Psychiatric Experiments with "Community" Under Dictatorship and Authoritarianism: The Case of the Protected Commune Experience, 1980-1989.

In Chile, a long and oppressive military regime (1973-1990) dismantled emergent initiatives for the deinstitutionalisation of psychiatric care, imposing a neoliberal constitution that opened public services to market forces and limited the state's role in health and social care. After being associated with communism and socialism, community-based mental health work was banned, and socialist psychiatrists were silenced through torture or exile. However, some therapeutic initiatives persisted, such as the "Protected Commune" (PC) initiative within the El Peral psychiatric asylum. The PC attempted to mimic a real town inside the asylum's gated perimeter. It featured an ecumenical chapel, a school, and various "council" departments like recreation, education, waste, economy, and health. Paths received names, wards became districts, and patients and workers were assigned new, democratic roles, all while the authoritarian regime entirely controlled the "outside" world. The initiative ceased with the return of democracy in 1990. Deemed an eccentric and negligible episode, the PC is often seen as an interruption to the radical community-based experiences of the pre-dictatorial era. Drawing on archival research and oral history interviews with participants, this paper examines how the PC harnessed the notion of community to navigate the complex socio-political landscape of the dictatorship. Differing from established accounts of the political uses of psychiatry under authoritarianism, the study positions the PC as a prism for understanding the contradictory ways in which the idea of 'community' has been able to transcend radically opposed social and political regimes, becoming a core feature in the vocabulary of mental health reform, despite its ambiguities.

Moving psychiatric deinstitutionalization forward: A scoping review of barriers and facilitators.

Psychiatric deinstitutionalization (PDI) processes aim to transform long-term psychiatric care by closing or reducing psychiatric hospitals, reallocating beds, and establishing comprehensive community-based services for individuals with severe and persistent mental health difficulties. This scoping review explores the extensive literature on PDI, spanning decades, regions, socio-political contexts, and disciplines, to identify barriers and facilitators of PDI implementation, providing researchers and policymakers with a categorization of these factors. To identify barriers and facilitators, three electronic databases (Medline, CINAHL, and Sociological Abstracts) were searched, yielding 2,250 references. After screening and reviewing, 52 studies were included in the final analysis. Thematic synthesis was utilized to categorize the identified factors, responding to the review question. The analysis revealed that barriers to PDI include inadequate planning, funding, and leadership, limited knowledge, competing interests, insufficient community-based alternatives, and resistance from the workforce, community, and family/caregivers. In contrast, facilitators encompass careful planning, financing and coordination, available research and evidence, strong and sustained advocacy, comprehensive community services, and a well-trained workforce engaged in the process. Exogenous factors, such as conflict and humanitarian disasters, can also play a role in PDI processes. Implementing PDI requires a multifaceted strategy, strong leadership, diverse stakeholder participation, and long-term political and financial support. Understanding local needs and forces is crucial, and studying PDI necessitates methodological flexibility and sensitivity to contextual variation. At the same time, based on the development of the review itself, we identify four limitations in the literature, concerning "time," "location," "focus," and "voice." We call for a renewed research and advocacy agenda around this neglected aspect of contemporary global mental health policy is needed.

State of the Art of Participatory and User-led Research in Mental Health in Brazil: A Scoping Review.

Background: Participatory research denotes the engagement and meaningful involvement of the community of interest across multiple stages of investigation, from design to data collection, analysis, and publication. Traditionally, people with first-hand experience of psychiatric diagnoses, services users and those living with a psychosocial disability have been seen objects rather than agents of research and knowledge production. This, despite the ethical and practical benefits of their involvement. The state of the art of knowledge about participatory research in mental health Brazil is poorly understood outside of its local context. The purpose of this article was to conduct a scoping review of participatory and user-led research in mental health in Brazil. Findings: We identified 20 articles that met eligibility criteria. Participation in research was not treated as separate from participation in shaping mental health policy, driving care, or the broader right to fully participate in societal life and enjoy social and civil rights. Studies identified several obstacles to full participation, including the biomedical model, primacy of academic and scientific knowledge, and systemic barriers. Our extraction, charting, and synthesis yielded four themes: power, knowledge, autonomy, and empowerment. Implications of the work: Participation in this context must address the intersecting vulnerabilities experienced by those who are both Brazilian and labeled as having a mental illness. Participatory research and Global South leadership must foreground local epistemologies that can contribute to the global debate about participation and mental health research.

Erratum: Moving psychiatric deinstitutionalization forward: A scoping review of barriers and facilitators - CORRIGENDUM.

[This corrects the article DOI: 10.1017/gmh.2023.18.].

Public Policy Responses to Address the Mental Health Consequences of the COVID-19 Pandemic: Evidence From Chile.

Objectives: This paper reviews the mental health policies that have been implemented in Chile in response to the COVID-19 pandemic and the international context of countries' responses. Even before the start of the pandemic, there were significant barriers to access mental health services in Chile, coupled with a scenario of nationwide social unrest and protests that questioned the legitimacy of public institutions; now the rapidly worsening outbreaks of COVID-19 are exacerbating the pre-existing mental health crisis. Methods: We conducted a bibliometric and content analysis of the Chilean mental health public policies implemented during the COVID-19 pandemic and then compared these policies with international experiences and emerging scientific evidence on the mental health impact of pandemics. Results: Our analysis of the policies identifies five crucial points of action developed in Chile: (i) an established framework to address mental health in emergency and disaster situations; (ii) a timely COVID-19 Mental Health Action Plan; (iii) inclusion of mental health in the public health agenda; (iv) development of a presidential strategy during the pandemic for comprehensive mental health and well-being; and (v) emerging research assessing the mental health implications of COVID-19. Conclusions: In Chile, the public policy responses to address the mental health consequences of the COVID-19 pandemic has been characterized by the coordinated implementation of mental health plans, ranging from a health sectoral initiative to inter-agency and intersectoral efforts. However, it is imperative that increased funding is allocated to mental health, and efforts should be made to promote the participation of people with lived experiences and communities in the design and implementation of the proposed actions. This aspect could be of key importance to social peace and community recovery after the pandemic.

Addressing power asymmetries in global health: Imperatives in the wake of the COVID-19 pandemic.

Seye Abimbola and co-authors argue for a transformation in global health research and practice in the post-COVID-19 world.

What Does "Good" Community and Public Engagement Look Like? Developing Relationships With Community Members in Global Health Research.

Community and public engagement (CPE) is increasingly becoming a key component in global health research. The National Institute for Health Research (NIHR) is one of the leading funders in the UK of global health research and requires a robust CPE element in the research it funds, along with CPE monitoring and evaluation. But what does "good" CPE look like? And what factors facilitate or inhibit good CPE? Addressing these questions would help ensure clarity of expectations of award holders, and inform effective monitoring frameworks and the development of guidance. The work reported upon here builds on existing guidance and is a first step in trying to identify the key components of what "good" CPE looks like, which can be used for all approaches to global health research and in a range of different settings and contexts. This article draws on data collected as part of an evaluation of CPE by 53 NIHR-funded award holders to provide insights on CPE practice in global health research. This data was then debated, developed and refined by a group of researchers, CPE specialists and public contributors to explore what "good" CPE looks like, and the barriers and facilitators to good CPE. A key finding was the importance, for some research, of investing in and developing long term relationships with communities, perhaps beyond the life cycle of a project; this was regarded as crucial to the development of trust, addressing power differentials and ensuring the legacy of the research was of benefit to the community.

Del malestar a la depresión: dinámicas en la construcción del significado personal de la experiencia de la depresión / From Discomfort to Depression: Dynamics in Building Personal Meaning from the Depressive Experience

Resumen Objetivo: Comprender las dinámicas mediante las cuales los pacientes significan su experiencia de la depresión. Metodología: Se utilizó una metodología cualitativa, basada en la Teoría Fundamentada. Se realizaron entrevistas semiestructuradas a 10 pacientes diagnosticados de un trastorno del ánimo con episodio depresivo, por el que habían estado en tratamiento psicoterapéutico previamente. Las entrevistas fueron analizadas desde un enfoque descriptivo-relacional, para reconocer las principales unidades temáticas referidas por los participantes y luego identificar sus relaciones y significados subyacentes. Resultados: El significado de la experiencia de la depresión se reveló como un proceso denominado "Construcción subjetiva de la experiencia de la depresión", caracterizado por tres momentos. (1) "La experiencia de un malestar sin nombre"; (2) "Anclaje de la experiencia del paciente en la palabra depresión"; (3) "Apropiación de la experiencia de la depresión". Conclusión: la experiencia de la depresión se presenta como un proceso dinámico de interacción entre el malestar subjetivo y la construcción de significados asociados a él; transitando de una experiencia desconcertante observada en el cuerpo, el ánimo y/o lo conductual, hacia una experiencia elaborable discursivamente, a través de una referencia semántica (depresión) que integra los significados y origina un proceso de apropiación de lo que implica para cada individuo tener depresión o estar deprimido.

Abstract Objective: To understand the dynamics by which patients signify their depressive experience. Methodology: A qualitative methodology was used, based on the Grounded Theory. Semi-structured interviews were conducted with 10 patients diagnosed with a mood disorder with depressive episode, who had been in a psychotherapy treatment about it. The interviews were analyzed from a descriptive-relational approach, recognizing the main thematic units referred by the participants, and then identifying their relationships and underlying meanings. Results: The meaning of "depression" experience was revealed as a process, named "subjective construction of depression experience", characterized by three moments: (1) "The experience of an unnamed discomfort"; (2) "Anchoring the patient's experience in the word depression"; (3) "Appropriation of depression experience". Conclusion: The depressive experience is presented as a dynamic process of interaction between subjective discomfort and the construction of meanings associated to it. Transitioning from a disconcerting experience observed on their body, mood, and/or their behaviour, to something available to be elaborated discursively, through a semantic reference (depression) that integrates them, originates a process of appropriation about what it implies for each individual to be depressed or have depression.

[Variceal and non-variceal upper gastrointestinal bleeding. Analysis of 249 hospitalized patients]. / Hemorragia digestiva alta variceal y no variceal: mortalidad intrahospitalaria y características clínicas en un hospital universitario (2015-2017).

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is one of the main reasons of hospitalization due to gastrointestinal causes. Reported mortality rates range from 5 to 12%. AIM: To determine hospital mortality and associated risk factors in hospitalized patients with UGIB. To compare the clinical characteristics and outcomes of patients with variceal versus non-variceal UGIB. MATERIAL AND METHODS: Review of medical records of 249 patients (62% males) discharged with the diagnosis of UGIB at a clinical hospital between 2015 to 2017. Demographic and clinical characteristics and adverse clinical outcomes (surgery, length of hospital stay and in-hospital mortality) were recorded. A comparative analysis between patients with Variceal and Non-variceal UGIB was carried out. RESULTS: Seventy two percent of UGIB were non-variceal (peptic ulcer in 44%). Two patients required surgery (both died). Median of length of hospital stay was seven days (interquartile range (IQR) 4-13). Overall hospital mortality was 13 and 4% in variceal and non-variceal UGIB, respectively (p = 0.024). The variables associated with mortality were: red blood cell transfusion (odds ratio (OR): 18.7, p < 0.01), elevated creatinine on admission (OR: 3.30, p = 0.03) and variceal bleeding (OR: 3.23, p = 0.02). CONCLUSIONS: Hospital mortality of UGIB remains high, especially in variceal UGIB. Elevated creatinine levels on admission, the need of transfusion of red blood cells and variceal etiology are risk factors for mortality.

Hemorragia digestiva alta variceal y no variceal: mortalidad intrahospitalaria y características clínicas en un hospital universitario (2015-2017) / Variceal and non-variceal upper gastrointestinal bleeding. Analysis of 249 hospitalized patients

Background: Upper gastrointestinal bleeding (UGIB) is one of the main reasons of hospitalization due to gastrointestinal causes. Reported mortality rates range from 5 to 12%. Aim: To determine hospital mortality and associated risk factors in hospitalized patients with UGIB. To compare the clinical characteristics and outcomes of patients with variceal versus non-variceal UGIB. Material and Methods: Review of medical records of 249 patients (62% males) discharged with the diagnosis of UGIB at a clinical hospital between 2015 to 2017. Demographic and clinical characteristics and adverse clinical outcomes (surgery, length of hospital stay and in-hospital mortality) were recorded. A comparative analysis between patients with Variceal and Non-variceal UGIB was carried out. Results: Seventy two percent of UGIB were non-variceal (peptic ulcer in 44%). Two patients required surgery (both died). Median of length of hospital stay was seven days (interquartile range (IQR) 4-13). Overall hospital mortality was 13 and 4% in variceal and non-variceal UGIB, respectively (p = 0.024). The variables associated with mortality were: red blood cell transfusion (odds ratio (OR): 18.7, p < 0.01), elevated creatinine on admission (OR: 3.30, p = 0.03) and variceal bleeding (OR: 3.23, p = 0.02). Conclusions: Hospital mortality of UGIB remains high, especially in variceal UGIB. Elevated creatinine levels on admission, the need of transfusion of red blood cells and variceal etiology are risk factors for mortality.

Communities, health-care organizations and the contingencies and contradictions of engagement: A case study from Chile.

CONTEXT: Despite a growing interest in service-user involvement in mental health services, the interaction between health institutions and local groups is only beginning to receive attention, particularly in global south settings. OBJECTIVE: Looking at a participatory initiative in Chile, this study explores how, under unfavourable administrative conditions, health organizations approach and work with communities. METHODS: We interviewed policy-makers (5), local professionals (10), service users and community representatives (6) linked to a concrete participatory initiative. Participant observation in relevant meetings helped to enrich the interpretations. Thematic analysis was applied to interview transcripts and field notes. FINDINGS: The findings present a sequence of actions starting with the creation of a network of community-based groups. A set of problems ensued, related to the group's diversity, internal representation, decision-making and funding processes. In response, processionals implemented simultaneously bureaucratic and democratic adjustments, developing a vision of community that ignored the particularities-including the motivations-of local groups. DISCUSSION AND CONCLUSION: Based on these findings, we argue that participatory initiatives should be studied as on-going achievements shaped by broad policy orientations and local configurations of interest. In the process, they produce ad hoc forms of knowledge and visions of community that provide orientation to the agents involved.

"No hay salud mental sin justicia social": desigualdades, determinantes sociales y salud mental en Chile / "No mental health without social justice": inequalities, social determinants and mental health in Chile

Las desigualdades en las condiciones de vida impactan negativamente sobre la salud mental de las personas y comunidades. Este artículo tiene por objetivo describir algunas de las principales líneas de investigación y reflexión en torno a la relación entre desigualdad y salud mental. Más que una revisión sistemática, se trata de una discusión orientada a contribuir al debate público en torno a las dimensiones materiales, simbólicas y subjetivas de la desigualdad, mencionando algunos mecanismos que permiten comprender su relación con la salud mental. Entre estas dimensiones abordamos las desigualdades de ingreso y de género, además de otras que han recibido menor atención en los estudios nacionales e internacionales: las desigualdades en la participación, en la interacción cotidiana, y las desigualdades socio-territoriales y en el uso del tiempo. Finalmente, mencionamos algunas limitaciones teóricas de la investigación tradicional sobre desigualdad en salud y sugerimos potenciales líneas de investigación que pueden orientar los estudios en torno a desigualdades y salud mental

[Helicobacter pylori infection detected during upper gastrointestinal endoscopy]. / Disminución en la frecuencia de infección por Helicobacter pylori en endoscopías digestivas altas.

BACKGROUND: Helicobacter pylori (HP) is the most widespread chronic human infection worldwide and the most important pathogenic factor of gastric cancer. The calculated prevalence at the Clinical Hospital of the University of Chile from 2002 to 2005 was 44.9%. AIM: To determine the current prevalence of HP in patients undergoing an upper gastrointestinal endoscopy (UGI) and analyze its distribution according to age and endoscopic findings. MATERIAL AND METHODS: We reviewed 3.433 UGI performed during the year 2015, selecting those in which rapid urease test (RUT) was done. A positive RUT or a positive gastric biopsy (GB) were considered as HP infection. RESULTS: RUT was done in 1862 UGI (55%) performed in patients aged 51 ± 17 years, (66% women). In 23% of these endoscopies, the RUT was positive. A GB was obtained 43% of endoscopies and 30% were positive for HP. In 105 patients the RUT was negative and the GB positive (rendering a 19.5% false negative rate). HP was detected by RUT and GB in 29% of endoscopies. The highest prevalence of infection (38.1%) was found between 40 and 49 years. HP infection had odds ratio of 4.24 for nodular gastropathy, 2.63 for gastric ulcer and 2.14 for duodenal ulcer (p < 0.05). CONCLUSIONS: HP prevalence in our center decreased significantly from 44.9% to 28.9% in 11 years. False negative RUT results may bias this finding. The use of proton pump inhibitors and antimicrobials that can interfere with the detection of HP should be registered to properly analyze the results of the RUT.

Correction to: Beyond Participation: Politics, Incommensurability and the Emergence of Mental Health Service Users' Activism in Chile.

The article, "Beyond Participation: Politics, Incommensurability and the Emergence of Mental Health Service Users' Activism in Chile", written by Cristian R. Montenegro, was originally published electronically on the publisher's internet portal (currently SpringerLink) on April 24, 2018 without open access.

Disminución en la frecuencia de infección por Helicobacter pylori en endoscopías digestivas altas / Helicobacter pylori infection detected during upper gastrointestinal endoscopy

Background: Helicobacter pylori (HP) is the most widespread chronic human infection worldwide and the most important pathogenic factor of gastric cancer. The calculated prevalence at the Clinical Hospital of the University of Chile from 2002 to 2005 was 44.9%. Aim: To determine the current prevalence of HP in patients undergoing an upper gastrointestinal endoscopy (UGI) and analyze its distribution according to age and endoscopic findings. Material and Methods: We reviewed 3.433 UGI performed during the year 2015, selecting those in which rapid urease test (RUT) was done. A positive RUT or a positive gastric biopsy (GB) were considered as HP infection. Results: RUT was done in 1862 UGI (55%) performed in patients aged 51 ± 17 years, (66% women). In 23% of these endoscopies, the RUT was positive. A GB was obtained 43% of endoscopies and 30% were positive for HP. In 105 patients the RUT was negative and the GB positive (rendering a 19.5% false negative rate). HP was detected by RUT and GB in 29% of endoscopies. The highest prevalence of infection (38.1%) was found between 40 and 49 years. HP infection had odds ratio of 4.24 for nodular gastropathy, 2.63 for gastric ulcer and 2.14 for duodenal ulcer (p < 0.05). Conclusions: HP prevalence in our center decreased significantly from 44.9% to 28.9% in 11 years. False negative RUT results may bias this finding. The use of proton pump inhibitors and antimicrobials that can interfere with the detection of HP should be registered to properly analyze the results of the RUT.