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As práticas de inclusão social: o desafio para os serviços de saúde mental.; Social inclusion practices: challenge for mental health services.

Leão, Adriana
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 31/07/2006 Português
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Os Centros de Atenção Psicossocial (CAPS) são considerados dispositivos estratégicos para a mudança de modelo assistencial em saúde mental e apresentam proposições que vão ao encontro dos conceitos da Reabilitação Psicossocial, na perspectiva de promover a inclusão social das pessoas com a experiência do sofrimento psíquico. Neste contexto insere-se a temática desta pesquisa: as ações de inclusão social. Busca-se compreender como ocorrem as práticas de inclusão social voltadas para essa população, no intuito de contribuir para a avaliação deste serviço, considerado um importante avanço no processo da Reforma Psiquiátrica Brasileira. O objeto de estudo são as representações sociais dos sujeitos sobre práticas de inclusão social realizadas pelos serviços substitutivos em saúde mental, no âmbito do Sistema Único de Saúde (SUS). Para apreender esta realidade, os objetivos delineados foram: identificar as ações desenvolvidas no CAPS que, de acordo com a equipe de saúde mental, tenham por finalidade a inclusão social das pessoas portadoras de transtornos mentais severos e persistentes; analisar a concepção de inclusão social expressa na representação social dos trabalhadores; compreender as dificuldades e as possibilidades...

Papéis e perfil dos profissionais que atuam nos serviços e seus conhecimentos sobre políticas em saúde mental; Roles and profile of the professionals working and their knowledge of policies in mental health services

Almeida, Aline Siqueira de
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 12/08/2014 Português
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A atual proposta de reestruturação dos serviços de saúde mental no país tem o compromisso de prestar assistência integral e resolutiva, por meio de equipes interdisciplinares, a toda a população. Este estudo teve por objetivo Identificar o perfil dos profissionais que atuam nos serviços de saúde mental de Uberlândia, conhecer as atividades desenvolvidas nestas equipes e sua opinião sobre a aplicação das políticas de saúde mental. Metodologia: Trata-se de pesquisa exploratório descritiva. Faz parte de um amplo projeto, desenvolvido por pesquisadores do Departamento de Enfermagem Psiquiátrica e Ciências Humanas - EERP USP. Participaram do estudo 51 dos 135 profissionais de ensino superior que atuam nos serviços de saúde mental do município de Uberlândia. Para a coleta dos dados, utilizou-se um roteiro com duas partes: 1- informações de identificação, formação e sobre as praticas desenvolvidas pelos sujeitos nos serviços; 2- questões sobre politicas e formação em saúde mental. Os dados foram analisados pelo STATA para encontrar prováveis associações entre variáveis. O Teste exato de Fisher foi utilizado para analisar a não resposta. Resultados e Discussão: Dos 135 funcionários de nível superior de 09 serviços locais (01 enfermaria...

Avaliação de serviços em saúde mental no contexto da reforma psiquiátrica; La evaluación en los servicios de la salud mental según el contexto de la reforma psiquiátrica; Evaluation of mental health services in the context of psychiatric reform

Wetzel, Christine; Kantorski, Luciane Prado
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Artigo de Revista Científica Formato: application/pdf
Português
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O presente trabalho tem como proposta discutir a avaliação de serviços no campo da saúde mental, atrelando-a à proposta de reformulação do modelo assistencial, realizando uma reflexão crítica. Entendemos que a avaliação toma, juntamente com a sua função técnica, a função política de servir como instrumento de apoio na efetiva implantação dos serviços substitutivos ao modelo psiquiátrico hospitalocêntrico, como um dispositivo, entre outros, na busca da consolidação do modelo de reforma psiquiátrica proposto.; El presente trabajo discute la evaluación de los servicios en el campo de la salud mental, arrastrándola a la propuesta de la reformulación del modelo asistencial, através de una reflexión crítica. Entendemos que la evaluación conjuntamente con su función técnica, la función política de servir como instrumento de apoyo en la implantación efectiva de los servicios substitutivos al modelo hospital-céntrico psiquiátrico, como un dispositivo de búsqueda en la consolidación del modelo de la reforma psiquiátrica propuesta.; The present work describes a proposal for evaluation of mental health services, harnessing it to the proposal of transformation of the care model, and accomplishing a critical reflection. We understand that the evaluation takes...

Child and adolescent mental health services in Brazil: structure, use and challenges

Santos,Vagner dos; Fernández,Anna
Fonte: Instituto de Medicina Integral Prof. Fernando Figueira Publicador: Instituto de Medicina Integral Prof. Fernando Figueira
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2014 Português
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Objectives: to examine the state of Child and Adolescent Mental Health (CAMH) services and to compare the availability and use of CAMH services across the five regions of Brazil. Methods: the Mental Health Matrix Model was used as a framework to describe the state of CAMH services. Documents and administrative datasets were consulted, covering the whole country and the five Brazilian regions as separate levels. This enabled crossregion comparisons and combination with thethree temporal dimensions (Input, Process andOutcome) Results: although there are national policies regulating CAMH, along with an integral protection doctrine, scarcity of services was unequally distributed across the regions. A number of trends relating to social development and mental health (e.g. intellectual disability treated prevalence) were also identified. Conclusion: substantial advances in CAMH policy characterize the contemporary Brazilian CAMH system, especially regarding the implementa tion of community based mental health services for children and adolescents. However, the data reveals great inequalities and geographic variation regarding social indicators, service structure and use.

Trends in Medicare Part B Mental Health Utilization and Expenditures: 1987-92

Rosenbach, Margo L.; Ammering, Carol J.
Fonte: CENTERS for MEDICARE & MEDICAID SERVICES Publicador: CENTERS for MEDICARE & MEDICAID SERVICES
Tipo: Artigo de Revista Científica
Publicado em //1997 Português
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This article examines the impact of expanding Medicare Part B coverage of mental health services, based on analysis of 6 years of Medicare Part B claims data (1987-92). Inflation-adjusted per capita spending more than doubled (from $9.91 to $21.63) following the elimination of the annual outpatient treatment limit and extension of direct reimbursement to clinical psychologists and social workers. There was a 73-percent increase in the user rate (from 23.25 to 40.20 per 1,000 Medicare beneficiaries), and a 27-percent increase in the average number of services per user (from 8.9 to 11.3). Mental health spending increased from 1 percent to 2 percent of expenditures for Part B professional services. Ongoing monitoring of mental health utilization is desirable to ensure that recent access gains are not eroded with the increasing shift to managed care and implementation of gatekeeper mechanisms.

Expenditures for Mental Health Services in the Utah Prepaid Mental Health Plan

Stoner, Tamara; Manning, Willard; Christianson, Jon; Gray, Donald Z.; Marriott, Sally
Fonte: CENTERS for MEDICARE & MEDICAID SERVICES Publicador: CENTERS for MEDICARE & MEDICAID SERVICES
Tipo: Artigo de Revista Científica
Publicado em //1997 Português
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This article examines the effect of a mental health carve-out, the Utah Prepaid Mental Health Plan (UPMHP), on expenditures for mental health treatment and utilization of mental health services for Medicaid beneficiaries from July 1991 through December 1994. Three Community Mental Health Centers (CMHCs) provided mental health services to Medicaid beneficiaries in their catchment areas in return for capitated payments. The analysis uses data from Medicaid claims as well as “shadow claims” for UPMHP contracting sites. The analysis is a pre/post comparison of expenditures and utilization rates, with a contemporaneous control group in the Utah catchment areas not in the UPMHP. The results indicate that the UPMHP reduced acute inpatient mental health expenditures and admissions for Medicaid beneficiaries during the first 2½ years of the UPMHP. In contrast, the UPMHP had no statistically significant effect on outpatient mental health expenditures or visits. There was no significant effect of the UPMHP on overall mental health expenditures.

Assessing the Need, Use, and Developments in Mental Health/Substance Abuse Care

Bae, Jay P.
Fonte: CENTERS for MEDICARE & MEDICAID SERVICES Publicador: CENTERS for MEDICARE & MEDICAID SERVICES
Tipo: Artigo de Revista Científica
Publicado em //1997 Português
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This overview presents an introduction to the articles published in this issue of the Health Care Financing Review, entitled “Mental Health Services and Vulnerable Populations.” This article discusses the challenges the mental health and substance abuse (MH/SA) care system is confronted with in terms of equity and efficiency and how the system is responding to these challenges. It further addresses research issues in assessing the need and use of mental health services and summarizes recent activities in the research and evaluation of new delivery and payment systems.

Panorama dos serviços de saúde mental do interior do estado de Goiás; Panorama of the mental health services the interior the state of Goias

SILVA, Nathália dos Santos
Fonte: Universidade Federal de Goiás; BR; UFG; Mestrado em Ciências Farmacêuticas; Ciências da Saúde - Farmácia Publicador: Universidade Federal de Goiás; BR; UFG; Mestrado em Ciências Farmacêuticas; Ciências da Saúde - Farmácia
Tipo: Dissertação Formato: application/pdf
Português
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INTRODUCTION: Psychiatric Reform is being built in Brazil for over 20 years and is one of its main pillars deinstitutionalization. In the country, the National Mental Health (PNSM) follows a global trend the organization of community practices and home care in place procedures institutionalized for treatment. The mental health work represents great challenges because of its complexity, which are in the restructuring of the quality of care, through the labor relations and the adoption of new technologies, knowledge and work practices. This research is part of a multicenter project coordinated by the School of Nursing of Ribeirão Preto, University of Sao Paulo in partnership with the School of Nursing, Federal University of Goiás, which proposes to perform diagnostic studies on mental health care in Brazil. GENERAL PURPOSE: To present an overview of mental health services in the state of Goias METHODOLOGY: This is a descriptive-exploratory quantitative and qualitative approach, carried out in all municipalities in the state of Goias who provide public mental health, totaling 19 municipalities and 22 services. The subjects were professionals who have higher education level, as well as those who act as coordinators in services. Data were collected through the use of self-administered forms and screenplay for oral interview. For quantitative analysis were used relative and absolute frequencies in order to characterize the profiles of professionals...

Approaches to delivering child and adolescent mental health services: The South Australian experience

Sawyer, M.; Kosky, R.
Fonte: Royal Australian and New Zealand College of Psychiatrists Publicador: Royal Australian and New Zealand College of Psychiatrists
Tipo: Artigo de Revista Científica
Publicado em //1995 Português
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Approximately 10% of children and adolescents experience mental health programs, however only a small proportion receive specialised help. Identifying approaches which can provide a balanced and effective service for the large number of children and adolescents with problems is currently a major challenge for child and adolescent mental health services in Australia. In South Australia, following a review in 1983, child and adolescent services were reorganised into two separate but closely related services. This paper draws on experience in South Australia over the last decade to identify approaches which can be employed in six key areas that significantly influence the effectiveness of child and adolescent mental health services. The paper also describes the specific features which were included in the South Australian child and adolescent mental health service to address these issues.

Depression in rural adolescents: relationships with gender and availability of mental health services

Black, G.; Roberts, R.; Tan, L.
Fonte: Deakin University Publicador: Deakin University
Tipo: Artigo de Revista Científica
Publicado em //2012 Português
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Introduction: There is growing evidence in the literature which indicates that the prevalence of depression is similar in both non-metropolitan and metropolitan areas. However, it is generally perceived that factors associated with compromised mental health in rural residents include deprivation and lack of access to healthcare services. This study examines the relationship between depression and possible determinants of mental health among rural adolescents. The determinants identified were degree of remoteness, gender, socioeconomic status and the perception of rural community characteristics. Rural community characteristics examined were long waiting lists and lack of mental health professionals. Method: Respondents were 531 South Australian adolescents (55.7% female) aged 13 to 18years, living outside the Adelaide (state capital) metropolitan area. Respondents completed a questionnaire including: demographic questions; the Kutcher Adolescent Depression Scale (KADS); and questions regarding individual perceptions of community characteristics. The data were obtained by self-report, degree of remoteness was measured using the Accessibility and Remoteness Index of Australia Plus, and socio-economic status was determined from the Australian Bureau of Statistics (ABS) Socio-Economic Index of Relative Socio-Economic Advantage and Disadvantage (SEIFA). Results: The rate of depression obtained from this sample of rural adolescents is concerning; 18% screened positive for depression on the KADS...

Therapeutic Project at Extra-Hospital Mental Health Services: a critical reflection on the elaboration and management of services' therapeutic projects

Fiorati, Regina Celia; Saeki, Toyoko
Fonte: UNIV SAO PAULO, FAC SAUDE PUBLICA; SAO PAULO Publicador: UNIV SAO PAULO, FAC SAUDE PUBLICA; SAO PAULO
Tipo: Artigo de Revista Científica
Português
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Based on a study conducted in Ribeirao Preto, SP, Brazil in extra-hospital mental health services that addressed the organization of these services, therapeutic projects and the inclusion of psychosocial rehabilitation in health actions available, a theoretical-critical reflection concerning the development process of the therapeutic projects by the services' teams is presented. The qualitative study was conducted in an outpatient clinic and a Psychosocial Care Center. Data were collected through semi-structured interviews and focal groups. Data analysis was based on the hermeneutic dialectic philosophy of Jurgen Habermas according to the techniques of reconstruction and interpretation. Data analysis revealed that professionals have difficulty developing and managing therapeutic projects. Health actions are made available without being concretely supported by a proposal guiding the service's practical activities. The therapeutic projects are referred by professionals as the result of guidelines provided by management levels or technical orientations inherent to each profession but not as an activity that represents a philosophy of work of the health team. When the therapeutic project is focused on as a type of consensus that results from a communicative action directed to a mutual and intersubjective understanding among the members of the mental health extra-hospital team...

Constraints Perceived by Psychiatrists Working in Community Mental Health Services. Development and Pilot Study of a Novel Instrument

Galeazzi, Gian Maria; Mackinnon, Andrew; Curci, Paolo
Fonte: Springer Publicador: Springer
Tipo: Artigo de Revista Científica
Português
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An inventory of institutional constraints perceived as limiting therapeutic choices was developed and completed by psychiatrists working in Italian public mental health services. Constraints considered most limiting were social and institutional pressures

Towards a development framework of consumer and carer participation in child and adolescent mental health services

MacDonald, Elspeth; Lee, Erica; Geraghty, Kerry; McCann, Karen; Mohay, Heather; O'Brien, Tom
Fonte: Sage Publications Inc Publicador: Sage Publications Inc
Tipo: Artigo de Revista Científica
Português
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Objective: This paper examines the concept of consumer participation in the context of developmental changes in parent/child relationships and associated differences in the utilization of child and adolescent mental health services. Method: Existing defin

The Delivery of Mental Health Services in the Xenia Tornado

Dynes, Russell R.; Quarantelli, E. L.
Fonte: Disaster Research Center Publicador: Disaster Research Center
Tipo: Outros Formato: 20804421 bytes; application/pdf
Português
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The report consists of seven chapters and an appendix. The first chapter is background: it sets forth rather briefly the history of the organized delivery of mental health services in American disasters, the general research and analytical framework we used to study the delivery of such services in Xenia, and concludes with a discussion of the nature of the data we obtained in the study, including its limitations. Chapter II selectively describes pre-impact Xenia, the damage, destruction and disruption of community life occasioned by the tornado, and the expected as well as the actual post-impact reactions manifested by victims as well as others in the general population. The pre-impact mental health delivery service system existing in Xenia is described in Chapter III; it is seen as having evolved out of a general historical context. Chapter IV details the characteristics of the mental health delivery services attempted and provided after the tornado hit: it answers such questions as what services were delivered, how, where, and by whom. The following chapter analyzes the specific post-impact conditions, both those which arose after the tornado impact and those that were carried over from before the disaster, which lead to the kind of services described in Chapter IV. In Chapter VI we trace out at system...

The Effects of College Students' Perceptions and Knowledge of Mental Illness and Mental Health Services on Help-Seeking Behavior

Meier, Erica
Fonte: University of Delaware Publicador: University of Delaware
Tipo: Tese de Doutorado
Português
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Ann Bell; College presents students with many exciting opportunities to grow socially and academically. Students may choose to enroll in courses that explore topics they’ve never studied, interact with people who are very different from their friends back home, and join new clubs and social groups. While all of these collegiate activities offer invaluable opportunities for enrichment and growth, they also operate within institutions that are, in many cases, unfamiliar and far from home. Students who are unable to adjust to these unfamiliar institutions in a healthy manner are at a greater risk of developing poor mental health or exacerbating an already existing condition. In addition to the stress of being in an unfamiliar and constantly changing institution, students who have mental health concerns may also experience personal and/or other stigma, which may decrease their ability to cope in a healthy manner or to seek professional help. College students may also be unaware of—or may have a negative perception of—the mental health services that are available to them, which may also decrease the likelihood that they will seek help. This paper seeks to explore students’ perceptions and knowledge and mental health, with an emphasis on co-occurring depression and substance abuse and depression with suicidal ideation.; Sociology

Who uses mental health services in Australia? An analysis of data from the National Survey of Mental Health and Well-being

Parslow, Ruth; Jorm, Anthony F
Fonte: SAGE Publications Publicador: SAGE Publications
Tipo: Artigo de Revista Científica
Português
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Objective: This study sought to identify sociodemographic and psychological measures associated with utilisation of mental health services in Australia, using information collected through the 1997 National Survey of Mental Health and Wellbeing. Method: Twenty-one potential predictor variables were selected from the National Survey. Predisposing and enabling factors included age, sex, marital status, labour force status, geographical location and level of education. Predictor variables measuring need for services included the General Health Questionnaire score, a neuroticism scale, diagnoses of affective, anxiety and substance-abuse disorders from the Composite International Diagnostic Interview, and self-identified depression, anxiety and substance abuse. Simple and multiple logistic regressions were under taken to identify predictor variables associated with use of mental health services from general practitioners, psychiatrists, psychologists and other health professionals. Results: General practitioners were the most commonly reported providers of mental health services with 76% of those receiving any mental health care reporting using this type of service. Using multiple logistic regression, the predictor variables most associated with use of mental health services were measures of the need for such services...

A inserção da reabilitação psicossocial nos serviços extra-hospitalares de saúde mental: o conflito entre racionalidade instrumental e racionalidade prática; The inclusion of psychosocial rehabilitation in outpatient mental health services: the conflict between instrumental rationality and practical rationality

Fiorati, Regina Célia; Saeki, Toyoko
Fonte: Universidade de São Paulo. Faculdade de Medicina Publicador: Universidade de São Paulo. Faculdade de Medicina
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; ; Formato: application/pdf
Publicado em 01/04/2011 Português
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A partir de uma pesquisa desenvolvida no município de Ribeirão Preto, SP, realizada em dois serviços extra-hospitalares de saúde mental, um Ambulatório Regional de Saúde Mental e um Centro de Atenção Psicossocial II, objetivou-se estudar a organização dos serviços extra-hospitalares, os projetos terapêuticos desses serviços e a inserção da reabilitação psicossocial nos projetos terapêuticos. A pesquisa foi realizada com base em metodologia qualitativa, como técnicas de coleta de dados utilizou-se entrevistas semidiretivas e grupos focais, e a análise dos dados foi realizada com base em referencial hermenêutico dialético de Jürgen Habermas, seguindo uma técnica interpretativa reconstrutiva. Os resultados foram a identificação de que o trabalho nesses serviços se organiza com centralidade no trabalho clínico-psiquiátrico, enfatiza o diagnóstico e a patologia, o tratamento centrado no medicamento e a reabilitação psicossocial é secundarizada nos projetos e ações disponibilizadas aos usuários. O artigo traz discussão sobre parte desse estudo no que diz respeito à inserção da reabilitação psicossocial nos serviços estudados, enfocando o assunto sob o prisma do conflito entre dois tipos de racionalidade...

Formação profissional e serviços de saúde mental no SUS: estudo sobre a inserção de egressos do Curso de Terapia Ocupacional da FMUSP; Interprofessional education and Mental Health Services on the context of SUS: study about the insertion of graduates of the Course of Occupational Therapy - FMUSP

Mângia, Elisabete Ferreira; Muramoto, Melissa Tieko; Marques, Ana Lucia Marinho
Fonte: Universidade de São Paulo. Faculdade de Medicina Publicador: Universidade de São Paulo. Faculdade de Medicina
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; ; Formato: application/pdf
Publicado em 01/08/2010 Português
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A implementação das redes de serviços de saúde mental configura-se como processo complexo que coloca exigências para o ensino de graduação. O curso de Terapia Ocupacional da FMUSP implementou mudanças curriculares tendo em vista a formação de profissionais comprometidos e capazes de compreender e lidar com as exigências teóricas e técnicas da atenção e da reabilitação psicossocial de pessoas com transtornos mentais. OBJETIVOS: Conhecer, caracterizar e analisar a inserção de egressos em serviços e/ou projetos de saúde mental no contexto do SUS e analisar a adequação entre a formação e as exigências para a atuação profissional colocadas pelos novos serviços e/ou projetos de saúde mental. MÉTODO: Pesquisa qualitativa baseada em procedimentos da etnometodologia consistiu na realização de grupos focais, ao longo do segundo semestre de 2009, com egressos inseridos em serviços públicos de saúde mental. RESULTADOS: dados obtidos demonstram que os egressos: conseguem inserção em serviços de saúde mental nos primeiros 6 meses de formados; buscam principalmente cursos de especialização e/ou aprimoramento; vivenciam grande rotatividade em serviços novos; relatam que tais serviços são heterogêneos em relação à organização...

Projeto terapêutico nos serviços extra-hospitalares de saúde mental: uma reflexão crítica sobre a forma de elaboração e gestão dos projetos terapêuticos nos serviços; Therapeutic project at extra-hospital mental health services: a critical reflection on the elaboration and management of services' therapeutic projects

Fiorati, Regina Célia; Saeki, Toyoko
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; Formato: application/pdf
Publicado em 01/09/2012 Português
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Com base em uma pesquisa realizada no município de Ribeirão Preto, SP, em serviços extra-hospitalares de saúde mental, que teve como objetivo estudar a organização desses serviços, os projetos terapêuticos e a inserção da reabilitação psicossocial nas ações de saúde disponibilizadas, apresenta-se reflexão teórico-crítica sobre o processo de elaboração dos projetos terapêuticos pelas equipes dos serviços. A pesquisa, que foi desenvolvida em um Ambulatório e em um Centro de Atenção Psicossocial II, foi realizada com base em metodologia qualitativa; como técnicas de coleta de dados, utilizou-se entrevistas semidiretivas e grupos focais, e a análise dos dados apoiou-se em referencial hermenêutico dialético de Jürgen Habermas, seguindo técnica interpretativa reconstrutiva. A análise dos dados mostrou que os profissionais têm apresentado dificuldade na elaboração e gestão dos projetos terapêuticos. Ações de saúde são disponibilizadas sem o referencial concreto de uma proposta norteadora das atividades práticas do serviço. Os projetos terapêuticos são referenciados pelos profissionais como decorrentes das diretrizes provenientes de instâncias gestoras ou das orientações técnicas próprias a cada categoria profissional...

Models of collaboration between general practice and mental health services in Italy

Berardi,Domenico; Bortolotti,Biancamaria; Menchetti,Marco; Bombi,Annarosa; Tarricone,Ilaria
Fonte: The European Journal of Psychiatry Publicador: The European Journal of Psychiatry
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/03/2007 Português
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Background and objectives: Anxiety and Depressive disorders represent an important public health problem, which involves not only the mental health services, but the General Practice as well. This paper examines models of Collaboration between General Practice and Community Mental Health Services developed in Italy. Methods: Different Consultation -Liaison activities are presented. For every Collaboration model advantages and disadvantage are discussed. Results: The structured Consultation Liaison Service is based on supplying diagnostic consultation and therapeutic interventions in support of General Practitioners (GPs). The service could be based in either a Community Mental Health Centre (CMHC) or externally. Diagnostic evaluation can be followed by brief and focal therapeutic interventions, in support of the GP's therapeutic plan. The spontaneous collaboration in small centres are frequent in rural areas where the contained dimensions of the services and the direct acquaintance between psychiatrists and GPs encourage the personalization of the collaboration. The model of Liaison and Group-Training focuses on direct contact between consultant and GPs. In the course of regular meetings, the consultant gives the GPs supervision and education...