Users’ perspective inclusion in mental health services evaluation

Progresivamente ha ganado reconocimiento la importancia de incluir a los usuarios y su perspectiva en la evaluación de servicios de salud, y específicamente de salud mental. El presente trabajo desarrolla algunas ideas referidas al lugar de éstos en el proceso de mejoramiento de los servicios provistos -desde su inclusión en calidad de consumidores hasta su lugar de ciudadanos en pleno ejercicio de derechos-, el modo en que perciben a los servicios de salud mental y la atención que allí reciben, así como algunas discusiones acerca de las posibilidades y dificultades para considerar dicha perspectiva.It has been progressively recognized the importance of including users and their perspective in the evaluation of health and mental health services. This paper develops some ideas related to the involvement of users in the service improvement process -from their participation as consumers up to their citizens’ place in full exercise of rights-; and the way in which they perceive received services and attention, as well as some discussions about the possibilities and difficulties for taking into account that perspective.Fil: Ardila Gómez, Sara Elena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Lanús. Departamento de Salud Comunitaria; Argentin

El concepto de Comunidad en la Salud Mental Comunitaria

Este trabajo tiene como propósito discutir acerca del lugar que ocupa y el sentido que tiene el concepto de comunidad en la perspectiva y propuestas de la salud mental comunitaria. Para ello se realiza un recorrido histórico del concepto mismo de comunidad, partiendo de sus orígenes en la sociología del siglo XIX, ligado a la añoranza de aquello que se estaba perdiendo por las transformaciones en los vínculos sociales producidas por la revolución industrial, hasta llegar a su resurgimiento teórico a fines del siglo XX, ligado a la necesidad y demanda de seguridad. A su vez, se revisa el sentido que ha tenido el concepto de comunidad en los diferentes movimientos de reforma psiquiátrica, y el que ha ido cobrando en el contexto presente, señalándose algunos de los retos que enfrentan las propuestas de salud mental comunitaria en la actualidad.The purpose of this work is to discus about the place and meaning of the community concept in the context of community mental health. To achieve that purpose the concept of community has been historically reviewed since its origins in XIX century sociology -when it was connected to something that was missing due to the transformation of social links caused by the industrial revolution- until its theoretical revival at the end of XX century as part of the need of security. The meaning of the community concept in the different movements of psychiatric reforms is also reviewed as well as its meaning in the present context. Some challenges that community mental health proposals have right now are also pointed out.Fil: Ardila Gómez, Sara Elena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Galende, Emiliano. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentin

Investigando sobre Procesos de Evaluación de Programas de Reinserción Comunitaria de Personas Externadas de Instituciones Psiquiátricas

Pese a reconocerse la importancia de la evaluación de programas y servicios de salud mental para transformar y mejorar la atención, su inclusión como práctica cotidiana ha sido reducida. Este problema fue abordado por la investigación aquí presentada (PICTO-UNLa 2008- 2011) cuyo objetivo fue desarrollar conceptual y técnicamente metodologías contextuales y participativas de evaluación de programas y servicios comunitarios de reinserción de pacientes psiquiátricos, y estudiar la aplicabilidad de herramientas internacionales al contexto local, en un estudio de caso de un programa de externación de la Provincia de Buenos Aires. Se utilizó una metodología de investigación social participativa con componentes de Investigación en Sistemas y Servicios de Salud. Las técnicas fueron: encuesta a los trabajadores del programa, talleres de discusión, aplicación de herramientas internacionales de evaluación de programas y servicios de salud mental, y la conformación de un comité de seguimiento de la investigación. Los resultados muestran que el personal considera positivamente la evaluación como potenciador de cambios y visibilizador de la tarea realizada. La escasa formación en elementos de gestión y los modos reducidos y dispersos de contratación del personal constituyen obstáculos para la evaluación permanente. Las herramientas internacionales fueron valoradas porque permiten desnaturalizar la práctica al contrastarla con estándares externos, aunque el marco referencial implícito en su elaboración obstaculiza su aplicabilidad. El proceso de investigación promovió la revisión de los objetivos del programa, y la necesidad de incluir la perspectiva de las usuarias en la evaluación, tarea que se adelanta actualmente.Although exists an agreement about the importance of use evaluation as a tool to improve and develop mental health programs and services, it is still not a part of the everyday practice. This problem was the starting point of the present research (PICTO-UNLa2008-2011) where the objectives were: 1) to develop contextual and participative methodologies both conceptual and technically for the evaluation of community programs and services for reinsertion of psychiatric patients and 2) to study the applicability of international tools to the local context, in a case study of a discharge program in the Buenos Aires Province. A social participation methodology with Health Systems and Services Research components was used. The techniques used were: inquiry to the workers of the program; discussion workshops; international tools for evaluating mental health programs and services, and a research-follow-up committee was created. The results shows that the staff has a positive attitude towards evaluation as a facilitator of change in their practice. The international tools were valued because they create a contrast between the practice and external standards even though its implicit theoretical frame made it difficult to apply. Results also show that the main obstacles for routine evaluation in services are a lack of training in management issues and the hiring styles of health services. The research process promoted a review of the program objectives and the need of the inclusion of the points of view of the users of the program.Fil: Ardila Gómez, Sara Elena. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Stolkiner, Alicia. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Universidad de Buenos Aires. Facultad de Psicología; Argentin

Investigando sobre Procesos de Evaluación de Programas de Reinserción Comunitaria de Personas Externadas de Instituciones Psiquiátricas

Pese a reconocerse la importancia de la evaluación de programas y servicios de salud mental para transformar y mejorar la atención, su inclusión como práctica cotidiana ha sido reducida. Este problema fue abordado por la investigación aquí presentada (PICTO-UNLa 2008- 2011) cuyo objetivo fue desarrollar conceptual y técnicamente metodologías contextuales y participativas de evaluación de programas y servicios comunitarios de reinserción de pacientes psiquiátricos, y estudiar la aplicabilidad de herramientas internacionales al contexto local, en un estudio de caso de un programa de externación de la Provincia de Buenos Aires. Se utilizó una metodología de investigación social participativa con componentes de Investigación en Sistemas y Servicios de Salud. Las técnicas fueron: encuesta a los trabajadores del programa, talleres de discusión, aplicación de herramientas internacionales de evaluación de programas y servicios de salud mental, y la conformación de un comité de seguimiento de la investigación. Los resultados muestran que el personal considera positivamente la evaluación como potenciador de cambios y visibilizador de la tarea realizada. La escasa formación en elementos de gestión y los modos reducidos y dispersos de contratación del personal constituyen obstáculos para la evaluación permanente. Las herramientas internacionales fueron valoradas porque permiten desnaturalizar la práctica al contrastarla con estándares externos, aunque el marco referencial implícito en su elaboración obstaculiza su aplicabilidad. El proceso de investigación promovió la revisión de los objetivos del programa, y la necesidad de incluir la perspectiva de las usuarias en la evaluación, tarea que se adelanta actualmente.Although exists an agreement about the importance of use evaluation as a tool to improve and develop mental health programs and services, it is still not a part of the everyday practice. This problem was the starting point of the present research (PICTO-UNLa2008-2011) where the objectives were: 1) to develop contextual and participative methodologies both conceptual and technically for the evaluation of community programs and services for reinsertion of psychiatric patients and 2) to study the applicability of international tools to the local context, in a case study of a discharge program in the Buenos Aires Province. A social participation methodology with Health Systems and Services Research components was used. The techniques used were: inquiry to the workers of the program; discussion workshops; international tools for evaluating mental health programs and services, and a research-follow-up committee was created. The results shows that the staff has a positive attitude towards evaluation as a facilitator of change in their practice. The international tools were valued because they create a contrast between the practice and external standards even though its implicit theoretical frame made it difficult to apply. Results also show that the main obstacles for routine evaluation in services are a lack of training in management issues and the hiring styles of health services. The research process promoted a review of the program objectives and the need of the inclusion of the points of view of the users of the program.Fil: Ardila Gómez, Sara Elena. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Stolkiner, Alicia. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Universidad de Buenos Aires. Facultad de Psicología; Argentin

El concepto de Comunidad en la Salud Mental Comunitaria

Este trabajo tiene como propósito discutir acerca del lugar que ocupa y el sentido que tiene el concepto de comunidad en la perspectiva y propuestas de la salud mental comunitaria. Para ello se realiza un recorrido histórico del concepto mismo de comunidad, partiendo de sus orígenes en la sociología del siglo XIX, ligado a la añoranza de aquello que se estaba perdiendo por las transformaciones en los vínculos sociales producidas por la revolución industrial, hasta llegar a su resurgimiento teórico a fines del siglo XX, ligado a la necesidad y demanda de seguridad. A su vez, se revisa el sentido que ha tenido el concepto de comunidad en los diferentes movimientos de reforma psiquiátrica, y el que ha ido cobrando en el contexto presente, señalándose algunos de los retos que enfrentan las propuestas de salud mental comunitaria en la actualidad.The purpose of this work is to discus about the place and meaning of the community concept in the context of community mental health. To achieve that purpose the concept of community has been historically reviewed since its origins in XIX century sociology -when it was connected to something that was missing due to the transformation of social links caused by the industrial revolution- until its theoretical revival at the end of XX century as part of the need of security. The meaning of the community concept in the different movements of psychiatric reforms is also reviewed as well as its meaning in the present context. Some challenges that community mental health proposals have right now are also pointed out.Fil: Ardila Gómez, Sara Elena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Galende, Emiliano. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentin

Marrying research evidence and policies in Latin America and the Caribbean: The Case of Violence

Violence is probably the most important public health problem in Latin America and the Caribbean. Despite the efforts to attach that problem, research and policies do not feedback each other in an apropiate way. There is need for develop implementation research in the region in order to reduce that gap.Fil: Ardila Gómez, Sara Elena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Universidad de Buenos Aires. Facultad de Psicología. Área de Salud Pública y Salud Mental; ArgentinaFil: Lugo Palacios, D.. London School Of Hygiene And Tropical Medicine; Reino UnidoFil: Vargas Palacios, E.. No especifíca

Conceptualizing mental health into practice: considerations from the latin american social medicine/collective health percepctive

Este trabajo tiene como objetivo discutir las posibilidades de una definición de salud mental desde la perspectiva de la medicina social/salud colectiva latinoamericanas, señalándose algunas líneas de articulación entre dicho pensamiento y la salud mental. Para ello se realiza una historización de dicho movimiento y se analizan las facetas de su conceptualización del proceso salud-enfermedad-cuidado, enfatizando en ello la complejidad, la perspectiva de derechos y la referencia a la vida, en contraste con la tendencia a la objetivación/medicalización. Finalmente, se ligan estas conceptualizaciones con los debates actuales del campo de la Salud Mental.The aim of this work is to discuss about the possibilities of a mental health definition from the perspective of the Latin American social medicine/collective health movement. Some relations between that movement and the mental health are pointed out. A historical analysis of that movement is presented. The conceptualizations of the health-sickness-care process are considered, emphasizing the complexity, rights perspective and the reference to life, in contrast with the objetivation/medicalization trend. Finally, these ideas are linked with the current debates on the Mental Health field.Fil: Stolkiner, Alicia Ines. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Ardila Gómez, Sara Elena. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología; Argentin

Development of mental health first-aid guidelines for depression: a Delphi expert consensus study in Argentina and Chile

Background: Depression is one of the most common mental health problems worldwide and, while prevalence rates in Latin America are relatively high, most people who meet the criteria for diagnosis do not receive treatment. Family and friends of a person with depression can play an important role in supporting a person to seek and engage with treatment. However, many people do not have the necessary skills or confidence to help. English-language mental health first aid guidelines have been developed to support people to provide such help. The aim of this study was to culturally adapt these guidelines for Chile and Argentina. Methods: A Delphi expert consensus study was conducted with two expert panels, one of people with lived experience of depression (either their own or as a carer; n = 26) and one of health professionals (n = 29). Overall, 172 statements from the English-language guidelines were translated and compiled into a questionnaire. Participants were asked to rate statements based on how essential or important those statements were for Chile and Argentina and to suggest new statements if necessary. Results: Data were obtained over two survey rounds. Consensus was achieved on 172 statements. A total of 137 statements were adopted from the English-language guidelines, whereas 35 new endorsed statements were generated from panel suggestions. There were similarities between the English-language guidelines and those for Chile and Argentina. The adapted guidelines did not include some of the items from the English-language guidelines related to commenting on a person’s strengths or making judgements about their character, and also incorporated new items related to the incorporation of sociocultural considerations as causes of depression and attention to inequities in mental health. Conclusions: The significant number of new items underscores the importance of undertaking a careful process of cultural adaptation. Further research on dissemination and incorporation of the guidelines into the Mental Health First Aid training course for Chile and Argentina is still required.Fil: Encina Zúñiga, Esteban. Universidad de Chile; ChileFil: Agrest, Martín. No especifíca;Fil: Tapia Munoz, Thamara. University College London; Estados UnidosFil: Vidal-Zamora, Isidora. Universidad de Chile.; ChileFil: Ardila Gómez, Sara Elena. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Alvarado, Rubén. Universidad de Valparaíso; ChileFil: Leiderman, Eduardo A.. Universidad de Palermo. Facultad de Ciencias Sociales; ArgentinaFil: Reavley, Nicola. University of Melbourne; Australi

Development of mental health first-aid guidelines for suicide risk: a Delphi expert consensus study in Argentina and Chile

Background: Suicide continues to pose a significant global public health challenge and ranks as one of the leading causes of death worldwide. Given the prevalence of suicide risk in the community, there is a significant likelihood of encountering individuals who may be experiencing suicidal thoughts or plans, creating an opening for non-health professionals to offer support. This study aims to culturally adapt the original Australian Mental Health First Aid Guidelines for suicide risk to the Chilean and Argentine context. Methods: A two-round Delphi expert consensus study was conducted involving two panels, one comprising individuals with personal experience in suicide thoughts/attempts or caregiving for those with such experiences (n = 18), and the other consisting of professionals specialized in suicide assessment and support for individuals at risk (n = 25). They rated a total of 179 items mainly derived from guidelines developed by Australian experts and translated into Spanish (168), and new items included by the research team (11). The panel members were requested to assess each item utilizing a five-point Likert scale. During the second round, items that received moderate approval in the initial round were re-evaluated, and new items suggested by the local experts in the first round were also subjected to evaluation in the next round. Inclusion in the final guidelines required an 80% endorsement as “essential” or “important” from both panels. Results: Consensus of approval was reached for 189 statements. Among these, 139 statements were derived from the English-language guidelines, while 50 locally generated statements were accepted during the second round. A significant difference from the original guideline was identified concerning the local experts’ reluctance to discuss actions collaboratively with adolescents. Furthermore, the local experts proposed the inclusion of an entirely new section addressing suicide risk in older individuals, particularly focusing on suicide methods and warning signs. Conclusions: A Delphi expert consensus study was conducted to culturally adapt mental health first aid guidelines for assessing suicide risk in Chile and Argentina. This study involved professionals and individuals with lived experience. While many items were endorsed, some related to inquiring about suicide risk and autonomy, particularly for adolescents, were not. An additional section for older individuals was introduced. Future research should explore the implementation and impact of these adapted guidelines in training courses. This is vital for enhancing mental health support and implementing effective suicide prevention strategies in Chile and Argentina.Fil: Encina Zúñiga, Esteban. Universidad de Chile; ChileFil: Rodante, Demián. Universidad de Buenos Aires; ArgentinaFil: Agrest, Martín. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Tapia Muñoz, Thamara. University College London; Estados UnidosFil: Vidal Zamora, Isidora. Universidad de Chile.; ChileFil: Ardila Gómez, Sara Elena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; ArgentinaFil: Alvarado, Rubén. Universidad de Chile.; ChileFil: Leiderman, Eduardo A.. Universidad de Palermo. Facultad de Ciencias Sociales; ArgentinaFil: Reavley, Nicola. University of Melbourne; Australi

Neighborhood living with psychiatric patients and its impact on community attitudes: study in the Province of Buenos Aires, Argentina. 2012-2013

Objetivo: Analizar las transformaciones producidas en la comunidad de vecinos al tener entre sus miembros a personas externadas de hospitales psiquiátricos. Métodos: Estudio observacional analítico en el que se compararon zonas de vecinos de casas de convivencia en las que habitan personas externadas de un hospital psiquiátrico y zonas equivalentes pero sin casas de convivencia. Se elaboró y aplicó un cuestionario a 236 personas (grupo de estudio n=117; grupo control n=119), que indagaba por características del barrio, actitudes frente a poblaciones específicas e ideas frente a la enfermedad mental y su tratamiento. También se analizó una sub-muestra de vecinos (n=9) con otro cuestionario que exploraba por la convivencia barrial con las personas externadas y sus efectos. El análisis de los datos fue cuantitativo (SPSS 18.0) y cualitativo. Resultados: Se destaca la asociación estadísticamente significativa entre ser vecino y el grado de aceptación hacia personas con "enfermedad mental", y entre el grado de cohesión social y la aceptación de la "enfermedad mental". Conclusiones: La convivencia barrial con personas externadas tendría efectos en la salud mental de la comunidad, entendida ésta en términos psicosociales. Indexada en: Latindex Catálogo, Latindex Directorio.Objective: To analyze the effects on the neighbors’ attitudes related with the community living with people discharged from a psychiatric hospital. Methodology: Observational analytical study where two groups were compared: one composed by neighbors of group homes for discharged patients from a psychiatric hospital (study group, n = 117) and the other composed by an equivalent area but without group homes nearby (control group, n = 119). A questionnaire was administered to both groups and it explored: neighborhood features, attitudes toward certain groups, attitudes toward mental illness and its treatment. A sub-sample of the study group (n = 9) was re-contacted and a new questionnaire was administered with the purpose to analyzed in depth the community life with the group home tenants and its effects on the neighborhood and the neighbors. Data was analyzed quantitatively (SPSS 18.0) and qualitatively. Results: It was found a statistically significant difference between the study and the control group regarding acceptance toward people with mental illness. Also, and association between the level of social cohesion and the acceptance toward people with mental illness, was found. Conclusions: Community life with people discharged form psychiatric hospital would have an effect on the neighbors’ attitudes, which could be seen as a dimension of the community mental health.Fil: Ardila Gómez, Sara Elena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Fernández, Marina. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Hartfiel, María Isabel. Universidad Nacional Arturo Jauretche; ArgentinaFil: Guadalupe, Ares Lavalle. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Borelli, Mariana. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Canales, Valeria. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Stolkiner, Alicia Ines. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentin