Highly varying concepts and capacities of forensic mental health services across the European Union.

Introduction: There is wide variation in the processes, structures and treatment models for dealing with mentally disordered offenders across the European Union. There is a serious lack of data on population levels of need, national service capacities, or treatment outcome. This prevents us from comparing the different management and treatment approaches internationally and from identifying models of good practice and indeed what represents financial efficiency, in a sector that is universally needed. Methods: From March 2019 till January 2020 we surveyed forensic psychiatric experts from each European Union Member State on basic concepts, service capacities and indicators for the prevalence and incidence of various forensic psychiatric system components. Each expert completed a detailed questionnaire for their respective country using the best available data. Results: Finally, 22 EU Member States and Switzerland participated in the survey. Due to the frequent lack of a clear definition of what represented a forensic psychiatric bed, exact numbers on bed availability across specialized forensic hospitals or wards, general psychiatric hospitals or prison medical wards were often unknown or could only be estimated in a number of countries. Population-based rates calculated from the survey data suggested a highly variable pattern of forensic psychiatric provision across Europe, ranging from 0.9 forensic psychiatric beds per 100,000 population in Italy to 23.3 in Belgium. Other key service characteristics were similarly heterogeneous. Discussion: Our results show that systems for detaining and treating mentally disordered offenders are highly diverse across European Union Member States. Systems appear to have been designed and reformed with insufficient evidence. Service designers, managers and health care planners in this field lack the most basic of information to describe their systems and analyse their outcomes. As a basic, minimum standardized national reporting systems must be implemented to inform regular EU wide forensic psychiatry reports as a prerequisite to allow the evaluation and comparison of the various systems to identify models of best practice, effectiveness and efficiency.

Infância e práticas de cuidado nos Centros de Atenção Psicossocial à Infância e Adolescência (Capsi) / Childhood and care practices in the field of child and youth mental health (Capsi) / Infancia y prácticas del cuidado en el campo de la salud mental infanto juvenil (Capsi)

Resumo Neste trabalho, discute-se como a noção de infância vai se constituindo nas narrativas de profissionais de saúde que atuam em Centros de Atenção Psicossociais Infantojuvenis (Capsi) e que discursos sobre as infâncias se organizam, desdobrando-se nas ações de cuidado às crianças nos serviços de saúde mental. Trata-se de uma pesquisa qualitativo-exploratória, baseada em entrevistas semiestruturadas, observações participantes e diários de campo, discutidas através da análise temática. Como resultados desse processo, observa-se uma romantização da infância que perpassa a construção do cuidado nos serviços de saúde; a dificuldade da equipe quanto à decisão sobre o que é demanda de Capsi e o que não se enquadra na população adscrita frente à complexidade dos impactos sociais que implicam o diagnóstico; e a ênfase na medicalização em detrimento da construção de ações de caráter psicossocial.

Abstract This paper discusses how the notion of childhood is built in the narrative of Psychosocial Care Centers (Capsi) and which discourses on childhood are articulated and extended to the actions for children care in mental health services. It is a qualitative-exploratory research, based on semi structured interviews, participant observations and field notes, from the theme analysis. As results of this process, it is possible to notice a romantic view of childhood which goes through the constructions of care in the health services; the team difficulty in deciding which is the Capsi demand and which does not adjust to the ascribed population in the face of the complexity of the social impact implied by the diagnosis; and the emphasis on medicalization to the detriment in the construction of psychosocial nature actions.

Resumen En este trabajo se discute como se constituye la noción de infancia en las narrativas de los profesionales de la salud que actúan con niños en los Centros de Atención Psicosocial Infantil y Juvenil (Capsi) y qué discursos sobre la infancia se organizan y extienden a las acciones de cuidado de los niños en los servicios de salud mental. Se trata de una investigación cualitativa exploratoria, basada en entrevistas semiestructuradas, observaciones participantes y diarios de campo, que luego son discutidos mediante un análisis temático. Como resultados de ese proceso, se observa una "romantización" de la infancia que permea la construcción del cuidado en los servicios de salud; la dificultad del equipo para decidir cuál es la demanda de los Capsi y que no se ajusta a la población adscrita frente a la complejidad del impacto social que implica el diagnóstico; y el énfasis en la medicalización en detrimento de la construcción de acciones de carácter psicosocial.

Global child and adolescent mental health perspectives: bringing change locally, while thinking globally.

Child and adolescent mental health (CAMH) are a global priority. Different countries across the globe face unique challenges in CAMH services that are specific to them. However, there are multiple issues that are also similar across countries. These issues have been presented in this commentary from the lens of early career CAMH professionals who are alumni of the Donald J Cohen Fellowship program of the IACAPAP. We also present recommendations that can be implemented locally, namely, how promoting mental health and development of children and adolescents can result in better awareness and interventions, the need to improve quality of care and access to care, use of technology to advance research and practices in CAMH, and how investing in research can secure and support CAMH professionals and benefit children and adolescents across the globe. As we continue to navigate significant uncertainty due to dynamic circumstances globally, bolstering collaborations by "bringing change locally, while thinking globally" are invaluable to advancing global CAMH research, clinical service provision, and advancement of the field.

Mental health for LGBTQI people: a policies' review.

The mental health of lesbian, gay, bisexual, transgender, queer, intersexual (LGBTQI) individuals is significantly influenced by many factors such as difficulties in coming-out, poor acceptance, isolation and discrimination as well as minority-related stress. LGBTQI individuals, in fact, show a significant higher risk of mental health conditions, substance- use disorders and suicide. In addition, mental health services access may be difficult for personal and social barriers as well as a lack of adequate and specific mental health support. This review aims to assess and describe international policies, guidelines, position statements and recommendations regarding the promotion and protection of mental health rights for LGBTQI people. The search has been focussed on peer-reviewed papers, Governmental and Mental Health Association- Guidelines and Position Statements, Health Agencies - Guidelines and Position Statements (with a specific focus on mental health), LGBTQI Alliances and Foundations Publishing (with a specific focus on mental health). In addition, relevant international initiatives, and projects in the field of LGBTQI mental health will be described.

Designing the Well-Being of Romanians by Achieving Mental Health with Digital Methods and Public Health Promotion.

Taking care of mental health is a state of mind. Amid the challenges of the current context, mental health has become one of the problems with the greatest impact on citizens and the evolution of any economy. Due to the COVID-19 pandemic, people have become more anxious, solitary, preoccupied with themselves, and depressed because their entire universe has changed, by restricting their social and professional life; the increase in concern caused by a possible illness of them or those close to them made to isolate themselves. Two qualitative (group and in-depth interviews) and one survey-based quantitative research were carried out, which allowed the quantification of the opinions, perceptions, and attitudes of Romanians regarding the effectiveness of policies for the prevention and treatment of depression. Quantitative research revealed that most of the subjects had never participated in a mental health assessment, and a quarter of them had visited a mental health specialist more than two years ago. Based on the results, proposals were elaborated, which have been addressed both to the specialists from the Ministry of Health and to those from the academic environment, that may have an impact on the elaboration of some public mental health programs.

Mental health in Nigeria: A Neglected issue in Public Health.

In Nigeria, the disparity between available healthcare services and need for mental health services is palpable. Although, the country has made significant advances on challenging public health problems, health-related policy development and legislation in trying to achieve health for all policy, there have been challenges with regards to mental health services including that of policy development and legislation, financing, research, training and integration of mental health care into primary health care. We consulted relevant publications, official document, policy statement, blueprints, working plans of the relevant organizations responsible for mental care and services locally and globally. We identify and highlight challenges faced in mental health services implementation and provide recommendations as way forward and call for urgent action to government, non-governmental organizations (NGOs), policy makers and legislatives which are urgently needed to reform and implement them for a better, accessible, and affordable mental health services for the mental well-being of the populace.

Escala de avaliação das ações de reabilitação psicossocial para cidadania (ERPC) realizadas em CAPS / Quality assessment scale of mental and psychiatric health actions for citizenship (ERPC) performed in CAPS

No Brasil a partir da década de 90, realça-se a proposta de assistência centrada na reabilitação, autonomia e melhora da qualidade de vida das pessoas com doença mental junto à sociedade. Em 2001, a Lei Federal 10.2016 consolidou o movimento da reforma psiquiátrica ao redirecionar a assistência em saúde mental, tornando-se um marco legal da reforma psiquiátrica brasileira. Dentre estes serviços de saúde, destacam-se os Centros de Atenção Psicossocial (CAPS). Eles são os dispositivos estratégicos da Política brasileira de saúde mental e constituem o núcleo organizador da rede assistencial em Saúde Mental. Estes dispositivos têm como objetivo oferecer atendimento às pessoas com transtorno mental severo e persistente, residentes em sua área de abrangência, por meio de acompanhamento clínico, e da reinserção social dos usuários pelo acesso ao lazer, trabalho, exercício da cidadania e fortalecimento dos laços familiares e comunitários. No contexto assistencial, o enfoque se desloca da exclusão, centrando-se na reabilitação psicossocial. Os serviços como os CAPS passam a ser representativos da Reabilitação Psicossocial quando possibilitam ao sujeito oportunidade de enfrentar os afazeres da vida cotidiana, através da integração às atividades do projeto terapêutico, com o intuito de estimular a autonomia, resgatar sua cidadania e inseri-lo à sociedade. Eles são os dispositivos estratégicos da Política Brasileira de Saúde Mental e constituem o núcleo organizador da rede assistencial em Saúde Mental. Na década de 90, no Brasil, buscou-se avaliar os serviços substitutivos de saúde mental com o intuito de assegurar a melhor assistência aos usuários destes serviços e para assegurar que o que foi proposto na lei estava sendo cumprido. As primeiras avaliações se restringiam à estrutura do serviço e após, às práticas terapêuticas, à sobrecarga de trabalho dos profissionais de saúde mental, à satisfação dos usuários e familiares, e em outro momento passaram a avaliar a qualidade de vida dos usuários e seus direitos propostos pela Reabilitação Psicossocial. É neste momento que este trabalho se insere, com o intuito de avaliar o processo de Reabilitação Psicossocial com enfoque na cidadania desenvolvido com pessoas com transtorno mental em CAPS. O intuito desta pesquisa foi construir uma escala que avalie as ações de Reabilitação Psicossocial para cidadania com pessoas com transtornos mentais usuários de Centros de Atenção Psicossocial. Trata-se de estudo psicométrico, no qual a meta é alcançar um instrumento preciso e utilizável, e que possa ser empregado por outros pesquisadores, tratando da elaboração, validação do instrumento em sua construção. Os estudos metodológicos visam à investigação de métodos para coleta e organização dos dados, tais como: desenvolvimento, validação e avaliação de ferramentas e métodos de pesquisa, o que favorece a condução de investigações com rigor acentuado. A realização deste estudo se deu em três etapas: Revisão integrativa de literatura e Conceito de Reabilitação Psicossocial de Saraceno e, Realização de Grupos Focais com a Associação Vida em Ação (AVA), na busca de desvelar elementos importantes para a construção de uma escala, que avaliem ações que promovam a cidadania de pessoas com transtornos mentais usuários de Centros de Atenção Psicossocial; Elaboração de uma escala de avaliação de ações, a partir da revisão integrativa de literatura, da realização dos Grupos Focais e do Conceito de Reabilitação Psicossocial de Saraceno contendo dimensões e itens que considerem o construto do qual parte este estudo e; Verificação da Validade de conteúdo da Reabilitação Psicossocial para cidadania com pessoas com transtornos mentais usuários de Centros de Atenção Psicossocial. Foi desenvolvida uma escala de 113 itens e avaliada pelo comitê de juízes que sugeriu alterações na escrita de 7 itens e o pesquisador acatou as sugestões.

In Brazil since the 1990s, the proposal of assistance focused on rehabilitation, autonomy and improvement of the quality of life of people with mental illness in society is highlighted. In 2001, Federal Law 10.2016 consolidated the psychiatric reform movement by redirecting mental health care, becoming a legal framework for Brazilian psychiatric reform. Among these health services, the Centers of Psychosocial Attention (CAPS) stand out. They are the strategic devices of the Brazilian Mental Health Policy and constitute the organizing nucleus of the Mental Health care network. These devices have the objective of offering assistance to people with severe and persistent mental disorder, residents in their area of coverage, through clinical follow-up, and social reinsertion of users through access to leisure, work, exercise of citizenship and strengthening of family and community ties. In the welfare context, the focus shifts from exclusion to psychosocial rehabilitation. Services such as CAPS become representative of Psychosocial Rehabilitation when they allow the subject the opportunity to face the tasks of daily life, through the integration to the activities of the therapeutic project, in order to stimulate autonomy, rescue his citizenship and insert him into society. They are the strategic devices of the Brazilian Mental Health Policy and constitute the organizing nucleus of the Mental Health assistance network. In the 90's, in Brazil, it was sought to evaluate the substitute mental health services in order to ensure the best assistance to the users of these services and to ensure that what was proposed in the law was being fulfilled. The first evaluations were restricted to the structure of the service and after, to the therapeutic practices, to the work overload of mental health professionals, to the satisfaction of the users and their families, and at another time they started to evaluate the quality of life of the users and their rights proposed by Psychosocial Rehabilitation. It is at this moment that this work is inserted, with the purpose of evaluating the process of Psychosocial Rehabilitation with a focus on citizenship developed with people with mental disorders in CAPS. The purpose of this research was to build a scale that evaluates the actions of Psychosocial Rehabilitation for citizenship with people with mental disorders who use Psychosocial Attention Centers. It is a psychometric study, in which the goal is to achieve a precise and usable instrument that can be used by other researchers, dealing with the elaboration, validation of the instrument in its construction. Methodological studies aim at investigating methods for data collection and organization, such as: development, validation and evaluation of research tools and methods, which favors the conduction of investigations with marked rigor. This study was carried out in three stages: Integrative literature review and Concept of Psychosocial Rehabilitation of Saraceno and, Conducting Focus Groups with the Association Life in Action (AVA), in order to unveil important elements for the construction of a scale, which evaluate actions that promote the citizenship of people with mental disorders users of Psychosocial Attention Centers; Elaboration of a scale for the evaluation of actions, based on the integrative review of literature, the realization of Focus Groups and the Concept of Psychosocial Rehabilitation of Saracen containing dimensions and items that consider the construction of which this study starts; Verification of the Validity of the content of Psychosocial Rehabilitation for citizenship with people with mental disorders who are users of Psychosocial Attention Centers. A scale of 113 items was developed and evaluated by the committee of judges who suggested changes in the writing of 7 (6.2%) items and the researcher accepted the suggestions. The process of building the ERPC was extensive and resulted in a scale with a Content Validity Coefficient (CVC) above the average required. Regarding CVC - Practical Relevance and CVC - Theoretical Relevance the items were with very good grades and CVC - Language Clarity was the only one that was evaluated by the judges and made changes according to their suggestions. The ERPC presented evidence of above average content validity.

Escala de avaliação das ações de reabilitação psicossocial para cidadania (ERPC) realizadas em CAPS / Quality assessment scale of mental and psychiatric health actions for citizenship (ERPC) performed in CAPS

No Brasil a partir da década de 90, realça-se a proposta de assistência centrada na reabilitação, autonomia e melhora da qualidade de vida das pessoas com doença mental junto à sociedade. Em 2001, a Lei Federal 10.2016 consolidou o movimento da reforma psiquiátrica ao redirecionar a assistência em saúde mental, tornando-se um marco legal da reforma psiquiátrica brasileira. Dentre estes serviços de saúde, destacam-se os Centros de Atenção Psicossocial (CAPS). Eles são os dispositivos estratégicos da Política brasileira de saúde mental e constituem o núcleo organizador da rede assistencial em Saúde Mental. Estes dispositivos têm como objetivo oferecer atendimento às pessoas com transtorno mental severo e persistente, residentes em sua área de abrangência, por meio de acompanhamento clínico, e da reinserção social dos usuários pelo acesso ao lazer, trabalho, exercício da cidadania e fortalecimento dos laços familiares e comunitários. No contexto assistencial, o enfoque se desloca da exclusão, centrando-se na reabilitação psicossocial. Os serviços como os CAPS passam a ser representativos da Reabilitação Psicossocial quando possibilitam ao sujeito oportunidade de enfrentar os afazeres da vida cotidiana, através da integração às atividades do projeto terapêutico, com o intuito de estimular a autonomia, resgatar sua cidadania e inseri-lo à sociedade. Eles são os dispositivos estratégicos da Política Brasileira de Saúde Mental e constituem o núcleo organizador da rede assistencial em Saúde Mental. Na década de 90, no Brasil, buscou-se avaliar os serviços substitutivos de saúde mental com o intuito de assegurar a melhor assistência aos usuários destes serviços e para assegurar que o que foi proposto na lei estava sendo cumprido. As primeiras avaliações se restringiam à estrutura do serviço e após, às práticas terapêuticas, à sobrecarga de trabalho dos profissionais de saúde mental, à satisfação dos usuários e familiares, e em outro momento passaram a avaliar a qualidade de vida dos usuários e seus direitos propostos pela Reabilitação Psicossocial. É neste momento que este trabalho se insere, com o intuito de avaliar o processo de Reabilitação Psicossocial com enfoque na cidadania desenvolvido com pessoas com transtorno mental em CAPS. O intuito desta pesquisa foi construir uma escala que avalie as ações de Reabilitação Psicossocial para cidadania com pessoas com transtornos mentais usuários de Centros de Atenção Psicossocial. Trata-se de estudo psicométrico, no qual a meta é alcançar um instrumento preciso e utilizável, e que possa ser empregado por outros pesquisadores, tratando da elaboração, validação do instrumento em sua construção. Os estudos metodológicos visam à investigação de métodos para coleta e organização dos dados, tais como: desenvolvimento, validação e avaliação de ferramentas e métodos de pesquisa, o que favorece a condução de investigações com rigor acentuado. A realização deste estudo se deu em três etapas: Revisão integrativa de literatura e Conceito de Reabilitação Psicossocial de Saraceno e, Realização de Grupos Focais com a Associação Vida em Ação (AVA), na busca de desvelar elementos importantes para a construção de uma escala, que avaliem ações que promovam a cidadania de pessoas com transtornos mentais usuários de Centros de Atenção Psicossocial; Elaboração de uma escala de avaliação de ações, a partir da revisão integrativa de literatura, da realização dos Grupos Focais e do Conceito de Reabilitação Psicossocial de Saraceno contendo dimensões e itens que considerem o construto do qual parte este estudo e; Verificação da Validade de conteúdo da Reabilitação Psicossocial para cidadania com pessoas com transtornos mentais usuários de Centros de Atenção Psicossocial. Foi desenvolvida uma escala de 113 itens e avaliada pelo comitê de juízes que sugeriu alterações na escrita de 7 itens e o pesquisador acatou as sugestões.

In Brazil since the 1990s, the proposal of assistance focused on rehabilitation, autonomy and improvement of the quality of life of people with mental illness in society is highlighted. In 2001, Federal Law 10.2016 consolidated the psychiatric reform movement by redirecting mental health care, becoming a legal framework for Brazilian psychiatric reform. Among these health services, the Centers of Psychosocial Attention (CAPS) stand out. They are the strategic devices of the Brazilian Mental Health Policy and constitute the organizing nucleus of the Mental Health care network. These devices have the objective of offering assistance to people with severe and persistent mental disorder, residents in their area of coverage, through clinical follow-up, and social reinsertion of users through access to leisure, work, exercise of citizenship and strengthening of family and community ties. In the welfare context, the focus shifts from exclusion to psychosocial rehabilitation. Services such as CAPS become representative of Psychosocial Rehabilitation when they allow the subject the opportunity to face the tasks of daily life, through the integration to the activities of the therapeutic project, in order to stimulate autonomy, rescue his citizenship and insert him into society. They are the strategic devices of the Brazilian Mental Health Policy and constitute the organizing nucleus of the Mental Health assistance network. In the 90's, in Brazil, it was sought to evaluate the substitute mental health services in order to ensure the best assistance to the users of these services and to ensure that what was proposed in the law was being fulfilled. The first evaluations were restricted to the structure of the service and after, to the therapeutic practices, to the work overload of mental health professionals, to the satisfaction of the users and their families, and at another time they started to evaluate the quality of life of the users and their rights proposed by Psychosocial Rehabilitation. It is at this moment that this work is inserted, with the purpose of evaluating the process of Psychosocial Rehabilitation with a focus on citizenship developed with people with mental disorders in CAPS. The purpose of this research was to build a scale that evaluates the actions of Psychosocial Rehabilitation for citizenship with people with mental disorders who use Psychosocial Attention Centers. It is a psychometric study, in which the goal is to achieve a precise and usable instrument that can be used by other researchers, dealing with the elaboration, validation of the instrument in its construction. Methodological studies aim at investigating methods for data collection and organization, such as: development, validation and evaluation of research tools and methods, which favors the conduction of investigations with marked rigor. This study was carried out in three stages: Integrative literature review and Concept of Psychosocial Rehabilitation of Saraceno and, Conducting Focus Groups with the Association Life in Action (AVA), in order to unveil important elements for the construction of a scale, which evaluate actions that promote the citizenship of people with mental disorders users of Psychosocial Attention Centers; Elaboration of a scale for the evaluation of actions, based on the integrative review of literature, the realization of Focus Groups and the Concept of Psychosocial Rehabilitation of Saracen containing dimensions and items that consider the construction of which this study starts; Verification of the Validity of the content of Psychosocial Rehabilitation for citizenship with people with mental disorders who are users of Psychosocial Attention Centers. A scale of 113 items was developed and evaluated by the committee of judges who suggested changes in the writing of 7 (6.2%) items and the researcher accepted the suggestions. The process of building the ERPC was extensive and resulted in a scale with a Content Validity Coefficient (CVC) above the average required. Regarding CVC - Practical Relevance and CVC - Theoretical Relevance the items were with very good grades and CVC - Language Clarity was the only one that was evaluated by the judges and made changes according to their suggestions. The ERPC presented evidence of above average content validity.

Análise da inserção do tema da violência na Política de Saúde Mental brasileira a partir de seus marcos legais (2001-2011) / Analysis of the insertion of the issue of violence in Brazilian Mental Health Policies based on its legal frameworks (2001-2011)

O artigo tem por objetivo descrever e analisar o processo de inserção do tema da violência nos marcos legais da política pública brasileira de saúde mental, com vistas a contribuir para a identificação dos principais desafios e impasses presentes nessa área. Realizou-se análise documental das leis, decretos e portarias publicadas pelo Ministério da Saúde e publicações oficiais da Coordenação de Saúde Mental do ministério emitidas no período de janeiro de 2001 a dezembro de 2011. Observa-se a consolidação de três tendências nesses documentos, denominadas: a violência e a instituição psiquiátrica (2001-2003), marcada pela consolidação dos parâmetros norteadores da política na perspectiva da desinstitucionalização e garantia dos direitos dos indivíduos com transtornos mentais; a violência, o território e suas demandas (2004-2008), onde são identificadas a atenção às vulnerabilidades sociais e a integralidade dos cuidados em saúde; a violência e o desafio do uso prejudicial de álcool e outras drogas (2009-2011), evidenciando situações de risco e violência associadas a esse uso, e acirrando tensões entre forças políticas conservadoras no campo das políticas sociais. Conclui-se que a política de saúde mental adequou-se aos problemas sociais emergentes no país com vistas à promoção da qualidade de vida e a prevenção das violências.

The paper aims to describe and analyze the process of inserting the issue of violence in the legal frameworks of the Brazilian public politics on mental health, with a view to contribute to the identification of challenges and dilemmas in this area. We conducted a documental analysis of laws, decrees and orders issued by the Health Ministry and official publications of this Coordination of Mental Health Ministry issued from January 2001 to December 2011. We observed the consolidation of three trends in these documents: Violence and psychiatric institution (2001-2003), marked by the consolidation of parameters guiding deinstitutionalization policies and ensuring the rights of individuals with mental disorders; violence, the territory and its demands (2004-2008), where attention to social vulnerabilities and integral health care are identified; violence and the challenge of harmful use of alcohol and other drugs (2009-2011), showing that risk situations and violence associated with this use sharpen tensions between conservative political forces in the field of social policies. We conclude that mental health policies were adapted to the emerging social problems in the country, with a view to enhancing the quality of life and prevention of violence.

Desafios da rede de atenção psicossocial: problematização de uma experiência acerca da implantação de novos dispositivos de álcool e outras drogas na rede de saúde mental da cidade de Vitória-ES / Challenges of network of psychosocial attention: problematization of an experiment about the implantation of new devices of alcohol and other drugs in mental health network of the city of Vitória-ES / Desafíos de la red de atención psicosocial: problematización de una experiencia sobre la implantación de nuevos dispositivos de alcohol y otras drogas en la red de salud mental de la ciudad de Vitória-ES

O presente artigo apresenta a experiência de implantação de novos dispositivos ligados a Rede de Atenção Psicossocial, voltados principalmente ao usuário de drogas na cidade de Vitória-ES. A partir do paradigma de Reforma Psiquiátrica Brasileira, reconhece-se que nos anos mais recentes, os agravos de saúde referentes ao uso abusivo de álcool e outras drogas passaram a ganhar destaque. O Ministério da Saúde passou a financiar através do SUS, projetos tais como de Consultórios Móveis de Rua, Casas de Acolhimento Transitório, o que propiciou o surgimento de experiências de diversificação de dispositivos assistenciais para além dos CAPS AD. Tais mudanças resultam de uma disputa pelo modelo de atenção em saúde mental no país em que está em jogo afirmar práticas a favor da vida, em que o outro, moribundo ou não, seja acolhido em suas dores visíveis e invisíveis.(AU)

This article presents the experience of deploying new devices connected to Network of Psychosocial Attention, geared primarily to drug users in the city of Vitória-ES. From the paradigm ofBrazilian Psychiatric Reform, it is recognized that in last years, the health hazards related to the abuse of alcohol and other drugs were gaining prominence. The Ministry of Health began funding through Unified health System -SUS, projects such as Consultórios Móveis de Rua, Casas de Acolhimento Transitório, which has given rise to a diversity of experiences of caring beyond the CAPS AD. These changes result from a dispute over the care model for mental health in the country where the question at stake is affirm practices in defense of life, in that the other, moribund or not, to be welcomed into their visible and invisible pains.(AU)

En este artículo se presenta la experiencia de la implementación de nuevos dispositivos conectados a la Red de Atención Psicosocial, orientados principalmente a usuarios de drogas en la ciudad de Vitória-ES. Desde el paradigma de la Reforma Psiquiátrica Brasileña, se reconoce que en los últimos años, los riesgos de salud relacionados con el abuso de alcohol y otras drogas fueron ganando protagonismo. El Ministerio de Salud comenzó a financiar a través del SUS, proyectos como los Consultórios de Rua y Casas de Acolhimento Transitório, lo que ha dado lugar a una diversidad de experiencias de cuidado más allá de la de los CAPS AD. Estos cambios resultan en una disputa acerca del modelo de atención a la salud mental en el país en el que se juega la afirmación de prácticas en favor de la vida en las cuales uno, moribundo o no, sea acogido en su dolor visible e invisible.(AU)

Lessons learned in developing community mental health care in East and South East Asia.

This paper summarizes the findings for the East and South East Asia Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Im-plementation of Community Mental Health Care. The paper presents a description of the region, an overview of mental health policies, a critical ap-praisal of community mental health services developed, and a discussion of the key obstacles and challenges. The main recommendations address the needs to campaign to reduce stigma, integrate care within the general health care system, prioritize target groups, strengthen leadership in policy mak-ing, and devise effective funding and economic incentives.

Lessons learned in developing community mental health care in Latin American and Caribbean countries.

This paper summarizes the findings for the Latin American and Caribbean countries of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. It presents an overview of the provision of mental health services in the region; describes key experiences in Argentina, Belize, Brazil, Chile, Cuba, Jamaica and Mexico; and discusses the lessons learned in developing community mental health care.

Participação social na saúde mental: espaço de construção de cidadania, formulação de políticas e tomada de decisão / Social participation in mental health: space of construction of citizenship, policy formulation and decision making

O artigo aborda a compreensão dos profissionais que atuam na área de saúde mental sobre o movimento de construção da participação social no sistema de saúde de Fortaleza (CE). A metodologia adotada respalda-se na abordagem qualitativa, junto aos profissionais de saúde mental do referido município. Utilizamos a entrevista semiestruturada com dezessete participantes. O material empírico foi analisado através da técnica de análise de conteúdo categorial temática, na qual foram identificados três núcleos de análise: participação social como espaço de cidadania e formulação de políticas; orientada para a atenção às necessidades coletivas e de tomada de decisão. O estudo revela a participação social como uma possibilidade de ampliação da relação da sociedade civil com o Estado, o qual possibilita a intervenção social na proposição das políticas de saúde. Evidencia-se o direito à saúde articulado à consolidação da democracia na atenção às necessidades e edificação coletiva.

The article approaches the comprehension of professionals that act in the mental health area about the movement of construction of social participation in the health system of Fortaleza, Ceará State. The methodology adopted is based upon qualitative approach. The study was developed with semi-structured interviews with 17 mental health professionals of the city above mentioned. The empirical data was analyzed through the technique of thematic content analysis, where it was identified three cores of analysis: social participation as space of citizenship and policy formulation; oriented to attention of collective needs; and decision taking. The study reveals that social participation represents a possibility of amplifying X the relations between the Civil Society and the State, which makes possible the social intervention in proposals of the health policies. It is highlighted the right to health linked to the consolidation of democracy in the attention to the needs and collective edification.

Diagnóstico evaluativo para el fortalecimiento de estrategias de intervención en salud mental en Argentina / Diagnostic evaluation for the strengthening of strategies of intervention in mental health in Argentina

El estudio muestra los principales hallazgos de un diagnóstico evaluativo sobre políticas, planes y servicios que brindan cuidados en salud mental en Argentina. Con un diseño plural cuali-cuantitativo y un carácter multicéntrico y colaborativo, su desarrollo incorporó diversas contribuciones teórico-metodológicas, a partir del relevamiento de información de diferentes fuentes primarias y secundarias. Se trabajó sobre seis áreas geográficas que ya contaban con legislación para salud mental en 2007: Río Negro, Córdoba, EntreRíos, San Juan, Santa Fe y Ciudad Autónoma de Buenos Aires. Su objetivo fue producir conocimientos que contribuyeran a estimular el debate y a priorizar la salud mental en la agenda de las políticas sanitarias. Tomando por referencia los principios que impulsan los procesos internacionales de reforma de la atención en salud mental, se señala que Argentina aún carece de una ley nacional de salud mental. La expansión de los servicios de salud mental articulados a la atención primaria muestra una dirección ya consistente y asumida en las políticas sanitarias. A excepción de Río Negro, en las demás jurisdicciones se evidencia un modelo dual que superpone la atención hospitalaria centrada en la enfermedad mental junto a incipientes estrategias y dispositivos alternativos insertos en la vida comunitaria. La escasa información epidemiológica compone un cuadro disperso que no permite conocer problemáticas prevalentes ni priorizar grupos poblacionales vulnerables

The study shows the main findings from a diagnostic evaluation up on strategies, planning and services formental health care in Argentina. With an extensive qualitative and quantitative design and a multicentric and collaborative character, the study has incorporated several theoretical and methodological contributions and information primary and secondary sources. It has worked in five areas that had legislation for mental health in 2007: Río Negro, Córdoba, Entre Ríos, San Juan, Santa Feand Ciudad Autónoma de Buenos Aires. It intended to produce know ledge to stimulate the debate and give a priority status to mental health in the agenda of health policies. Taking into account, as a reference, the principles that gave impulse to the international processes to reform the attention in mental health, it is important to point out that Argentina do not have, yet, a national law for mental health. The expansion of services in mental health, articulated to primary care, shows a consistent direction assumed by the sanitary policies. Exception made to Río Negro, in the remaining jurisdictions there is a dual model that overlaps the hospital centered care in mental health, together with incipient strategies and alternative devices, inserted in the communitarian life. The very little epidemiological information created an elusive panorama that makes impossible to reach the core of the main problems, or give a priority attendance to the most vulnerable population

Mortalidade por transtornos mentais e comportamentais e a reforma psiquiátrica no Brasil contemporâneo - II: elementos para um debate / Mortalidad por trastornos mentales y de comportamiento y la reforma psiquiátrica en el Brasil contemporáneo - II: elementos para un debate / Mortalité par désordres mentaux et comportementaux et la réforme psychiatrique au Brésil contemporain - II: eléments pour un débat / Death from mental and behavioral disturbances and psychiatric reform in contemporary Brazil - II: elements for a debate

O aumento da mortalidade na categoria dos transtornos mentais e comportamentais - face à redução progressiva das internações hospitalares promovida pela reforma psiquiátrica em curso - tem aquecido o debate entre os proponentes da reforma e parte da comunidade psiquiátrica brasileira. Neste artigo, analisa-se os argumentos dos reformistas.

El incremento de la mortalidad en la categoría desordenes mentales y del comportamiento - concerniente a la reducción progresiva de camas psiquiátricas - tiene acalorado la discusión entre los que proponen la reforma y parte de la comunidad psiquiátrica brasileña. En este artículo se analizan los argumentos de los reformistas.

L'augmentation de la mortalité dans la catégorie des désordres mentaux et comportementaux - face à la réduction progressive des lits psychiatriques préconisée par la réforme psychiatrique en cours - a attisé le débat entre les réformistes et une partie de la communauté psychiatrique brésilienne. Cet article analyse les arguments des réformistes.

The rising death rate in the category of mental and behavioral disorders - related to the progressive reduction in the number of psychiatric beds - is bringing new elements to the discussion between reformists and some sectors of the Brazilian psychiatric community. In this paper, the arguments of the reformists are analyzed.

Mortalidade por transtornos mentais e comportamentais e a reforma psiquiátrica no Brasil contemporâneo / Mortalidad por los trastornos mentales y del comportamiento y la reforma psiquiátrica en el Brasil contemporáneo / La mortalité par trouble mental et comportemental et la réforme psychiatrique au Brésil contemporain / Death resulting from mental and behavioral disorders, and psychiatric reform in contemporary Brazil

A mortalidade por transtornos mentais e comportamentais têm aumentado no Brasil com a redução progressiva das internações hospitalares. A reforma psiquiátrica do governo aparentemente está contribuindo para este cenário preocupante, com sua política de desospitalização.

La mortalidad por trastornos mentales y del comportamiento ha aumentado en Brasil con la reducción gradual de las internaciones hospitalarias. La reforma psiquiátrica del gobierno aparentemente, está contribuyendo para ese escenario preocupante con su política de deshospitalización.

La mortalité par trouble mental et comportemental a augmenté au Brésil avec la réduction progressive des hospitalisations. La réforme psychiatrique du gouvernement contribue apparemment à ce cadre inquiétant, avec sa politique de deshospitalisation.

Death due to mental and behavioral disorders has increased in Brazil with the gradual reduction in the numbers of hospitalized mental patients. The federal government's psychiatric reform, based largely on closing down mental hospitals, is apparently contributing to this phenomenon.