Processo de integração das ações em saúde mental no cotidiano dos serviços de Belo Horizonte / Process of integration of actions in mental health in the daily life of the services of Belo Horizonte

O presente estudo tem como objetivo compreender, em uma perspectiva histórica, o processo de construção de saberes e práticas referentes à integração das ações de saúde mental nos Centros de Referência à Saúde Mental e nas Unidades Básicas de Saúde que compõem a Rede de Atenção Psicossocial de Belo Horizonte. Trata-se de uma pesquisa qualitativa, com abordagem da História Oral, na perspectiva teórica da Sociologia Compreensiva do Cotidiano, considerando a Reforma Psiquiátrica Brasileira. Participaram da pesquisa dezenove profissionais de saúde, que atuam por pelo menos dois anos, nos Centros de Referência em Saúde Mental e nas Unidades Básicas de Saúde. Foram utilizadas entrevistas como técnica de coleta de dados, que foram submetidas à técnica de Análise de Conteúdo Temática. Os resultados encontram-se organizados em quatro categorias: 1. Reforma psiquiátrica belo-Horizontina sob o olhar dos profissionais: traz as primeiras iniciativas reformistas e transição do cuidado realizado nos hospitais psiquiátricos para o cuidado realizado nos serviços de base comunitária e territorial, indicando quais saberes e práticas de integração foram percebidas nesse processo; 2. O louco e sua família: paciente estigmatizado e diferenciado, que trata da construção e desconstrução histórica e cultural acerca da pessoa em sofrimento mental e suas ações e rupturas que influenciam na integração entre os serviços. 3. A história construída no cotidiano dos profissionais de saúde, dividida em duas subcategorias: 3.1. O cuidado às pessoas em sofrimento psíquico e 3.2. Os furos da rede no cotidiano dos serviços de saúde, as quais evidenciam no cotidiano dos serviços estudados como vem se dando a construção do diálogo, comunicação e articulação para o cuidado em saúde mental e as lacunas percebidas nos serviços para a atenção integral e global à saúde mental e 4. Experiências cotidianas exitosas, que trata das realidades presentes na vivência diária dos profissionais, seus modos de fazer e operar para a garantia da integração de ações e assistência à saúde mental efetiva. Os resultados apontam para a dinamicidade presente nas relações entre os serviços que constituem a Rede de Atenção Psicossocial de Belo Horizonte e as várias facetas encontradas na assistência oferecida às pessoas em sofrimento psíquico. Ao final, diante de limites e desafios encontrados nessa trajetória, percebem-se caminhos possíveis para a efetivação de um trabalho em rede e que garanta cuidado qualificado, exercido na comunidade, com base territorial e práticas psicossociais.(AU)

The present study aimed to understand in a historical perspective, the process of building knowledge and practices regarding the integration of mental health actions in the Mental Health Reference Centers and the Basic Health Units that make up the Network of Psychosocial Care of Belo Horizonte. This is a qualitative research, with an Oral History approach, within Michel Maffesoli's Comprehensive Sociology, considering the Brazilian Psychiatric Reform. The participants were nineteen health professionals who worked for at least two years in the Reference Centers of Mental Health and Basic Health Units. Interviews were used as data collection technique, which were submitted to the Thematic Content Analysis technique. The results are organized into four categories:1.Psychiatric Reform in Belo Horizonte under the eyes of professionals: brings the first reformist initiatives and transition of care performed in psychiatric hospitals to the care performed at CERSAM and UBS, indicating which knowledge and integration practices were perceived in this process. 2. The madman and his family: stigmatized and differentiated patient that deals with the construction and historical and cultural deconstruction about the person in mental suffering and their actions and ruptures that influence the integration between the services; 3. The history constructed in the daily life of health professionals, divided into two subcategories: 3.1. Care for people in psychological distress and 3.2. The holes of the network in the daily life of the health services, which evidence in the daily life of the services studied how the construction of the dialogue, communication and articulation for the care in mental health and the perceived gaps in the services for the integral and global attention to the mental health and 4. Successful everyday experiences, that shows the present realities in the daily experience of professionals, their ways of doing and operating to guarantee the integration of actions and assistance to effective mental health. The results point to the dynamics present in the relations between the services that make up the Network of Psychosocial Care of Belo Horizonte and the various facets found in the assistance offered to people in psychological distress. In the end, faced with the limits and challenges encountered in this trajectory, one can perceive possible paths for the execution of a network and guarantee a qualified care, exercised in the community, with territorial basis and psychosocial practices.(AU)

Community Protection versus Individual Healing: Two Traditions in Community Mental Health.

This article identifies two major traditions that drive the mandate for a community mental health care system-community protection and individual healing. It discusses the historical antecedents of these two traditions and how these traditions relate to different visions of what the "common good" means. It then discusses how they both operate in the current US-based system, creating inherent conflicts and tensions, and gives specific examples from the personal and professional experiences of the authors. The article proposes ways to reduce the tension and discusses what sacrifices and compromises this resolution would entail for the US community mental health system. Copyright © 2017 John Wiley & Sons, Ltd.

"A fine new child": the Lafargue Mental Hygiene Clinic and Harlem's African American communities, 1946-1958.

In 1946, the Lafargue Mental Hygiene Clinic, a small outpatient facility run by volunteers, opened in Central Harlem. Lafargue lasted for almost thirteen years, providing the underserved black Harlemites with what might be later termed community mental health care. This article explores what the clinic meant to the African Americans who created, supported, and made use of its community-based services. While white humanitarianism often played a large role in creating such institutions, this clinic would not have existed without the help and support of both Harlem's black left and the increasingly activist African American church of the "long civil rights era." Not only did St. Philip's Church provide a physical home for the clinic, it also helped to integrate it into black Harlem, creating a patient community. The article concludes with a lengthy examination of these patients' clinical experiences. Relying upon patient case files, the article provides a unique snapshot of the psychologization of postwar American culture. Not only does the author detail the ways in which the largely working class patient community used this facility clinic, he also explores how the patients engaged with modern psychodynamic concepts in forming their own complex understandings of selfhood and mental health.

Regional collaboration in reconstruction of mental health services in Bosnia and Herzegovina.

The war in the former Yugoslavia between 1991 and 1995 destroyed the mainly hospital-based mental health care system in Bosnia and Herzegovina. This report summarizes the situation before and after the war and describes efforts to rebuild and reform mental health services under politically and economically challenging conditions. As a result of these efforts, there are now 39 multidisciplinary community mental health centers that are linked to primary care and that aim to provide prevention, treatment, and rehabilitation of mental disorders. The reform process has been supported by international initiatives and is now continuing in collaboration with other countries in South Eastern Europe.

Four decades of community mental health: a symphony in four movements.

The authors present a detailed chronological discussion of the evolution of community mental health care in the United States with emphasis on the period of the 40 years since the passage of the Community Mental Health Centers Construction Act of October 31, 1963.

The history of community mental health treatment and rehabilitation for persons with severe mental illness.

The authors review the evolution of the treatments for persons with severe mental illnesses over the past 40 years in three areas: pharmacological and other somatic treatments, psychosomatic treatments, and rehabilitation. Current treatments are based on a much stronger evidence base, are more patient-centered, and are more likely to target autonomy and recovery.

Psicología y salud comunitaria durante la transición democrática / Phychology and community health during the transition to democracy

Este trabajo analiza los discursos, modelos y prácticas profesionales de los psicólogos en la salud comunitaria en Madrid desde el final del franquismo hasta 1982, es decir en la etapa de la transición política democrática. Entre los primeros se analiza el discurso crítico de los estudiantes/primeros licenciados, el enfoque comunitario de los jóvenes profesionales y los comienzos del discurso corporativo. Respecto a los modelos se hace referencia a los modelos críticos denominados psicoanálisis y marxismo y psicología científica, siendo las prácticas profesionales más relevantes las referidas a la planificación familiar, a las experiencias de Psicología de barrios y salud (mental) comunitaria (integradas todas ellas posteriormente en los Centros Municipales y de Promoción de la Salud) y las Unidades del Síndrome Tóxico. Por último se reflexiona sobre la incorporación de nuevo discurso científico y profesional -la psicología en la salud comunitaria de Madrid- en relación con las demandas de cambio social y la salud como calidad de vida comunitaria, los discursos políticos críticos sobre la reforma de la sanidad, la busca de un nuevo rol social de los médicos y la 'ideologización' del discurso psiquiátrico (AU)

This study analyses the discourse, models and professional practice of psychologists in community health in Madrid from the end of the Franco era to 1982, that is, during the political transition to democracy. As regards the first of these, it analyses the critical discourse of students and young graduates, the community perspective of young professionals and the beginnings of corporative discourse. In the second case, the models discussed are the critical ones referred to as psychoanalysis and Marxism and scientific psychology. The most relevant aspects of professional practice referred to are family planning, Psychology's experiences in poor areas and the field of community (mental) health (later within the network of the Municipal Centres for Promotion of Health), and the Syndrome Toxic Units. Finally, there is a reflection upon the incorporation of a new type of scientific and professional discourse -psychology in community health in Madrid- in relation to the demands for social change and health as quality of community life, to critical political discourse on the reform of the health system, to the search for a new social role for doctors and to the 'ideologisation' of psychiatric discourse (AU)

Trends in the development of psychiatric services, 1844-1994.

Over the past 150 years, support for providing appropriate services for mentally ill persons has waxed and waned. In colonial America, mentally ill persons were institutionalized in jails or almshouses. In the 18th and 19th centuries, asylums constituted the primary psychiatric service. Only in the late 19th and early 20th centuries did alternatives to long-term hospitalization appear. The mental hygiene movement of the early 20th century and the community mental health centers movement of the 1960s and 1970s both increased the number of services and introduced new types of services. Today, however, despite hopeful signs of reduced public prejudice against mentally ill persons, a new "dark age" for support of psychiatric services may be dawning, as negative attitudes about mental illness continue to drive public policy.

The Mental Health Association and prevention: a history.

The history of the Mental Health Association's involvement in prevention is described. From its inception in 1909 the Association has played a key role in advocating for prevention. It contributed to the Child Guidance Center movement, the community mental health center movement, and helped focus the 1978 President's Commission on Mental Health on prevention. In recent years, it has served as the catalyst for the formation of a coalition of national organizations with an interest in prevention.