RESUMO
OBJECTIVE: Brief case histories are presented of people with schizophrenia treated in the Indonesian province of Aceh, where the author worked as a clinical psychologist for Medecines Sans Frontieres in 2005. Aceh was severely affected by the December 2004 tsunami, with significant destruction and loss of life. CONCLUSIONS: The case studies highlight the needs of patients and the current opportunities to establish more effective mental health services. The role of culture as a significant consideration and a possible barrier to accessing care is also discussed.
Assuntos
Antipsicóticos/uso terapêutico , Pessoal de Saúde/estatística & dados numéricos , Serviços de Saúde Mental/organização & administração , Esquizofrenia/tratamento farmacológico , Adulto , Área Programática de Saúde , Feminino , Acessibilidade aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , Indonésia/epidemiologia , Masculino , Serviços de Saúde Mental/normas , Pessoa de Meia-Idade , Psicologia Clínica/métodos , Restrição Física , Índice de Gravidade de Doença , Recursos HumanosRESUMO
OBJECTIVES: The aims of this study were to compare the rates of inpatient admission between a mobile community-based psychiatric emergency service and a hospital-based psychiatric emergency service, and to identify the clinical characteristics of consumers more likely to be admitted to hospital. METHODS: A retrospective, quasi-experimental design was used with a 3-month cohort of all face-to-face emergency service contacts presenting at the mobile and hospital-based sites. The Health of the Nation Outcome Scales and details of the outcome following initial assessment were completed for all contacts, and each group was compared for differences in clinical characteristics and outcome. RESULTS: Hospital-based emergency service contacts were found to be more than three times as likely to be admitted to a psychiatric inpatient unit when compared with those using a mobile community-based emergency service, regardless of their clinical characteristics. Those with severe mental health disorders such as schizophrenia and major affective disorder, and experiencing problems with aggression, non-accidental self-injury, hallucinations and delusions, problems with occupation, activities of daily living, and living conditions were more likely to be admitted to hospital. Nevertheless, after controlling for clinical characteristics, site of initial assessment accounted for a substantial proportion of the variance in decisions to admit to hospital. CONCLUSIONS: Emergency psychiatric services which include a mobile component and provide a specialized multidisciplinary team approach appear to be most effective in providing services in the least restrictive environment and avoiding hospitalization.
