Mental health services in Gauteng, South Africa: A proxy evaluation using pharmaceutical data

Background: South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment. Aim: The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system. Setting: The Public health sector, Gauteng province formed the setting for the study. Method: A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing. Results: General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals. Conclusion: In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended. Contribution: This study provides insight into service provision for MNS disorders.

Infâncias imigrantes, silêncios e fronteiras do cuidado em um CAPS infantojuvenil / Niñeces inmigrantes, silencios e fronteras del cuidado en un CAPS para niños y adolescentes / Immigrant childhoods, silences and frontiers of care in a CAPS for children and adolescents / Enfances immigrées, silences et limites du soin psychologique dans un CAPS pour enfants et adolescents

O trabalho aborda o cuidado em saúde mental de crianças de famílias bolivianas em um CAPS (Centro de Atenção Psicossocial) Infantojuvenil em São Paulo. Essas crianças apresentam dificuldades na aquisição da fala e na interação social, e são encaminhadas majoritariamente pelas escolas. A apresentação de vinhetas clínicas buscará articular suas histórias ao contexto de imigração, às rupturas nas transmissões familiares, vivências de desamparo e estratégias de enfrentamento de um lugar social desqualificado. Discute-se a tendência à redução de tais impasses ao diagnóstico de autismo, cristalizando uma compreensão reducionista e dificultando a diferenciação e singularização dos casos. O silêncio dessas crianças e de suas famílias é entendido como efeito dos abalos nas transmissões familiares, mas também como formas de resistência à submissão cultural e identitária.

Este trabajo tematiza la atención en salud mental de niños de familias bolivianas atendidos en un Centro de Atención Psicosocial para niños y adolescentes en São Paulo. Estos niños presentan dificultades para adquirir el habla y desarrollar la interacción social y son derivados principalmente por las escuelas. La presentación de viñetas clínicas buscará articular sus trayectorias al contexto de la inmigración, las rupturas en las transmisiones familiares, sus vivencias de desamparo y las estrategias para afrontar una posición social descalificada. Se discute la tendencia a reducir los obstáculos que se enfrentan al diagnóstico de autismo. El silencio de estos niños y sus familias se entiende tanto como resultado de los efectos del contexto migratorio como una forma de resistencia a la sumisión cultural e identitaria.

This article concerns mental health care among children from Bolivian families being attended at a Psychosocial Attention Care Center for Children and Youth in São Paulo. These children present difficulties in acquiring speech and developing social interaction and are referred principally by schools. The presentation of clinical vignettes will seek to articulate their trajectories to the context of immigration, the ruptures in family transmissions, their experiences of helplessness and the strategies they use to cope with the disqualified social position they occupy. The tendency to reduce the obstacles confronted by diagnosing such children as autistic is discussed. These children's and their families' silence is understood both as a result of the effects of the immigration context and as a form of resistance to cultural and identity submission.

Ce travail porte sur les soins psychologiques (de la santé mentale) donnés aux enfants issus de familles boliviennes dans un Centre de Soins Psychosociaux pour enfants et adolescents à São Paulo. Ces enfants ont des difficultés à acquérir la parole et à établir des liens d'interaction sociale. La présentation des vignettes cliniques porte sur l'articulation de leurs histoires avec leurs contextes migratoires et les ruptures de leurs transmissions familiales, leurs expériences d'impuissance et leurs stratégies pour affronter une place sociale dégradée. La tendance à réduire cette complexité au diagnostic de l'autisme est débattue. Le silence de ces enfants et de leurs familles est donc ici compris à la fois comme effets de leurs contextes migratoires mais aussi comme une forme de résistance à la soumission culturelle et identitaire.

Quantitative Analysis of Providers' Experiences in the Disaster Behavioral Health Services of South Korea / 신경정신의학

OBJECTIVES: This study was conducted to quantify the six dimensions of obstacles to disaster behavioral health (DBH), which was explored through the previous Qualitative Content Analysis of field workers' experiences after the Sewol Ferry accident and to determine the preference and significance of the details of every dimension. METHODS: Based on the six dimensions and their details, structured questionnaires were devised. The field workers as DBH service providers were requested to choose not only the most urgent item but also the reason for their choice. For the statistical analysis, the field workers were grouped by age, employment period, place of employment, occupation, mental health professional certificate, and experience and education of DBH interventions. Differences of the groups were analyzed using chi-square test. RESULTS: The questionnaires were distributed to 284 field workers for DBH, and a total of 79 usable questionnaires were collected and analyzed. Out of six dimensions, 43% of the field workers primarily suffered from difficulties in vertical relations of the administration system. Vague policy on DBH was the most challenging in difficulties in vertical relations of administration system (32.9%). The details of the other 5 dimensions were also discovered. Several significant differences were identified among groups according to the structured questionnaires. CONCLUSION: This study identifies the six dimensions and their significance as obstacles to DBH services. It may make a contribution to improving laws and systems when deciding on related policies and sorting out urgent problems.

Ética e clínica na atenção psicossocial: contribuições da psicanálise de Freud e Lacan / Ethics and clinic in psychosocial care: contributions of Freud's and Lacan's psychoanalysis

O objetivo central é discutir a possibilidade de uma ética pertinente ao conjunto de ações atualmente realizadas sob o enfoque da Atenção Psicossocial no campo da Saúde Mental Coletiva. Utilizando o método do ensaio, partirei da análise de algumas proposições importantes sobre a ética na Saúde Mental, presentes na literatura recente, e da experiência de vários anos no campo da Atenção Psicossocial como trabalhador, como assessor clínico-institucional do Ministério da Saúde e como formador de psicoterapeutas. Duas vertentes de análise são consideradas: éticas disciplinares, chamadas éticas da psiquiatria, incluindo uma tentativa importante de complementá-las criticamente sob o enfoque da "ética do cuidado", e éticas fundadas em concepções psicanalíticas do sujeito e seu sofrimento, que destacam as dimensões do sujeito como "entre" social e como "entre" subjetivo ou "entre sentido". Com base nas diretrizes do Sistema Único de Saúde e na psicanálise do campo freudiano, procura-se fundamentar a ética da Clínica na Atenção Psicossocial como ética do "cuidar-se" - base necessária para a construção do protagonismo dos sujeitos do sofrimento na produção do sentido necessário à superação do sofrimento e demais impasses que motivaram a procura de ajuda, e para a possibilidade de seu reposicionamento no "entre social" e no "entre sentido"; componentes da saúde em sintonia com a subjetividade singularizada referenciada nos Ideais socioculturais e no devir desejante. Demonstra-se que essa ética exige dos trabalhadores do campo a superação dialética dos modos de produção de saúde e subjetividade em sintonia com o Modo Capitalista de Produção e seus derivados autoritários.