Astute exploration of collective mental health events among the residents of elderly care homes.

Background & objective: Developing countries are presently witnessing a great burden of rapid aging followed by losing the social values of older adults due to age-related cognitive impairment as well as rising depression levels. This study was designed to assess the cognitive impairment and depression status combinedly among older adults in elderly care homes. Methods: It was a cross-sectional survey among randomly selected 200 older adults aged between 60 and 80 years residing in some old homes in Dhaka district, Bangladesh. Data were collected through face-to-face interviews while Cognitive function and level of depression were assessed by applying the Standardized Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS). Results: Among all the respondents, the majority (81.5%) were staying in old homes for 1-5 years. The majority (91.0%) had difficulties with vision, 40.7% had difficulties with hearing and 19.6% had difficulties moving around. The MMSE test revealed that 43% had moderate cognitive impairment, 36% had mild and 19.5% were found normal while more than half (56%) had severe depression. Significant cognitive impairment was found among the illiterate respondents who did not have any family care support. In addition, higher-educated respondents were found to have more severe depression (OR/p = 6.33/<0.01; 95% CI: 2.36-16.96). Furthermore, severely depressed respondents had more severe cognitive impairment (COR/p = 3.83/0.01; 95% CI: 1.66-8.83). Functional disabilities were also a greater concern for cognitive impairment and depression. Conclusion: An increasing number of old home residents are suffering from significant mental disorders while there is no mental health support in the elderly care homes in Bangladesh. Finally, there is a great need to develop packages and programs of mental health care for senior citizens and their caregivers residing in old homes, which can be scaled up across the country's mixed healthcare delivery system.

Salud Mental Colectiva y Determinación Social: Posibilidades Paradigmáticas / Collective Mental Healthand Social Determination: Paradigmatic Possibilities

En la presente revisión teórica exploro posibilidades para la construcción de un paradigma de salud mental colectiva. Lo hago tomando distancia de miradas positivistas, funcionalistas, bio-médicas e individualistas, y subrayando el rol fundamental de procesos de determinación social comprendidos de forma crítica, intercultural y transdisciplinaria. El procedimiento supuso una revisión exploratoria de fuentes tituladas “salud mental colectiva” (2016-2021) y la inclusión de publicaciones clave adicionales. Losresultados señalan la importancia de teorizar la salud mental de forma compleja y dialéctica, contextualizar ecológicamente los sufrimientos, accio-nar estrategias de bienestar y procurar reflexividad permanente en torno a la interculturalidad y las relaciones de poder. Las posibilidades exploradas resaltan el aporte esencial de la epide-miología crítica latinoamericana, en diálogo constante con otros valiosos saberes. Desde dicha construcción dialógica, un paradigma de salud mental colectiva emerge como unapotente al-ternativa para abordar sufrimientos mentales en el contexto de sistemas sociales que nos en-ferman. (AU)

In this theoretical review, I explore possibilities for the construction of a collective mental health paradigm. I conduct such review by distancing myself from positivist, functionalist, bi-omedical and individualist perspectives, while emphasizing the fundamental role of social de-termination processes conceived from a critical, intercultural and transdisciplinary stand-point. The procedure involved an exploratory review of sources entitled “collective mental health” (2016-2021) and the inclusion of additional key publications. Results indicate the im-portance of theorizing mental health in ways that are complex and dialectical; conducting an ecological contextualization of suffering; activating wellness strategies; and making perma-nent efforts towards reflexivity around interculturality and power relations. Explored possibil-ities highlight the essential contribution of Latin American critical epidemiology, in constant dialogue with other valuable knowledge. From such dialogic construction, a collective mental health paradigm emerges as a powerful alternative to address mental suffering in the context of social systems that make us ill. (AU)

Insurgências da parada gaúcha do orgulho louco: cartgrafando vidas na loucura / Insurgencies of the gaucho mad pride parade: mapping lives in madness

Insurgente! Parada Gaúcha do Orgulho Louco: o que é, o que é? Tem um dia especial para ser comemorado; circula pela cidade; envolve usuários, trabalhadores, gestores de saúde e assistência social, instituições de educação, coletivos e a população em geral; utiliza o corpo, a rua, a arte e a cultura; problematiza loucura e saúde mental; oferta espaços de diálogos, rodas de conversa e oficinas; apresenta uma multiplicidade de cores, de formas, de fantasias e chapéus. Essa pesquisa/indagação encontrará assento, ao longo das próximas linhas, visando aproximar realidade e teoria, tentando estabelecer relações mais orgânicas com o modo de produzir conhecimento científico sobre o campo da saúde mental coletiva, tomando como uma possível ponte para isso, a insurgência. A escolha do tema (loucura), do problema de pesquisa (insurgências na Parada), da metodologia (cartografia), dá pistas de que o movimento, na composição com a rua, oferece o (re)encontro com o corpo, a arte e a cultura, como dispositivos de produção de resistência a uma vida (pré)-escrita.

Insurgent! Gaucho Parade of Mad Pride: what is it, what is it? There is a special day to be celebrated; circulates around the city; involves users, workers, managers of health and social assistance, educational institutions, collectives and the population in general; it uses the body, the street, the art and the culture; problematizes madness and mental health; offer dialog spaces, conversation wheels and workshops; presents a multitude of colors, shapes, costumes and hats. Throughout the next few lines, this research will seek to bring reality and theory together, trying to establish more organic relations with the way of producing scientific knowledge about the field of collective mental health, taking as a possible bridge to this, the insurgency. The choice of the theme (insanity), the problem of research (insurgencies in Parade), the methodology (cartography), gives clues that the movement, in the composition with the street, offers a (re)discover with body, art and culture, as devices of production of resistance to a prescribed life.

Das reformas sanitária e psiquiátrica a educação em saúde mental: saber técnico e compromisso ético com a saúde mental coletiva

Este trabalho coteja as reformas sanitária e psiquiátrica vividas no Brasil e que enfocaram uma importante mudança no modelo tecnoassistencial em saúde mental, introduzindo, no caso dos transtornos mentais e sofrimento psíquico, as abordagens da reabilitação e da atenção psicossocial. Considerada a perspectiva de “mudança”, pode-se dizer, no mínimo, da prioridade à reversão dos paradigmas biomédico e manicomial em favor dos paradigmas da atenção básica e da saúde mental coletiva. Um projeto de mudança não se faz sem correspondente processo educativo e formativo, em que pese a resistência à mudança nos setores hegemonizados pela “racionalidade científica moderna” ou “razão médica” que dão guarida aos paradigmas sob necessária mutação...

This paper checks the sanitary and psychiatric reforms lived in Brazil and which have put focus on an important change in the mental health tecnoassistential model, introducing, in the case of mental disorders and psychic suffering, the approaches of rehabilitation and psychosocial care. Considering the outlook of "change", is possible to say, at least, about the priority of the reversion of the biomedical and asylum paradigms in favor of the basic attention and collective mental health paradigms...

Sem palavras na ponta da língua: saúde mental coletiva, pedagogia e gagueira / No words by heart: mental health conference, pedagogy and stuttering

Este artigo reescreve um trabalho de conclusão de residência multiprofissional em saúde mental coletiva. Escrita em narrativas de percurso, pretende, em processos de desmanches de palavras, provocar um gaguejar da língua em saúde mental coletiva. Trabalho feito em muitas mãos, de encontros com Roland Barthes e sua abordagem acerca da teatralização da língua, com Manoel de Barros a escovar palavras para ouvir seu primeiro sussurrar e Jorge Larosa com sua ideia de sujeitos enquanto viventes de palavras. Apresenta, sem palavras na ponta da língua, a pedagogia, a saúde coletiva e seus gaguejares. Com palavras a titubear trajetos em estar residente, perguntar: qual o lugar da pedagogia na saúde mental coletiva? Em atos de saúde, a pedagogia chega nova sem ser novidade: ela chega entre espaços de não estar. De pensamentos nômades, uma pedagogia em saúde mental coletiva pode emergir de práticas mestiças, do gaguejar de palavras, do trincar da língua.

This article is a new point of view of the work developed in the collective mental health residency. The route narratives were used to show miscarriages processes of words, and to crack collective mental health concepts. This paper was wrote by many hands as well as inspirations as Roland Barthes' dramatizing knowledge, Manoel de Barros' unpretentious poetry and Jorge Larosa's idea about subject, which is understood as living word. Even without completeness, it dares to show pedagogy, public health and their cracks. There is some hesitation, even after cross the path, but the question should be asked: what place has the Pedagogy in Collective Mental Health? The Pedagogy was transformed, but the usual health view can't see anything new, there is no assurance about the place in each one shall occupy. However, crossbred practices, stutter and cracks might bring out a peregrine thought to Collective Mental Health.