O direito à internação psiquiátrica no sistema de saúde brasileiro: as representações sociais do Tribunal de Justiça de São Paulo / The right to psychiatric admission in the Brazilian health system: the São Paulo Court of Justice' social representations

Este artigo teve como objetivo analisar as representações sociais do Tribunal de Justiça de São Paulo sobre o direito à internação psiquiátrica no sistema de saúde brasileiro. Os dados foram coletados do sítio eletrônico do tribunal paulista, a partir de 184 acórdãos de ações julgadas em segunda instância, proferidos em razão de recursos de apelação e publicados no período de janeiro de 1998 a dezembro de 2012, referentes às internações psiquiátricas pleiteadas no Sistema Único de Saúde e no sistema de saúde suplementar. Os métodos empregados para análise dos resultados foram a estatística descritiva e o discurso do sujeito coletivo. Aplicou-se, ainda, a Teoria das Representações Sociais como referencial teórico de interpretação dos discursos elaborados. No Sistema Único de Saúde, a internação reclamada em juízo foi a compulsória, representada, majoritariamente, como medida de proteção da dignidade da pessoa com transtorno mental e, minoritariamente, como violência contra essa mesma dignidade. No sistema suplementar, a representação judicial assumiu o enfoque consumerista, consubstanciado na abusividade da cláusula limitativa da internação psiquiátrica e no direito superior à vida. O direito à saúde, vislumbrado nas decisões judiciais, resumiu-se ao direito de acesso aos serviços de saúde e ao direito à doença. A compreensão do Poder Judiciário, nos dois sistemas investigados, foi a do direito à saúde como o direito ao bem de saúde pleiteado em juízo, o que coloca muitos desafios para os sistemas de saúde e para o Poder Judiciário frente à consolidação dos ideais da reforma psiquiátrica estatuída pela Lei n. 10.216/2001.

The current research sought to present the social representations of judges from the São Paulo Court of Justice about the law regarding psychiatric admissions. Data were collected through the court website, from 184 judgments including all the decisions published between January 1998, and December 2012, regarding psychiatric admissions claimed to both the Brazilian Public Health System, and the private insurance health system. As methods, the author used descriptive statistics and the collective subject speech. The Social Representations Theory was applied as a theoretical framework to interpret the collected speeches. Considering Brazilian Public Health System, the admissions claimed on the court were compulsory and judges presented the psychiatric admissions, mostly, as a protection measure of people with mental disorders dignity and, at a lower degree, as a violence against this same dignity. With respect to the private insurance health system, the judicial representation was related to the consumerist approach, supported by the abuse of a clause restricting the time for psychiatric admissions and its contradiction with the right to life. The right to health was characterized in the decisions as the right of access to health services and the right to be ill. The comprehension of the judges in both investigated systems related the right to health to the right to a health as a good claimed in court, imposing many challenges to health systems and the Judiciary Power in order to consolidate the principles of the psychiatric reform brought by Law n. 10.216/2001.

Sociodemographic Profile and Diagnostic Pattern of Psychiatric Patients Admitted Across One Year: Chart Review from Tertiary Care Hospital

Background: Mental health problems contribute significantly to morbidity and mortality across the globe. The impact is more visible in developing countries where less than one in five individuals with psychiatric disorder receives any form of psychiatric help despite immense need. Most of the states in India lack data about the pattern of psychiatric services use in general population thus making it difficult to plan accordingly, The present study was carried out to understand the Sociodemographic profile of inpatient psychiatric services beneficiaries and pattern of psychiatric illnesses among them. Methods: Retrospectively one-year data of admitted patients from July 2017 to June 2018 were extracted manually from the patient files. Results: The study demonstrated that younger individuals were most common recipient of inpatient services followed by middle age patients. Males availed services more frequently and occupied more than 70% of beds at any given time. Schizophrenia (24.8) and bipolar disorders (23.7%) were most common diagnosis and represented almost half of the admitted patients. The other common diagnosis included unspecified psychosis (17.35%), substance use disorders (10.32%) and depressive disorders (4.1%) and dissociative disorders (2.18%). The other categories of diagnosis were barely represented including various childhood and geriatric psychiatric disorders despite the sizeable caseload in community settings. Conclusion: The Sociodemographic profile of psychiatric inpatients was similar to community settings where younger individuals were over represented. Among the patients male preponderance was observed which denotes social and cultural framework of community.

Caracterização das internações de dependentes químicos em Unidade de Internação Psiquiátrica do Hospital Geral / Characterization of admission of chemical-dependents in a Psychiatric Admission Unit of the General Hospital

A Unidade de Internação Psiquiátrica do Hospital Geral (UIPHG) é uma proposta articulada ao movimento da reforma psiquiátrica. O objetivo deste estudo foi avaliar os determinantes das internações de dependentes químicos na UIPHG Dr. Estevam, em Sobral (CE). Este estudo foi do tipo documental com abordagem quantitativa, envolvendo 203 clientes que foram internados na UIPHG no período de outubro de 2005 a abril de 2006. Os dados foram coletados por meio de um roteiro adaptado a partir do documento usado no momento da internação. Observou-se predomínio de pacientes do sexo masculino (95,1 por cento), com idade entre 30 e 40 anos (62,5 por cento) e solteiros (59,1 por cento). Em 76,3 por cento dos casos, o diagnóstico da internação foi síndrome de abstinência do álcool. Após alta hospitalar, 70 por cento desses clientes foram encaminhados ao CAPS-AD. Esses resultados demonstram quão imprescindíveis são os serviços de saúde mental que enfoquem a problemática do alcoolismo.

The Psychiatric Admission Unit of the General Hospital (UIPHG) is integrated to the psychiatric reform movement. The aim of this study was to evaluate chemical-dependent's admission causes at the UIPHG Dr. Estevam in the city of Sobral, Ceará State. It was a documental study with a quantitative approach involving 203 patients who were admitted at the UIPGH Dr. Estevam from October 2005 to April 2006. Data were collected from a document filled during admission process in the hospital. 95.1 percent of the sample was represented by men, age range of 30-40 years (62.5 percent) and single (59.1 percent). The alcohol withdrawal syndrome was the main admission cause (76.3 percent). After leaving the hospital, 70 percent of the sample was conducted to aftercare at CAPS-AD. These results provide preliminary evidence for the need of mental health services emphasizing alcohol dependence problem.