Profile and costs involved in long-term compulsory hospitalization of psychiatric patients

Objective: Involuntary hospitalization for acute psychiatry cases can be acceptable when there is potential harm. However, there are few reasons for a patient committed on these grounds to stay in an institution for a long period. The objective of the present study was to identify the profile and costs of compulsory hospitalizations over 20 days in a public psychiatric hospital in the coastal region of the state of São Paulo. Methods: Retrospective data were collected from the medical records of 1,064 patients admitted between July 2013 and June 2016 from an intensive mental healthcare unit in Santos, state of São Paulo, Brazil. Results: Records were found of 527 patients who had been hospitalized for at least 21 days during the study period. Long-term hospitalization related to judicial mandates represented 5.9% of the total sample. These patients stayed in the hospital for an average period of 142 days, while patients hospitalized for any other reason stayed an average period of 35 days (p < 0.001). The cost of a long-term court-ordered hospitalization averaged US$ 21,311 per patient. Conclusion: Judicial mandate has been an important reason for the long-term hospitalization of chronic psychiatric patients in Santos, Brazil.

Equidade na cobertura dos gastos com saúde pelo Sistema Único de Saúde de pessoas com indicativos de transtornos mentais comuns no município de São Paulo / Equity in the coverage of health expenses by the Brazilian Unified Health System for people with signs of common mental disorders in the city of São Paulo

RESUMO: Introdução: O objetivo deste trabalho foi verificar a equidade na cobertura/complementação dos gastos com saúde pelo Sistema Único de Saúde (SUS) de pessoas com indicativos de transtornos mentais comuns (TMC), no ano de 2008, no município de São Paulo. Métodos: Foi realizado um estudo de corte transversal a partir dos dados do Inquérito de Saúde no Município de São Paulo de 2008 (ISA-Capital 2008). Os sujeitos incluídos na pesquisa tinham 16 anos de idade ou mais e indicativos de TMC, avaliados por meio do instrumento Self-Reporting Questionnaire (SRQ-20). Foram analisados: a procura pelo SUS, a cobertura dos gastos com saúde pelo SUS e os gastos com saúde no último mês, correlacionando-os com aspectos sociodemográficos e de condições de saúde. Resultados: A procura pelo SUS foi menor entre as pessoas de cor branca, renda per capita elevada, com união estável e Ensino Superior. A cobertura pelo SUS foi menor entre as faixas etárias de 45 a 59 anos e de 60 anos ou mais, com renda per capita elevada, Ensino Médio ou Técnico e Ensino Superior. As pessoas que gastaram mais com a saúde da família foram aquelas com idade igual ou superior a 60 anos, de cor branca, renda per capita mais elevada, com união estável e Ensino Superior. Conclusões: Foi observado que o SUS atende e cobre os gastos majoritariamente daqueles com renda per capita e escolaridade mais baixas, denotando uma cobertura desigual que favorece os mais necessitados. Porém, considerando o fator idade, ficou explícita uma situação de iniquidade, pois foi constatada maior cobertura dos gastos em saúde pelo SUS para a população mais jovem.

ABSTRACT: Introduction: The objective of this investigation was to check equity in coverage/complementation of health expenses by the Brazilian Unified Health System (SUS) for people with signs of common mental disorders, in 2008, in the city of São Paulo, Brazil. Methods: Cross-sectional study with data from the 2008 São Paulo Health Survey. Individuals aged 16 or older and with signs of common mental disorders were selected and evaluated with the Self-Reporting Questionnaire (SRQ-20). The following aspects were analyzed: demand for SUS, coverage of health expenses by SUS, and health expenses in the previous month, withal according to sociodemographic and health conditions. Results: The search for SUS services was lower among white people with higher per capita incomes, in a stable union, and with higher education degrees. Coverage by SUS was lower for people aged between 45 and 59 years and aged 60 years or older, with higher per capita incomes, with high or technical school, and college degrees. Subjects who spent more on family health were 60 years or older, white, with high per capita income, in a stable union, and with a college degree. Conclusions: Among people with signs of common mental disorders, SUS mainly services and covers the expenses of the poorer population with lower educational level; therefore coverage is unequal and favors who needs it the most. However, considering age, inequity became explicit, since SUS was shown to offer wider coverage of health expenses to the youngest population.

Determinants of Mental Health Care Utilization in a Suicide High-risk Group With Suicidal Ideation / 예방의학회지

OBJECTIVES: The suicide rate in Korea is increasing every year, and is the highest among the Organization for Economic Cooperation and Development countries. Psychiatric patients in particular have a higher risk of suicide than other patients. This study was performed to evaluate determinants of mental health care utilization among individuals at high risk for suicide. METHODS: Korea Health Panel data from 2009 to 2011 were used. Subjects were individuals at high risk of suicide who had suicidal ideation, a past history of psychiatric illness, or had utilized outpatient services for a psychiatric disorder associated with suicidal ideation within the past year. The chi-square test and hierarchical logistic regression were used to identify significant determinants of mental health care utilization. RESULTS: The total number of subjects with complete data on the variables in our model was 989. Individuals suffering from three or more chronic diseases used mental health care more frequently. Mental health care utilization was higher in subjects who had middle or high levels of educational attainment, were receiving Medical Aid, or had a large family size. CONCLUSIONS: It is important to control risk factors in high-risk groups as part of suicide prevention strategies. The clinical approach, which includes community-based intervention, entails the management of reduction of suicidal risk. Our study identified demographic characteristics that have a significant impact on mental health care utilization and should be considered in the development of suicide prevention strategies. Further studies should examine the effect of mental health care utilization on reducing suicidal ideation.

Reflections on the face of the person with mental illness: an american perspective / Reflexiones sobre la cara de la persona enferma mental: una perspectiva estadounidense

One in five adults and children in the United States experience some form of mental illness. Although there have been amazing developments in science, improved education of a cadre of mental health professionals, enhanced drug therapy, more public funding, and innovative trauma informed care, significant mental health disparities persist. Enduring myths about mental illness, separate but unequal physical and mental health delivery systems, lack of mental health parity in benefits, payments and access to health insurance, inadequate and un-coordinated community-based services, and an established mode of health delivery that values profit margins and rewards high technology medicine contribute to the burden of the person with mental illness. Poor individuals and families, members of minority groups, children in foster care, and persons who experience or witness violence are most at risk for mental disorders. These groups are untreated and lack access to the Social Determinants of Health. The great promise of the Community Mental Health Act of 1963 remains unfulfilled. Will the Affordable Care Act of 2010 and Medicaid expansion enable persons with mental disorders to obtain health insurance and find community-based delivery systems to help them cope with their treatable chronic disease? Good will is not enough. Social justice is an action theory. It invites us to stand in solidarity with the mentally oppressed and share their burdens. We are invited us to look into the faces of persons with mental illness with respect.

Uno de cada cinco adultos y niños en los Estados Unidos sufre algún tipo de enfermedad mental. Aunque se han producido avances asombrosos en la ciencia con la mejora de la educación de un grupo de profesionales de la salud mental, terapia de drogas mejorada, más fondos públicos y de atención de trauma innovadora, las disparidades significativas de salud mental persisten. Los mitos perdurables sobre las enfermedades mentales, los sistemas de salud física y mental separados pero desiguales, falta de paridad de salud mental en los beneficios, pagos y el acceso al seguro de salud, los servicios inadecuados y poco coordinados basados en la comunidad, y una vía reconocida de prestación de salud que los valores márgenes de beneficios y recompensas médicas de alta tecnología contribuyen a la carga de la persona con enfermedad mental. Los individuos y las familias pobres, los miembros de los grupos minoritarios, los niños en hogares y las personas que experimentan la violencia o testigo de ella están en riesgo de trastornos mentales. Estos grupos son tratados y no tienen acceso a los Determinantes Sociales de la Salud. La gran promesa de la Ley de Salud Mental de la Comunidad de 1963 no se ha cumplido. ¿La Ley de Asistencia Asequible de 2010 y la expansión de Medicaid de las personas con trastornos mentales para obtener un seguro de salud hacer frente a su enfermedad crónica tratable? La buena voluntad no es suficiente. La justicia social es una teoría de la acción. Nos invita a ser solidarios con los oprimidos mentales y compartir sus cargas. Los invitamos a mirar con respeto la cara de las personas con enfermedad mental.

Impacto de los trastornos psiquiátricos comunes y las condiciones crónicas físicas en el individuo y la sociedade / The impact of common mental and physical health conditions on days out of role: costs for the individual and society

OBJETIVO: Estimar los costos individuales y poblacionales de condiciones crónicas físicas y mentales comunes en la población mexicana, en función del número de días perdidos por problemas en el funcionamiento. MATERIAL Y MÉTODOS: 5 826 adultos fueron evaluados entre 2001-2002 con la Entrevista Internacional Psiquiátrica Compuesta y el Cuestionario para la Evaluación de Discapacidades. Se realizaron modelos generales lineales y se estimó la proporción de riesgo atribuible a la población, tomando en cuenta la prevalencia de la condición y la comorbilidad. RESULTADOS: Las condiciones de mayor impacto para el individuo son la depresión, el estrés postraumático y el trastorno bipolar. Las de mayor impacto a nivel poblacional son la depresión, el dolor, el insomnio y las enfermedades cardiovasculares. CONCLUSIÓN: Los hallazgos señalan la importancia de aumentar el gasto en salud mental para asignar una proporción más equitativa para su atención en cuanto al costo que representan para la sociedad.

OBJECTIVE: To estimate the individual and societal costs of common mental and physical health conditions in the Mexican population with regards to the number of days out of role. MATERIALS AND METHODS: 5 826 adults were evaluated in 2001-2002 with the Composite International Diagnostic Interview and the WHO Disability Assessment Schedule. General linear models were used to estimate individual-level effects. Societal-level effects were estimated with the population attributable risk proportion which takes into account prevalence and comorbidity of disorders. RESULTS: The conditions with the strongest individual -level effects were major depression, post-traumatic stress disorder and bipolar disorder. The strongest societal-level effects were associated with major depression, pain, insomnia and cardiovascular conditions. CONCLUSION: The findings suggest the importance of investing in mental health expenditure to a level commensurate with the costs to society of mental health disorders.

Economic evaluation in the field of mental health: conceptual basis

Objective: Technological advances in medicine have given rise to a dilemma concerning the use of new health technologies in a context of limited financial resources. In the field of psychiatry, health economic evaluation is a recent method that can assist in choosing interventions with different cost and/or effectiveness for specific populations or conditions. This article introduces clinicians to the fundamental concepts required for critical assessment of health economic evaluations. Methods: The authors conducted a review with systematic methods to assess the essential theoretical framework of health economic evaluation and mental health in Brazil through textbooks and studies indexed in the PubMed, Cochrane Central, LILACS, NHS CRD, and REBRATS databases. A total of 334 studies were found using the specified terms (MeSH - Mental Health AND Economic, Medical) and filters (Brazil AND Humans); however, only five Brazilian economic evaluations were found. Results and conclusions: Economic evaluation studies are growing exponentially in the medical literature. Publications focusing on health economics as applied to psychiatry are increasingly common, but Brazilian data are still very incipient. In a country where financial resources are so scarce, economic analyses are necessary to ensure better use of public resources and wider population access to effective health technologies. .

La incapacidad temporal en España por algunas enfermedades psiquiátricas. (Trastornos esquizofrénicos, trastorno bipolar y trastornos ansiosos, depresivos y adaptativos) / Sick leaves caused by psychiatric diseases in Spain during 2011

Background: Psychiatric and mood disorders may hamper the efficiency of workers and cause absenteeism. Material and Methods: Revision of sick leaves related to schizophrenia, bipolar diseases, anxiety, depression and adaptive disorders that were granted in Spain in the period January- December 2011. The mean number of days off work for each disease and the costs per each labor day lost were calculated. Results: The total number of labor days lost for schizophrenia, bipolar diseases and mood disorders were 72,831; 899,107 and 3,666,055 days, respectively. The mean duration of sick leaves for the same diagnoses were 84; 100 and 64 days/year respectively. The total indirect costs of sick leaves for psychiatric diseases during 2011 were € 100 million approximately, corresponding to 4% of costs for all diseases. Conclusions: The high costs of absenteeism derived from psychiatric diseases should prompt measures to promote a better adaptation to work environments of people suffering these ailments.

Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study / Benefícios auxílio-doença devido a transtornos mentais no Brasil: associações em um estudo de base-populacional

This study aims to determine the prevalence and duration of sickness benefit claims due to mental disorders and their association with economic activity, sex, age, work-relatedness and income replacement using a population-based study of sickness benefit claims (> 15 days) due to mental disorders in Brazil carried out in 2008. The prevalence of mental disorders was 45.1 claims per 10,000 workers. Prevalence and duration of sickness benefit claims due to mental disorder were higher and longer in workers aged over 40 years. Prevalence of claims was 73% higher in women but duration of sickness benefit claims was longer in men. Prevalence rates for claims differed widely according to economic activity, with sewage, residential care and programming and broadcasting activities showing the highest rates. Claims were deemed to be work-related in 8.5% of cases with mental disorder showing low work-relatedness in Brazil. A wide variation of prevalence and duration between age, economic activity and work-relatedness was observed, suggesting that working conditions are a more important factor in mental disorder work disability than previously assumed.

Este estudo visa determinar a prevalência e a duração dos benefícios auxílio-doença devidos à doença mental e sua associação com atividade econômica, sexo, idade, relação com o trabalho, e reposição salarial. Estudaram-se os benefícios auxílio-doença por doença mental concedidos no Brasil em 2008. Analisou-se a associação entre benefícios auxílio-doença e sexo, idade, atividade econômica, relação com o trabalho e reposição salarial. Doença mental representou 10.7% do total de benefícios auxílio-doença em 2008, com prevalência de 45,1/10 mil trabalhadores. A prevalência e a duração dos benefícios auxílio-doença foram maiores e mais longos entre trabalhadores ≥ 40 anos de idade; mulheres tiveram prevalência 73% maior do que homens, mas com menor duração. As prevalências variaram amplamente entre atividade econômica, sendo esgoto, saúde da família e rádio e televisão aquelas com as maiores taxas. A relação com o trabalho foi caracterizada em 8,5% dos benefícios. Doença mental mostrou baixa relação com o trabalho, mas com ampla variação na prevalência e na duração dos benefícios auxílio-doença em relação à idade, sexo e atividade econômica, sugerindo que as condições de trabalho constituem fator mais importante para incapacidade do que o presumido.

Política de Saúde Mental no Brasil: evolução do gasto federal entre 2001 e 2009 / Mental Health Policy in Brazil: federal expenditure evolution between 2001 and 2009 / Política de Salud Mental en Brasil: evolución del gasto federal entre 2001 y 2009

OBJETIVO: Analisar a evolução de estimativas do gasto federal com o Programa de Saúde Mental desde a promulgação da lei nacional de saúde mental. MÉTODOS: O gasto federal total do Programa de Saúde Mental e seus componentes de gastos hospitalares e extra-hospitalares foi estimado a partir de 21 categorias de gastos de 2001 a 2009. Os valores dos gastos foram atualizados para valores em reais de 2009 por meio da aplicação do Índice de Preços ao Consumidor Amplo. Foi calculado o valor per capita/ano do gasto federal em saúde mental. RESULTADOS: Observou-se o crescimento real de 51,3 por cento do gasto em saúde mental no período. A desagregação do gasto revelou aumento expressivo do valor extra-hospitalar (404,2 por cento) e decréscimo do hospitalar (-39,5 por cento). O gasto per capita teve crescimento real menor, embora expressivo (36,2 por cento). A série histórica do gasto per capita desagregado mostrou que em 2006, pela primeira vez, o gasto extra-hospitalar foi maior que o hospitalar. O valor per capita extra-hospitalar teve o crescimento real de 354,0 por cento; o valor per capita hospitalar decresceu 45,5 por cento. CONCLUSÕES: Houve crescimento real dos recursos federais investidos em saúde mental entre 2001 e 2009 e investimento expressivo nas ações extra-hospitalares. Houve inversão no direcionamento dos recursos, a partir de 2006, na direção dos serviços comunitários. O componente do financiamento teve papel crucial como indutor da mudança de modelo de atenção em saúde mental. O desafio para os próximos anos é sustentar e aumentar os recursos para a saúde mental num contexto de desfinanciamento do Sistema Único de Saúde.

OBJECTIVE: To analyze the evolution of estimates of federal spending in Brazil's Mental Health Program since the promulgation of the national mental health law. METHODS: The total federal outlay of the Mental Health Program and its components of hospital and extra-hospital expenses were estimated based on 21 expenses categories from 2001 to 2009. The expenses amount was updated to values in reais of 2009 by means of the use of the Índice de Preços ao Consumidor Amplo (Broad Consumer Price Index). The per capita/year value of the federal expenditure on mental health was calculated. RESULTS: The outlay on mental health rose 51.3 percent in the period. The breakdown of the expenditures revealed a significant increase in the extra-hospital value (404.2 percent) and a decrease in the hospital one (-39.5 percent). The per capita expenditures had a lower, but still significant, growth (36.2 percent). The historical series of the disaggregated per capita expenditures showed that in 2006, for the first time, the extra-hospital expenditure was higher than the hospital one. The extra-hospital per capita value increased by 354.0 percent; the per capita hospital value decreased by 45.5 percent. CONCLUSIONS: There was a significant increase in federal outlay on mental health between 2001 and 2009 and an expressive investment in extra-hospital actions. From 2006 onwards, resources allocation was shifted towards community services. The funding component played a crucial role as the inducer of the change of the mental health care model. The challenge for the coming years is maintaining and increasing the resources for mental health in a context of underfunding of the National Health System.

OBJETIVO: Analizar la evolución de estimaciones de gasto federal con el Programa de Salud Mental desde la promulgación de la ley nacional de salud mental. MÉTODOS: El gasto federal total del Programa de Salud Mental en Brasil y sus componentes de gastos hospitalarios y extra-hospitalarios fue estimado a partir de 21 categorías de gastos de 2001 a 2009. Los valores de los gastos fueron actualizados en valores en reales de 2009 por medio de la aplicación del Índice de Precios al Consumidor Amplio. Se calculó el valor per capita/año del gasto federal en salud mental. RESULTADOS: Se observó el crecimiento real de 51,3 por ciento del gasto en salud mental en el período. La separación del gasto reveló aumento expresivo del valor extra-hospitalario (404,2 por ciento) y disminución del hospitalario (-39,5 por ciento). El gasto per capita tuvo un crecimiento real menor, aunque expresivo (36,2 por ciento). La serie histórica del gasto per capita separado mostró que en 2006, por primera vez, el gasto extra-hospitalario fue mayor que el hospitalario. El valor per capita extra-hospitalario tuvo un crecimiento real de 354,0 por ciento; el valor per capita hospitalario disminuyó 45,5 por ciento. CONCLUSIONES: hubo crecimiento real de los recursos federales invertidos en salud mental entre 2001 y 2009 e inversión expresiva en las acciones extra-hospitalarias. hubo inversión en el direccionamiento de los recursos, a partir de 2006, en los servicios comunitarios. el componente del financiamiento tuvo papel crucial como inductor del cambio de modelo de atención en salud mental. el desafío para los próximos años es sustentar y aumentar los recursos para la salud mental en el contexto del desfinanciamiento del sistema único de salud.

Concession of sickness benefit to social security beneficiaries due to mental disorders / Chance de deferimento de requerimentos de auxílio-doença a segurados do Instituto Nacional do Seguro Social com transtornos mentais

OBJECTIVE: Assess the odds of having an initial claim for statutory sickness benefit awarded (ascribed to mental disorder as the main registered diagnosis), in relation to institutional, clinical, sociodemographic and welfare factors in Juiz de Fora-MG, Brazil. METHOD: Two models of logistic regression, taking into account the categories of the medical examiners, were built with the aim of characterizing the relative weight of several variables affecting the medical conclusion. RESULTS: The factors more strongly related to an award of benefit were claimants assessed by a physician without a specialization in psychiatry; with a diagnosis of psychosis; up to 29 years of age; with other non-psychiatric (musculoskeletal and cardiovascular) co-morbidities; registered with the national insurance system as employed; and male. DISCUSSION: In both models, examiners with a specialization in psychiatry were associated with a lower likelihood of award of benefit. This suggests that examinations undertaken by doctors having a specialty related to the diagnosis supporting the sickness benefit claim are stricter than those undertaken by non-specialists. CONCLUSION: The results suggest that benefit award odds were associated with the specialty of the examiner, medical diagnosis, age, gender and claimant category.

OBJETIVO: Avaliar a chance de deferimento em relação a fatores institucionais, clínicos, sociodemográficos e previdenciários em exames periciais iniciais de requerentes de auxílio-doença com registro de algum transtorno mental como diagnóstico principal em Juiz de Fora-MG. MÉTODO: Considerando as categorias de peritos médicos avaliadores, foram construídos dois modelos de regressão logística buscando caracterizar o peso relativo de diversas variáveis sobre a conclusão médico-pericial. RESULTADOS: Os fatores que se mostraram fortemente associados a maior chance de deferimento foram: segurado avaliado por perito médico sem especialidade em psiquiatria; com diagnóstico de psicoses; na faixa etária de até 29 anos de idade; com outras comorbidades clínicas que não as psiquiátricas, osteomusculares e cardiovasculares; vinculado ao INSS como empregado; e do sexo masculino. DISCUSSÃO: Nos dois modelos estudados, os peritos médicos especialistas em psiquiatria se associaram a menor chance de deferimento. Isto sugere que profissionais especializados na área relativa ao diagnóstico dos segurados sejam mais rigorosos em suas avaliações periciais que os peritos não especialistas. CONCLUSÃO: Os resultados sugerem que a chance de deferimento esteve associada à especialidade do perito médico examinador, ao diagnóstico, idade, sexo e categoria de segurado.

Carga del enfermar psíquico, barreras y brechas en la atención de Salud Mental en Chile / Burden of phychiatric diseases in Chile

Chile has one of the highest disease burdens caused by neuropsychiatric illnesses in the world, according to WHO, reaching to 31 percent- Major depression and alcohol use disorders are ranked first and second in attributed disability among adults. Nearly one-third of the population has had a psychiatric disorder in their lifetime, and 22.2 percent in the past year. Anxierty disorders are the most prevalent conditions, followed by major depression and alcohol abuse. Currently, mental health accounts for 2.3 percent) of the health care budget, which is less than some neighboring countries. The availability of 1.3 psychiatric beds per 10,000 inhabitants, is less than the mean of lower-income countries. Moreover, 81 percent are for chronic rather than acute care. Chile has 4.0 psychiatrist per 100,000 inhabitants, which is lower than other countries in Latin America. Only 38.5 percent of those patients with a psychiatric diagnosis receive any kind of mental health care, whether from a specialist or primary care. There is a perception among lay persons, that psychiatric treatments lack efficacy, despite evidence demonstrating the contrary. Not addressing the treament gap in mental health has serious public health implications.

Psychiatric epidemiology in India.

Epidemiological studies report prevalence rates for psychiatric disorders from 9.5 to 370/1000 populations in India. This review critically evaluates the prevalence rate of mental disorders as reported in Indian epidemiological studies. Extensive search of PubMed, NeuroMed and MEDLARS using search terms "psychiatry" and "epidemiology" was done. Manual search of literature was also done. Retrieved articles were systematically selected using inclusion and exclusion criteria. Only sixteen prevalence studies fulfilled the study criteria. Most of the epidemiological studies done in India neglected anxiety disorders, substance dependence disorders, co-morbidity and dual diagnosis. The use of poor sensitive screening instruments, single informant and systematic underreporting has added to the discrepancy in the prevalence rate. The prevalence of mental disorders reported in epidemiological surveys can be considered lower estimates rather than accurate reflections of the true prevalence in the population. Researchers have focused on broad non-specific, non-modifiable risk factors, such as age, gender and social class. Future research focused on the general population, longitudinal (prospective), multi-centre, co-morbid studies, assessment of disability, functioning, family burden and quality of life studies involving a clinical service providing approach, is required.

Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil

OBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41 percent (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5 percent of the budget in 1995 and 49 percent in 2005, and the expenses with community services and medication have increased 15 percent each. As a whole, the expenses in mental health decreased by 26.7 percent (2.66 to 1.95 US$ per capita). CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged.

OBJETIVO: Investigar o desenvolvimento da infra-estrutura de serviço de saúde mental e do seu financiamento no Brasil. MÉTODO: Os dados sobre número de leitos, centros comunitários de saúde mental, profissionais de saúde mental e custos, no período de 1995 a 2005, foram coletados no sítio de internet de livre acesso do DATASUS. RESULTADOS: Em 10 anos, houve uma redução de 41 por cento no número de leitos psiquiátricos (5,4 a 3,2 por 10.000 habitantes), enquanto os serviços comunitários aumentaram nove vezes (0,004 to 0,037 por 10.000). Psicólogos e assistentes sociais foram contratados três e duas vezes mais do que psiquiatras, respectivamente. As internações psiquiátricas representavam 95,5 por cento do total de gastos com saúde mental em 1995, passando para 49 por cento em 2005. Por outro lado, as despesas com serviços comunitários e medicação aumentaram 15 por cento cada. Em relação ao total de gastos, as despesas com saúde mental diminuíram 26,7 por cento (2,66 a 1,95 US$ per capita). CONCLUSÃO: Existe um claro movimento de transformação do modelo dos cuidados psiquiátricos no Brasil, passando do hospital psiquiátrico para os serviços comunitários. O sistema tem disponibilizado um maior número de modalidades de tratamento, incluindo o acesso gratuito aos psicotrópicos. A cobertura dos serviços comunitários, entretanto, ainda é precária e a reforma da assistência psiquiátrica não foi acompanhada pelo aumento do investimento público em saúde mental. A reforma psiquiátrica não é uma estratégia de redução de custos; ela necessariamente implica no aumento de investimentos se os países decidirem melhorar os cuidados em saúde para aqueles em desvantagens.

Impacto economico em familias de pessoas com transtornos mentais graves e com transtornos devido ao uso de substancias psicoativas / Economic impact on families of people with severe mental illness and substance use disorder

Em diversos paises desenvolvidos o transtorno por uso de substancias psicoativas e um problema relativamente comum em pacientes com transtornos mentais graves, e esta frequentemente associado a efeitos negativos, como aumento de agressividade, criminalidade, internacoes, infeccoes por HIV e falta de moradia, acarretando um custo adicional a familia e a sociedade. O objetivo dessa revisao e apresentar as evidencias existentes sobre o impacto economico, em familias de pessoas com transtornos mentais graves e com...

Doenças do cérebro: prioridade de política de saúde pública no Brasil? / Brain diseases: priority of public health policy in Brazil?

Este artigo estima a freqüência relativa das doenças do cérebro no Brasil com base nas internaçöes em hospitais conveniados pelo INAMPS, declaraçöes de óbitos e benefícios. Demonstrou-se a importância dessas doenças no Sistema de Saúde, pois elas representam 8,2% de todos os pacientes internados e 19,0% dos custos hospitalares. Os grupos de doenças prevalentes säo (CID 009): CID 290-319 - Transtornos mentais; CID 430-438 - Doenças cerebrovasculares; CID 320-359 - Doenças do sistema nervoso; e CID 800-804/850-854 - Fratura de crânio e traumatismos intracranianos. Entre as doenças do sistema nervoso, as epilepsias (CID 345), Transtornos do Sistema Nervoso Periférico (CID 350-359) e Doenças Inflamatórias do Sistema Nervoso Central (CID 320-326) säo dominantes