Os organismos comunitários em saúde mental no Quebec, Canadá / The mental health community organizations from Quebec (Canada)

Resumo Este estudo apresenta os organismos comunitários em saúde mental (OCSM) do Quebec, Canadá. Especificamente, traça reflexões considerando sua origem, inserção no sistema público de saúde, princípios, características e formatos. Os OCSM são serviços autônomos, originados na comunidade, que oferecem atividades sem fins lucrativos no setor da saúde e assistência social. Realizou-se estudo descritivo, de abordagem qualitativa, com revisão não sistemática da literatura. Os resultados apontaram o surgimento dos OCSM no contexto de desospitalização de pacientes, mas com déficit de recursos substitutivos ao hospital psiquiátrico. Apontaram também sua consolidação como alternativa à psiquiatria tradicional, reconhecimento e financiamento parcial, pelo governo, como parte da assistência à saúde mental. Constatou-se que os OCSM compartilham certos princípios, mas concretizam-se em vários formatos, destacando-se por estimular a defesa dos direitos e a convivência em comunidade de pessoas em sofrimento psíquico. Contudo, observaram-se limitações quanto ao alcance e à interação entre OCSM e estabelecimentos públicos, e questiona-se o papel do Estado frente a tais organismos. Conclui-se apontando aproximações e distanciamentos entre características da assistência em saúde mental promovida pelos OCSM no Quebec e pelo Brasil; e indica-se a continuidade das discussões, visando à sedimentação de políticas e práticas em saúde mental, que garantam o cuidado na comunidade.

Abstract This study presents the Mental Health Community Organizations (MHCO) from Quebec (Canada). The authors draw up reflections considering its origin, insertion into the public health system, principles, characteristics and formats. The MHCO are autonomous, community-based services that provide nonprofit activities in health and social service fields. A descriptive, qualitative study based on a non-systematic review of the literature was done. The results point to the emergence of the MHCO in a context of dehospitalization of patients, but without enough resources replacing the psychiatric hospital. They were consolidated as an alternative to traditional psychiatry, recognized by the government as part of mental health care, and partially financed by the State. The MHCO share some principles, but they materialize in several formats. They stand out for encouraging the defense of rights, and socially reintegrating people in psychological distress. However, there are limitations considering their reach and interaction with public establishments, and the role of the State over these institutions is questioned. We conclude by pointing out similarities and differences between mental health assistance promoted by the MHCO from Quebec and by Brazil. It is necessary to continue dialoguing, aiming to establish policies and practices in mental health that guarantee community-based care.

Study of the Effect of Activities by Community Organizations: Effect of AIIKU-HAN Activities on Pregnant Women in Rural Areas of Vietnam / 国際保健医療

<B>Objectives</B><BR>AIIKU-HAN is a community organization having a long history of involvement in maternal and child health and welfare in Japan. Its activities have been modeled in rural areas of Nge-An Province, Vietnam since 2002. This study clarifies the effect of AIIKU-HAN activities in Nge-An Province, and discusses the results in context by comparing pregnant women, who are one of the beneficiary groups of these activities, in areas with AIIKU-HAN involvement (activity areas) and areas without such involvement (non-activity areas).<BR><B>Method</B><BR>This study was conducted at three communes each with and without AIIKU-HAN activity areas, for a total of six communes. Structured questionnaires were used for this cross-sectional study, covering pregnant women who were more than 16 weeks pregnant. At the same time, additional information about health promotion offered to pregnant women was collected through interviews with midwives from each of the communes.<BR><B>Result</B><BR>Compared to pregnant women in non-activity areas, pregnant women in activity areas had more knowledge concerning health issues which arise during terms of pregnancy, performed more healt-seeking behaviors, and received more support from family members. They also referred to midwives for counseling and information more often, and were more likely to relieve their anxieties by consulting with midwives in closer area to CHC. Furthermore pregnant women in activity areas received additional social support through association with AIIKU-HAN volunteers. From interviews with midwives, we determined that the content of their advice to pregnant women in activity and non-activity areas wasn't substantially different; however IEC (Information, Education and Communication) activities were more promoted in activity areas than in non-activity areas.<BR><B>Conclusion</B><BR>The results discuss both the direct and indirect effects of AIIKU-HAN activities. The support of AIIKU-HAN allowed pregnant women to gain more knowledge and strengthened their health behaviors directly. Indirectly, family support for pregnant women was increased by promotion of family involvement by AIIKU-HAN, and an environment in which pregnant women could more easily perform healt-seeking behaviors was fostered. AIIKU-HAN volunteers served as the pipeline between pregnant women and midwives through the collaboration of AIIKU-HAN and midwives, and the organization further contributed to good relationships between midwives and pregnant women. This collaboration also served as a stimulus for IEC activities by midwives.