Mobile care service for psychiatric urgencies and emergencies: perception of nursing workers.

OBJECTIVE: To understand how the nursing staff perceives the care provided to people in situations of psychiatric urgencies and emergencies in the Mobile Emergency Care Service (SAMU - Serviço de Atendimento Móvel de Urgência). METHOD: Descriptive and qualitative study conducted in the Northeast region of Brazil with 34 of the SAMU nursing workers. Data were obtained by semi-structured interviews and processed by the Thematic Analysis. RESULTS: The analysis of interviews allowed the identification of three categories: mechanical practice, need for qualification and (de)humanization of care. The results showed that the care offered to users in psychiatric urgency or emergency situations is based on mechanistic and specific actions. FINAL CONSIDERATIONS: Nursing workers perceive that the care for people in situations of psychiatric urgency and emergency in SAMU is mainly based on physical and chemical containment measures, performing a little resolute and dehumanized care and raising the need for professional qualification.

Mobile care service for psychiatric urgencies and emergencies: perception of nursing workers / Atención móvil de urgencias y emergencias psiquiátricas: percepción de los trabajadores de enfermería / Atendimento móvel às urgências e emergências psiquiátricas: percepção de trabalhadores de enfermagem

ABSTRACT Objective: To understand how the nursing staff perceives the care provided to people in situations of psychiatric urgencies and emergencies in the Mobile Emergency Care Service (SAMU - Serviço de Atendimento Móvel de Urgência). Method: Descriptive and qualitative study conducted in the Northeast region of Brazil with 34 of the SAMU nursing workers. Data were obtained by semi-structured interviews and processed by the Thematic Analysis. Results: The analysis of interviews allowed the identification of three categories: mechanical practice, need for qualification and (de)humanization of care. The results showed that the care offered to users in psychiatric urgency or emergency situations is based on mechanistic and specific actions. Final considerations: Nursing workers perceive that the care for people in situations of psychiatric urgency and emergency in SAMU is mainly based on physical and chemical containment measures, performing a little resolute and dehumanized care and raising the need for professional qualification.

RESUMEN Objetivo: Comprender cómo los trabajadores de enfermería perciben la atención ofertada a personas en situaciones de urgencias y emergencias psiquiátricas en el Servicio de Atención Móvil de Emergencia (SAMU). Método: Estudio descriptivo, de tipo cualitativo, realizado en la región Noreste de Brasil con 34 trabajadores de enfermería del SAMU. Los datos se obtuvieron por medio de entrevista semiestructurada, y se los aplicaron un Análisis Temático. Resultados: El análisis de las entrevistas permitió identificar tres categorías: la práctica mecanicista, la necesidad de calificación y la (des)humanización de la atención. Fue posible identificar que la atención ofertada a los usuarios en situaciones de urgencia o de emergencia psiquiátrica se basa en acciones mecanicistas y puntuales. Consideraciones finales: Los trabajadores de enfermería perciben que la atención ofertada por SAMU a personas en urgencia y emergencia psiquiátrica se basa principalmente en medidas de contención física y química, lo que resulta en una atención poco determinante y deshumanizada, además de apuntar para la necesidad de calificación profesional.

RESUMO Objetivo: Compreender como os trabalhadores de enfermagem percebem o cuidado às pessoas em situações de urgências e emergências psiquiátricas no Serviço de Atendimento Móvel de Urgência (SAMU). Método: Estudo descritivo, de natureza qualitativa, realizado no Nordeste do Brasil com 34 trabalhadores de enfermagem do SAMU. Os dados foram obtidos por meio de entrevista semiestruturada e tratados pela Análise Temática. Resultados: A análise das entrevistas permitiu a identificação de três categorias: prática mecanicista, necessidade de qualificação e (des)humanização da assistência. Foi possível identificar que o cuidado ofertado aos usuários em situação de urgência ou emergência psiquiátrica é baseado em ações mecanicistas e pontuais. Considerações finais: Os trabalhadores de enfermagem percebem que o cuidado às pessoas em situações de urgências e emergências psiquiátricas no SAMU é baseado principalmente em medidas de contenção física e química, tornando a assistência pouco resolutiva e desumanizada e suscitando a necessidade de qualificação profissional.

Impact of Mobile Crisis Services on Emergency Department Use Among Youths With Behavioral Health Service Needs.

OBJECTIVE: Youths are using emergency departments (EDs) for behavioral health services in record numbers, even though EDs are suboptimal settings for service delivery. In this article, the authors evaluated a mobile crisis service intervention implemented in Connecticut with the aim of examining whether the intervention was associated with reduced behavioral health ED use among those in need of services. METHODS: The authors examined two cohorts of youths: 2,532 youths who used mobile crisis services and a comparison sample of 3,961 youths who used behavioral health ED services (but not mobile crisis services) during the same fiscal year. Propensity scores were created to balance the two groups, and outcome analyses were used to examine subsequent ED use (any behavioral health ED admissions and number of behavioral health ED admissions) in an 18-month follow-up period. RESULTS: A pooled odds ratio of 0.75 (95% confidence interval [CI]=0.66-0.84) indicated that youths who received mobile crisis services had a significant reduction in odds of a subsequent behavioral health ED visit compared with youths in the comparison sample. The comparable result for the continuous outcome of number of behavioral health ED visits yielded an incidence risk ratio of 0.78 (95% CI=0.71-0.87). CONCLUSIONS: Using comparison groups, the authors provided evidence suggesting that community-based mobile crisis services, such as Mobile Crisis, reduce ED use among youths with behavioral health service needs. Replication in other years and locations is needed. Nevertheless, these results are quite promising in light of current trends in ED use.

Validity and reliability of a novel Color-Risk Psychiatric Triage in a psychiatric emergency department.

BACKGROUND: Classification of Psychiatric Emergency Presentations (PEP) is not sufficiently clear due to their inherent high inter-subjectivity and lack of validated triage instruments. In order to improve current classification of psychiatric emergency presentations (PEP) at Emergency Departments, we implemented and validated the Color-Risk Psychiatric Triage (CRPT), an instrument for classifying PEP risk by sorting one to five color/risk levels and one to thirty-two possible conditions arranged by risk. METHODS: Users who visited the Emergency Department (ED) of a Mexican psychiatric hospital from Dec 1st, 2008 to Dec 1st, 2009 were included. One CRPT was assessed by an ED psychiatrist to each patient upon their arrival to ED. Some patients were randomly assessed simultaneously with an additional CRPT and a Crisis and Triage Rating Scale (CTRS) to test validity and reliability of the CRPT. RESULTS: A total of 7,631 CRPT assessments were included. The majority of PEP were non-urgent (74.28 %). For the validation phase n = 158 patients were included. CRPT score showed higher concurrent validity than CRPT color/risk. CRPT level/risk and score showed highest concurrent validity within dangerousness domain of CTRS (r = 0.703, p < 0.0001). CRPT and CTRS scores showed similar predictive validity (p < 0.0001). High intraclass correlation coefficient (0.982) and Cohen's Kappa (0.89) were observed for CRPT score (r = 0.982, p < 0.0001). CONCLUSIONS: CRPT appeared to be a useful instrument for PEP classification due to its concurrent validity, predictive validity and reliability. CRPT score showed higher correlations than the CRPT color/risk. The five levels of risk provided by the CRPT appear to represent a simple and specific method for classifying PEP. This approach considers actual or potential risk, rather than severity, as the main factor for sorting PEP, which improves upon the current approach to emergency classification that is mainly based on the criterion of severity. Regardless of the triage procedure, emergency assessments should no longer classify PEP as "not real emergencies."

An integrated program to train local health care providers to meet post-disaster mental health needs

This paper describes a post-disaster mental health training program developed by the International Section of the Department of Psychiatry at Dalhousie University (Halifax, Canada) and delivered in Grenada after Hurricane Ivan struck the country in Septemeber 2004. This train-the-trainer program used an integrated community health model to help local health care providers develop the necessary skills for the identification and evidenced-based treatment of mental disorders occuring after a natural disaster. The approach also provided for ongoing sustainable mental health care delivered in the community setting, as advocated by the World Health Organization and the Pan American Health Organization. This approach is in contrast to the largely ineffective and costly vertical whole-population psychosocial counselling activities that have often been used in the Caribbean following natural disasters(AU)

La urgencia subjetiva / The subjective urgency

A través de tres casos clínicos se analiza tanto al sujeto de la urgencia como al analista y su función por medio de las siguientes variables: apremio del tiempo, caída de la función subjetiva, y necesidad de que la respuesta a dar sea producida por la vía del acto

Implicancias del paciente psiquiátrico en el Departamento de Urgencia: Consideraciones médico legales / Psychiatric patient implications in the Urgency Departament: Medical and legal considerations

Ante el paciente psiquiátrico, el médico del Departamento de Urgencia de un hospital de agudos puede enfrentarse a una situación difícil para él y para los demßs pacientes de la institución. Se intenta orientar a un médico no especializado que debe resolver, orientar y ubicar al paciente con una internación o con tratamiento ambulatorio

La urgencia subjetiva / The subjective urgency

A través de tres casos clínicos se analiza tanto al sujeto de la urgencia como al analista y su función por medio de las siguientes variables: apremio del tiempo, caída de la función subjetiva, y necesidad de que la respuesta a dar sea producida por la vía del acto

Implicancias del paciente psiquiátrico en el Departamento de Urgencia: Consideraciones médico legales / Psychiatric patient implications in the Urgency Departament: Medical and legal considerations

Ante el paciente psiquiátrico, el médico del Departamento de Urgencia de un hospital de agudos puede enfrentarse a una situación difícil para él y para los demßs pacientes de la institución. Se intenta orientar a un médico no especializado que debe resolver, orientar y ubicar al paciente con una internación o con tratamiento ambulatorio