigating the repercussions of the politically polarized climate in mental health

Abstract The world is experiencing a moment of political polarization between liberal and conservative ideas, which has aggravated since the arrival of the Covid-19. Many countries (Brazil included) have been experiencing the generalized occurrence of people fighting over politics, in contexts including family, workplace, friendships, and romantic relationships. Over the past 2 years, it has been possible to observe an unexpected and overwhelming effect of the political climate on psychotherapy patients, some of whom have started to actively look for therapists who share their convictions. Brazil is experiencing a moment of severe sanitary, economic, social, and political crisis, which is directly affecting our patients. Nevertheless, the impact of the political climate on our population has not been systematically investigated. However, as the political environment is an inherent part of the social component of the psychosocial model, it is important that mental health professionals be prepared to have this conversation with their patients. This highlights the need to address these difficulties in supervision, rounds, and clinical discussions.

Análisis de la demanda asistencial en la urgencia y unidad de hospitalización psiquiátrica en el contexto de pandemia por COVID-19 / Analysis of the demand for care in a psychiatric emergency room and an acute inpatient unit in the context of the COVID-19 pandemic

INTRODUCCIÓN: El objetivo consiste en analizar el impacto del COVID-19 en la demanda asistencial de las urgencias y en los ingresos psiquiátricos durante el primer mes de la pandemia. MÉTODOS: Realizamos un estudio transversal observacional retrospectivo en pacientes que acuden a urgencias psiquiátricas entre el 11 de marzo y el 11 de abril de 2019 y 2020 respectivamente. Se incluyeron variables sociodemográficas y clínicas en el estudio. Se realizaron las pruebas de Chi Cuadrado o Test exacto de Fisher para el contraste de hipótesis de variables categóricas y la prueba U Mann-Whitney para el contraste de variables cuantitativas. El nivel de significación estadística se estableció en p<0.05. Los análisis se realizaron con IBM SPSS Statistics. RESULTADOS: Se observa un descenso significativo de la media de pacientes atendidos al día en urgencias entre ambos periodos, siendo esta de 5,91 (±2,53) en 2019 y de 2,41 (±1,81) en 2020 (p<0.001). Se ha visto una disminución significativa de la ocupación media de camas en la UHB, ocupándose un 91,84% (±7,72) de camas en 2019 y un 58,85% (±13,81) en 2020 (p<0,001). En cuanto a la proporción de ingresos de los pacientes que acuden a urgencias, se ha visto un aumento significativo en el año 2020 respecto al año anterior. CONCLUSIONES: La demanda en la urgencia de pacientes psiquiátricos y la ocupación media de camas se ha reducido durante el primer mes tras la declaración de la pandemia. El miedo al contagio puede actuar como modulador de la demanda psiquiátrica.

INTRODUCTION: The aim is to analyze the impact of COVID-19 on the demand for emergency care and psychiatric admissions during the first month of the pandemic. METHODS: We conducted a retrospective, observational and cross-sectional study. We reviewed the clinical records of all patients attending the psychiatric emergency room (ER) between March 11th and April 11th, of both 2019 and 2020. Sociodemographic and clinical variables were included in the study. Chi-square test or Fisher's exact test were performed to compare categorical variables, while U Mann-Whitney U test was used for quantitative variables. The level of statistical significance was set at p<0.05. Analysis were conducted using IBM SPSS Statistics. RESULTS: The was a significant decrease in the number of patients attended in the ER. An average of 5.91 (±2.53) patients were treated per day in 2019 compared to 2.41 (±1.81) in 2020 (p<0.001). There was also a significant decrease in the occupancy rate at the inpatient psychiatric unit, with a 91.84% (±7.72) of beds occupied in 2019 and only 58.85% (±13.81) in 2020 (p<0.001). Regarding the percentage of patients admitted after assessment in the ER, there was a significant increase in 2020 compared to the previous year. CONCLUSIONS: The demand for care in the psychiatric emergency room and the average bed occupancy have decreased during the first month after the declaration of the pandemic. Fear of contagion may act as a modulator of psychiatric demand.

El control de la correspondencia de los enfermos mentales en las instituciones psiquiátricas españolas: entre el cuidado y la censura, 1852-1987 / Monitoring the correspondence of the mentally ill in Spanish psychiatric institutions: from care to censorship, 1852-1987

Resumen Este trabajo pretende aproximarse a la legislación que ha permitido retener la correspondencia de los enfermos mentales en los hospitales psiquiátricos. Amparándose en el cuidado, las cartas eran leídas por médicos y administradores. Se ha realizado una búsqueda de los reglamentos que avalaban esta práctica en diferentes instituciones españolas desde el siglo XIX, medida ejercida por el personal subalterno por orden de sus superiores. Esta arbitraria decisión ha provocado que numerosa correspondencia permanezca en archivos de establecimientos psiquiátricos de diferentes latitudes, de modo que, actualmente, se pueden utilizar como valiosos documentos clínicos para conocer la vida cotidiana de dichas instituciones y, sin duda, la experiencia subjetiva de los enfermos mentales ante el internamiento.

Abstract This article examines the legislation allowing confiscation of the correspondence of the mentally ill in psychiatric hospitals. Arguing a duty of care, patients' letters were read by physicians and administrators. A study was performed of the regulations governing this practice in different Spanish institutions from the nineteenth century on; the measure was implemented by staff members under orders from their superiors. This arbitrary decision meant that a great deal of correspondence remains in the archives of psychiatric establishments in different locations; nowadays, these letters can be used as valuable clinical documents that help us to understand daily life in those institutions and, obviously, mental health patients' subjective experience of their confinement.

La institución psiquiátrica en Colombia en el año 2025. Investigación con método Delphi / Mental health institution in Colombia in 2025. Delphi Method / A instituição psiquiátrica na Colômbia no ano 2025. Pesquisa com o método Delphi

La incertidumbre de las instituciones psiquiátricas en Colombia tiene aspectos científicos, económicos, de mercado y regulatorios que dificultan la previsión de las decisiones para una atención adecuada, adaptada a las condiciones cambiantes de la prestación de salud. La investigación exploró cómo será la institución psiquiátrica en el año 2025, con metodología Delphi. Hallazgos: Existe gran incertidumbre de cómo adecuar la institución psiquiátrica en el futuro; de acuerdo con los cambios de legislación y las expectativas sociopolíticas en el momento del estudio. Se prevé la necesidad de educación del equipo profesional, mejoría en infraestructura e incremento de servicios, incluyendo consulta, hospitalización total y parcial, clínicas específicas y atención comunitaria. La institución ideal luce como un conjunto amplio de servicios desarrollados sobre la base de la prestación actual, asumiendo pacientes agudos y crónicos. El campo de acción de la clínica psiquiátrica se prevé continuará asumiendo la falta de desarrollo de la atención primaria y de dispositivos comunitarios.

Uncertainty of psychiatric institutions in Colombia has scientific, economic, market and regulatory aspects that hinder the provision of decisions for adequate, efficient and effective care, facing the changing conditions of the provision of health services. The research explores how psychiatric institution will be in 2025. Materials and Methods: Delphi methodology, quantitative and qualitative analysis. Findings: There is great uncertainty about how to adapt the psychiatric institution in the future; according with changes in legislation and sociopolitical expectations at time of study. Education of professional team, improved infrastructure and increased services, including ambulatory ones, total and partial hospitalization, specific clinical and community care is expected. The ideal institution looks like a comprehensive set of services developed on the basis of the current provision, assuming acute and chronic patients. The scope of the psychiatric clinic is expected to continue assuming the lack of development of primary care and community facilities.

A incerteza das instituições psiquiátricas na Colômbia tem aspectos científicos, económicos, de mercado e regulatórios que dificultam a previsão das decisões para um atendimento adequado, adaptado às condições variáveis da prestação de saúde. A pesquisa explorou como poderia ser a instituição psiquiátrica no ano 2025, com metodologia Delphi. Achados: Existe grande incerteza sobre como adequar a instituição psiquiátrica no futuro, de acordo com as mudanças da legislação e as expectativas sociopolíticas no momento do estudo. Prevê-se a necessidade de educação da equipe profissional, melhoramento da infraestrutura e acréscimo de serviços, incluindo consulta, hospitalização total e parcial, clínicas específicas e atendimento comunitário. A instituição ideal aparece como uma vasta gama de serviços desenvolvidos sobre a base da prestação atual, assumindo pacientes agudos e crônicos. O campo de ação da clínica psiquiátrica prevê-se continuando a assumir a falta de desenvolvimento no atendimento primário e de dispositivos comunitários.

Atendimento médico em grupo: disponibilidade pessoal e fortalecimento da comunidade / Medical group appointment: personal availability and strengthening of the community / Atención médica en grupo: disponibilidad personal y fortalecimiento de la comunidad

Esse relato de experiência tem o propósito de explicitar as duas teses que figuram no título: a de que fomentar atendimentos médicos em grupo depende antes de mais nada da disponibilidade do grupo intrapsíquico do profissional que realiza a assistência em saúde e a de que, quando este atendimento ocorre, além dos benefícios que uma consulta médica pode proporcionar, há também o fortalecimento dos sujeitos participantes dentro de suas comunidades. Percebe-se, ao longo dessa experiência, que essa modalidade de atendimento diminuiu as possibilidades de superficialidade e orientações mecânicas às quais o profissional está propenso nas curtas consultas psiquiátricas no sistema público de saúde e, mais importante que isso, traz a possibilidade de ajuda mútua dos participantes, empatia entre os munícipes e exemplos mais impactantes e verdadeiros de como lidar com o cotidiano de quem sofre de alguma doença mental.

This experience report has the purpose of expose these two theses in title: that stimulating medical appointment in a group format depends much more on the availability of the professional's intrapsychic group itself and that, when this type of consultation occurs, beyond the benefits that usually a doctor's appointment can provide, there is also the subjects strengthening on their communities. We are able to realise, in this experience, that this type of assistance has lowered the potentially weak and mechanical orientations that the professional is likely to make in shortened psychiatric appointments on Public Health System and, more importantly, has brought the possibility of helping each other, the empathy among citizens and more impactful and reliable examples of how to deal with the daily life of those suffering from a mental illness.

Este relato de experiencia tiene como objetivo explicar las dos tesis contenidas en el título: que una fomentación de los grupos de la atención médica depende antes de todo de la disponibilidad de un grupo intrapsíquico en el profesional que realiza esta atención y que, cuando ocurre esta modalidad de tratamiento además de los beneficios que una consulta médica puede proporcionar, también existe el fortalecimiento de los que participan en sus comunidades. Fue posible observar a lo largo de esta experiencia que este tipo de tratamiento ha disminuido la tendencia a la superficialidad y a las orientaciones mecánicas que son uma propensión de las consultas psiquiátricas de corta duración del sistema público de salud y además trae la posibilidad de ayuda mutua, la empatía y muchos y verdaderos ejemplos de cómo hacer frente a la vida cotidiana de estas personas con alguna enfermedad mental.

Relações entre religiosidade e saúde mental em imigrantes: implicações para a prática psi / Relationships between immigrants' religiosity and mental health: implications for psychiatric and psychological care / Relaciones entre religiosidad y salud mental de los inmigrantes: implicaciones para la práctica psi

Este artigo visa discutir possíveis relações entre religiosidade e saúde mental de imigrantes e suas implicações para a prática clínica de psiquiatras e psicólogos que os atendem em serviços especializados. Apresenta uma síntese analítica das principais questões apontadas na literatura concernente às relações entre religiosidade e saúde mental, articulando-as com a realidade específica do imigrante, bem como apontando a relevância desta questão no contexto contemporâneo e do modo como é percebido e elaborado pelos profissionais do campo psi. Conclui-se pela necessidade de mais pesquisas sobre o assunto, cuja discussão é praticamente inexistente ao longo da formação destes profissionais...

This paper aims to discuss the relationships between immigrants' religiosity and mental health and its implications for clinical practice of psychiatrists and psychologists who attend them in specialized services. It presents an analytical summary of the main issues raised in the literature concerning the relationships between religiosity and mental health, articulating them with immigrant's specific reality, as well as pointing to the importance of this issue in contemporary context and how it is perceived and drawn up by professionals of the PSY field. It concludes that more research is needed on the subject, whose discussion is largely absent throughout the training of PSY professionals.

En esta ponencia se analizan las posibles relaciones entre religiosidad y salud mental de los inmigrantes y de sus implicaciones para la práctica clínica de los psiquiatras y psicólogos que desempeñan servicios especializados. Presenta un resumen analítico de las principales cuestiones planteadas en la literatura sobre la relación entre religiosidad y salud mental, su vinculación a la realidad específica de los inmigrantes, así como señala la importancia de esta cuestión en el contexto actual y cómo es percibido por profesionales del PSI campo. Se concluye por la necesidad de más investigación sobre el tema, cuya discusión es prácticamente inexistente a lo largo de su formación...

Reforma psiquiátrica e os trabalhadores da saúde mental: a quem interessa mudar? / Psychiatric care reform and mental health workers: change in whose interest?

O artigo aborda a reforma psiquiátrica na perspectiva dos trabalhadores da saúde mental, entendendo-a como estratégia capaz de garantir melhor atendimento às demandas dos usuários e melhores condições de trabalho aos servidores. Parte-se do pressuposto de que um serviço de saúde mental baseado nos princípios da reforma psiquiátrica dispõe de trabalhadores mais satisfeitos e mais saudáveis. O presente artigo se baseia em uma pesquisa de mestrado realizada no Distrito Federal, dando ênfase a grupos focais compostos por trabalhadores da saúde mental, desenvolvidos no único hospital psiquiátrico da unidade da federação e em um Centro de Atenção Psicossocial (CAPS). Verificou-se, a partir da análise de conteúdo, que o ambiente manicomial provoca ou contribui para o sofrimento e o adoecimento mental dos trabalhadores.

This article addresses psychiatric care reform from the perspective of the mental health workers, viewing it as a strategy to guarantee better response to user demands and better working conditions. It builds on the premise that a mental health care service based on the principles of psychiatric care reform will lead to a more satisfied and healthier work force. This article is based on master's degree research conducted in the Brazilian Federal District with focus groups composed of mental health workers from the only local psychiatric hospital and a Psychosocial Care Centre (CAPS). Content analysis led to the conclusion that the psychiatric hospital environment caused or contributes toward the mental sickness and suffering of the workers.

The "mental feature" in mental illness: difficulties that this reality poses for diagnosis and classification / O "mental" na doença mental: dificuldades que sua realidade impõe em relação a diagnóstico e classificação

Four points are considered in this article. In the first place, it is argued that the "settings" of psychiatric care express the need to respond to the degree of decrease in personal freedom of the patient. Then, the issue of how "the mental feature" of the mental pathology has been recognized and categorized since the 18th century is examined, pointing out the difficulties involved in considering the mental nature of the subject of psychiatry. In the third place, the issue of how current systems of diagnosis and classification are posed regarding this reality is briefly looked at. Finally, the characteristics of a working hypothesis that allows organizing consistent clinical facts providing a heuristic perspective are analyzed

Neste artigo, quatro pontos são considerados. Em primeiro lugar, argumenta-se que os "espaços" da atenção psiquiátrica expressam a necessidade de responder ao grau de diminuição da liberdade pessoal do paciente. Em seguida, são discutidas as formas como o "mental" da doença mental tem sido reconhecido e categorizado a partir do século 18, apontando para dificuldades envolvidas ao se considerar o caráter mental do objeto da psiquiatria. Em terceiro lugar, são discutidas brevemente as formas como os sistemas atuais de diagnóstico e classificação se posicionam sobre essa realidade. Finalmente, as características de uma hipótese de trabalho que permita organizar de modo coerente os fatos clínicos e que proporcione uma perspectiva que seja heurística são analisadas

Da colônia agrícola ao hospital-colônia: configurações para a assistência psiquiátrica no Brasil na primeira metade do século XX / From the agricultural colony to the hospital-colony: configurations for psychiatric care in Brazil in the first half of the twentieth century

Discute os sentidos do modelo institucional das colônias na assistência psiquiátrica no Brasil, considerando suas diferentes configurações no contexto das políticas públicas de saúde na primeira metade do século XX. Toma como fio condutor a Colônia Juliano Moreira, fundada em 1924 no Rio de Janeiro. Demonstra o significado atribuído à concepção de colônia agrícola e sua importância na formatação da Colônia Juliano Moreira, para compreender como o ideário da colônia agrícola foi traduzido na concepção de hospital-colônia a partir dos anos 1940, quando essa instituição sofreu processo de acentuada expansão de sua estrutura física e de seus recursos terapêuticos.

The meanings given to the institutional model of the colonies in psychiatric care in Brazil are assessed, duly considering their different configurations in the context of public health policies in the first half of the twentieth century. The central thread of this analysis is the case of the Colônia Juliano Moreira, an institution founded in 1924 in Rio de Janeiro. It seeks to show the meaning attributed to the concept of agricultural colony and its importance in shaping the Colônia Juliano Moreira, in order to understand how the ideological precept of agricultural colony was translated into the concept of hospital-colony from the 1940s onwards, when this institution experienced a steady process of marked expansion of its physical structure and its therapeutic resources.

El proceso de transformación institucional del Hospital Psiquiátrico de San Luis / The process of institutional transformation of San Luis Psychiatric Hospital

Este artículo está centrado en las contradicciones humanas e institucionales que implica el proceso transformador de un hospital psiquiátrico clásico en la provincia de San Luis, Argentina. Ese proceso debe ir resolviendo conflictos de la clínica, culturales, ideológicos, políticos, en el corazón del camino elegido, para afirmar la existencia de la enfermedad mental, la necesidad de encontrar nuevos tratamientos ante los nuevos sufrimientos que implica abandonar el encierro optando por la libertad y el acompañamiento de quienes padecen.

This article focuses on the human and institutional contradictions involved in the transformation process of a classic psychiatric hospital in the province of San Luis, Argentina. This process has to resolve clinical, cultural, ideological, political conflicts, in the heart of the chosen path, in order to affirm the existence of the mental illness, the need to find new treatments for the new sufferings involved in leaving enclosure opting for freedom and the accompaniment of those who suffer.

Histórico da implantação de urgências e emergências psiquiátricas no Estado do Pará: contribuição do enfermeiro / Historical report of implementation of psychiatric urgencies and emergencies in the State of Para, Brazil: the nurse's contribution

Descreve a trajetória da implantação da reforma psiquiátrica, no período de 1980 a 1999, no Estado do Pará, baseada na linha de abordagem biopsicosocial com as estratégias de: 1) criação de espaços substitutivos para portadores de transtornos mentais; 2) adequação dos serviços existentes; e, 3) extinção progressiva do regime asilar. Ainda, como parte do processo, houve a criação de uma unidade de urgências e emergências psiquiátricas em hospital geral, como porta de entrada para que portadores de transtornos mentais pudessem ingressar no sistema de saúde. Para a época, a instalação desse serviço especializado dentro de hospital geral constituía uma inovação importante. O estudo tinha por objetivos: 1) resgatar a história da implantação de urgências e emergências no Hospital de Clinicas "Gaspar Viana" no Estado do Pará; 2) discutir a experiência da implantação no contexto da assistência de enfermagem psiquiátrica no Estado; e, 3) registrar a participação efetiva do enfermeiro no processo da implantação de urgências e emergências psiquiátricas, e da própria Reforma Psiquiátrica, nesse Estado, com análise das transformações ocorridas no papel da enfermagem, especialmente na sua contribuição como agente transformador daquele modelo assistencial. A validação do relato foi feita por três peritos, selecionados segundo determinados critérios, de acordo com a Técnica Delphi. Esses peritos, após analisarem o texto e preencherem o questionário, concordaram com o teor do texto e fizeram mínimos reparos.

|a The trajectory of the Psychiatric Reform based on the bio-psycho-social approach, in the State of Para, in the period of 1980-1999, is described. Such an approach includes the following strategies: the creation of substitutive space for those carrying mental disorders; an adaptation of existing services; progressive abolishment of the asylum regime. Yet, as part of the process, an unity for urgencies and emergencies within a general hospital was created as an open door to the health system for mentally ill patients. At that time, the implementation of this specialized service within a general hospital was considered an important innovation. The study has had the objectives to: 2) rescue the history of urgencies and emergencies in the Gaspar Viana Clinics Hospital, in the State of Para; 2) discuss the experience of this implementation in the context of the psychiatric nursing care in that State; 3) record the nurses´ participation in the urgencies and emergencies implementation process as well of the Psychiatric Reform itself, analyzing changes occurred in the nursing role, in particular, those related to their contribution as a transforming agent of this care model. The report was validated through three experts selected according a certain criteria following the Delphi Technique. Those experts, after analyzing the text, filled in a questionnaire and have agreed with its content and made minimal remarks.

Government in Korea with the Special Reference to the Clinical Activities at the Colonial Governmental Hospital: 'Chosun-Chong-Dok-Bu Ui-Won' (1913-1927) / 의사학

The purpose of this study is to elucidate the ways of introduction of modern psychiatric care into Korea and to demonstrate the changing patterns of psychiatric care during the time between 1913 and 1927. The study was focused on the clinical activities of the colonial governmental hospital on the basis of the annual reports of the hospital from 1912 to 1928. The investigation has revealed the fact that the first special institution for the care of the mentally ill patients was founded in 1911 in Seoul by the colonial government which was called 'Che Saeng Won'. It was also confirmed that the first clinical department of the psychiatry in Korea was established in 1913 at the colonial governmental hospital, 'Chong-dok-bu Ui-won' which has taken over the role of psychiatric care from Che Saeng Won. The first chairman of the department of psychiatry was Misuzu Nobuharu and his assistant was Shim Ho-Sub, the first Korean psychiatrist who became assistant professor of psychiatry at Kyongsung medical college in 1916-1917 but moved to Severance hospital and changed his speciality to neurology of internal medicine. The department had two physicians and 4 care persons at the beginning stage and 22 beds for the mentally ill patients in the hospital which had total 330 beds. Later, the department has developed to 54 bed clinic with 4 staff physicians.It was noteworthy, however, that the treatment and care for the mentally ill patients by the western medical facilities in Korea probably began since 1880s at the general hospitals and clinics, such as Che-saeng Ui-won in Pusan, Royal hospital, Che-choong-won in Seoul, Paton memorial hospital in Chinjoo, Tai-Han hospital and Severance hospital in Seoul.In 1911, Australian psychiatrist McLaren began to work at Paton memorial hospital in Chinjoo, who became professor of neurology and psychiatry at Severance Union Medical College in Seoul. At Severance hospital, the psychiatric ward opened in 1923 with 10 beds. Dr. McLaren as missionary physician allegedly carried out humanitarian treatment and care of the mentally ill patients.The patterns of admission rates in accordance with diagnostic categories and racial differences at In- and Outpatient clinic of psychiatric department have offered no significant clues for the cultural psychiatric interpretation except for the case of hysterical psychosis. Among the total number of admitted cases of hysterical psychosis at psychiatric ward of Chong-dok-bu Ui-won the number of Japanese women were predominantly high throughout the period of investigation in comparison with the Korean patients. Some possible factors which might have influenced to this fact were suggested. Discussion was also held on the changing patterns of psychiatric diagnosis and nomenclature during the period.Colonial governmental hospital made great effort to expand the clinical and research facilities, therefore, Japanese psychiatrists have introduced the advanced knowledges of German psychiatry into Korea. Regrettably, however, the knowledges could not be transmitted to the Korean psychiatrists continuously until 1927 probably due to the discriminative policy of colonial government on the medical education for the Korean people.