[psychiatric Care Policies And Deinstitutionalization In South America].

The process of restructuring psychiatric care in South America began in the 80's and increased in the 90's. This process had its landmark in the Declaration of Caracas (1990), which reinforced the need for alternative services to the mental hospital. to analyse the current situation of the psychiatric care in South America, with special emphasis on Psychiatric Units in General Hospitals (PUGHs). Two mail surveys were carried out. Questionnaires were sent to all Ministries of Health, Psychiatric Societies and key informants. All countries were represented in the returned questionnaires. In 7 countries there is a mental health plan. Material and human resources are inadequate in most countries. There has been a decrease in the total number of psychiatric beds over the last tem years. PUGHs were created in all the countries surveyed. All South America countries have a mental health program. A higher percentage of the programs is devoid of an evaluation system and almost all the countries lack budget estimates for mental health care. It was observed that the total number of psychiatric beds has been decreasing in most countries, and that the PUGHs and other decentralized centers were adopted as an alternative to the mental hospital.2822-3

Psychiatric Care Policies And Deinstitutionalization In South America [las Políticas De Asistencia Psiquiátrica Y Desinstitucionalización En América Del Sur]

Introduction: The process of restructuring psychiatric care in South America began in the 80's and increased in the 90's. This process had its landmark in the Declaration of Caracas (1990), which reinforced the need for alternative services to the mental hospital. Objectives: to analyse the current situation of the psychiatric care in South America, with special emphasis on Psychiatric Units in General Hospitals (PUGHs). Methods: Two mail surveys were carried out. Questionnaires were sent to all Ministries of Health, Psychiatric Societies and key informants. Results: All countries were represented in the returned questionnaires. In 7 countries there is a mental health plan. Material and human resources are inadequate in most countries. There has been a decrease in the total number of psychiatric beds over the last tem years. PUGHs were created in all the countries surveyed. Conclusions: All South America countries have a mental health program. A higher percentage of the programs is devoid of an evaluation system and almost all the countries lack budget estimates for mental health care. It was observed that the total number of psychiatric beds has been decreasing in most countries, and that the PUGHs and other decentralized centers were adopted as an alternative to the mental hospital.2812230Herrera, A., Corona, L., Dagnino, R., Furtado, A., Gallopín, G., Gutman, P., Vessuri, H., (1994) Las Nuevas Tecnologías y El Futuro de América Latina: Riesgos y Oportunidades, , México: Siglo XXI EditoresGreenhill, M., Psychiatric Units in General Hospitals: 1979 (1979) Hosp. Community Psychiatry, 30, pp. 169-182Botega, N.J., Dalgalarrondo, P., (1997) Saúde Mental No Hospital Geral: Espaço para O Psíquico, , São Paulo: Editora HUCITECVessuri, H., Scientific cooperation among unequal partners: The strait-jacket of the human resource base (1998) Twentieth Century Science Beyond the Metropolis, , Gaillard J, ed. En prensaLeón, C.A., Psychiatry in Latin America (1972) Br J Psychatry, 121, pp. 121-136Bandeira, M., Desinstitucionalização ou transinstitucionalização: Lições de alguns países (1991) J Bras Psiq, 40, pp. 355-360Giel, R., Harding, T.W., Psychiatric priorities in developing countries (1976) Br J Psychiatry, 128, pp. 513-522Organización de Servicios de Salud Mental en los países en desarrollo (1975) Serie de Informes Técnicos, 564. , Ginebra: OMSMental Health care in developing countries: A critical appraisal of research findings (1984) Technical Report Series, 698. , Geneva: WHO(1990) Quality Assurance in Mental Health, , (Division of Mental Health). Geneve: WHODelgado, H., Trelles, J.O., La Psychiatrie dans L'Amérique du Sud (1939) Ann Méd Psychol, pp. 567-615. , XVo série, 97o Anne, T.IPerales, A., Sogi, C., Lolas, F., Pacheco, A., Samaniego, N., Matute, G., (1995) Orientación de la Atención Psiquiátrica en Sudamérica, , Lima: Instituto Nacional de Salud Mental «Honorio Delgado-Hideyo Noguchi»;Botega, N.J., Schechtman, A., Censo Nacional de Unidades de Psiquiatria em Hospitais Gerais: Situação atual e tendências (1997) Revista ABP-APAL, 19, pp. 79-86Ministerio de Salud y Acción Social. Secretaría de Política y Regulación de Salud. Dirección de Estadística e Información de Salud. Guía de Establecimientos Asistenciales de la República Argentina. Ministerio de Salud y Acción Social. Buenos Aires1995(1996) Recomendaciones del Primer Grupo de Trabajo de Los Directores de Salud Mental de Los Ministerios de Salud de America Latina Y de la Reunión de Evaluación de la Iniciativa para la Reestructuración de la Atención Psiquiátrica en América Latina, , (División de Promoción y Protección de la Salud). Panamá: OPS;Caplan, G., (1985) Principios de Psiquiatria Preventiva, , Buenos Aires: Ediciones Paidós;Raftery, J., Mental Health Services in Transition. The United States and the United Kingdom (1992) Br J Psychiatry, 161, pp. 589-593Crepet, P., The Italian mental health reform nine years on (1988) Acta Psychiatr Scand, 77, pp. 515-523Reali, M., A psiquiatria democrática italiana - Repercussões sociais: A mudança na abordagem da saúde mental (1990) J Bras Psiq, 39, pp. 8S-9S(1990) Declaración de Caracas: Conferencia Reestructuración de la Atención Psiquiátrica en América Latina, , Caracas: OPSDetre, T.P., Kupfer, D.J., General Hospital Psychiatric Service (1975) American Handbook of Psychiatry, pp. 607-617. , Silvano A, ed. New York: Basic Books PublicGoldman, H.H., Deinstitutionalization in international perspective: Variations on a theme (1983) Int J Ment Al Health, 11, pp. 153-165Flynn, R., Restructuring health system: A comparative analysis of England and the Netherlands (1993) New Agendas in the Study of the Policy Process, pp. 57-87. , Hill M, eds. London: Harverster WheatsheafBachrach, L.L., General Hospital Psyquiatry and Deinstitutionalization: A Systems View (1985) Gen Hosp Psychriatry, 7, pp. 239-248Vasconcelos, E.M., Avaliação dos avanços recentes em legislação psiquiátrica no plano internacional: Uma contribuição ao debate sobre a reforma da lei psiquiátrica no Brasil (1990) J Bras Psiq, 39, pp. 228-235Infante, R., Cultura e subjetividade: Ao encontro do elo perdido (1990) J Bras Psiq, 39, pp. 37S-9SAlarcón, R.D., (1990) Identidad de la Psiquiatría Latinoamericana: Voces Y Exploraciones en Torno a Una Ciencia Solidaria, , Buenos Aires: Siglo XXI EditoresResende, H., Políticas de Saúde Mental no Brasil: Uma visão histórica (1997) Cidadania e Loucura: Políticas de Saúde Mental No Brasil, , Tundis SA, Costa NR, org. Vozes, Petrópolis;Busnello, E., Entrevista publicada (1990) Identidad de la Psiquiatría Latinoamericana: Voces Y Exploraciones en Torno a Una Ciencia Solidaria, pp. 135-157. , Alarcón R. Buenos Aires: Siglo XXI Editores;Bachrach, L.L., On Exporting and Importing Model Programs (1988) Hosp. Community Psychiatry, 39, pp. 1257-1258Arana, J.D., Algunos obstáculos teóricos en la praxis de la psiquiatría comunitaria: Consideraciones transculturales (1992) Rev Neuro-Psiquiatr, 55, pp. 34-42León, C.A., Reflexiones en torno a la Salud Mental comunitaria en nuestro medio (1981) Rev Colom Psiquiatr, 10, pp. 91-105Juliá, J., Soler, F., Cevallos, M., Sánchez, C., Batlle, E., Petit, M.T., Boixet, M., Nogué, T., El servicio de psiquiatría en el hospital general (1984) Actas Luso-Esp Neurol Psiquiatr, 12, pp. 121-12

Restructuring mental health: a South American survey

Background: There is little information available on the changes in mental health services in South American countries following the social and political upheavals of recent decades. Methods: A postal survey was conducted of all South American countries (health ministries, national psychiatric associations and key informants) to assess the development of mental health programs and the organization of alternative Psychiatric care centers such as the psychiatric units in general hospitals (PUGH). Results: Most of the mental health programs were implemented during the 1980s and 1990s, and aimed at incorporating psychiatric care into primary health care, as well as relocating provision from large hospitals to decentralized services. Most of the countries surveyed have less than 0.5 psychiatric beds per 1000 inhabitants. This change reflects a tendency to reduce the total number of psychiatric beds and increase the number of PUGH. Over the last 10 years this increase was significant in some countries (50-75 %),but was not reflected in the availability of adequate human and material resources. Conclusions: A transition from a system based on large mental hospitals to alternative service provision is on the way in South American countries. Intensive efforts have to be made to collect and disseminate information, as well as to monitor the development and outcome of the mental health programs in these countries.36525625

Philanthropic General Hospitals: A New Setting For Psychiatric Admissions [hospitais Gerais Filantrópicos: Novo Espaço Para A Internação Psiquiátrica]

Objective: To understand the process that led Brazilian philanthropic general hospitals to implement psychiatric units and to describe the main characteristics and therapeutic approaches of these services. Methods: Ten institutions in three Brazilian states (Minas Gerais, São Paulo e Santa Catarina) were assesed in 2002. Forty-three semi-structured interviews were carried out with health professionals who worked at the hospitals to collect data on service implementation process, therapeutic approaches and current situation. The interviews were audio-recorded and their content was analyzed. Results: There was no mental hospital in the cities where the institutions were located. In five hospitals, psychiatric patients were admitted to general medical wards because there was no psychiatric unit. The therapeutic approach in six hospitals was based on psychopharmacological treatment. Due to lack of resources and more appropriate therapeutic planning, the admission of patients presenting psychomotor agitation increases resistance against psychiatric patients in general hospitals. Financial constraints regarding laboratory testing is still a challenge. There is no exchange between local authorities and hospital administrators of these institutions that are compelled to exceed the allowed number of admissions to meet the demand of neighboring cities. Conclusions: The need for mental health care to local populations combined with individual requests of local authorities and psychiatrists made possible the implementation of psychiatric units in these localities. In spite of the efforts and flexibility of health professional working in these institutions, there are some obstacles to be overcome: resistance of hospital community against psychiatric admissions, financial constraints, limited professional training in mental health and the lack of a therapeutic approach that goes beyond psychopharmacological treatment alone.40610421048Bachrach, L.L., General hospital psychiatry: Overview from a sociological perspective (1981) Am J Psychiatry, 138, p. 7Bicudo, M.A.V., (2000) Fenomenologia: Confrontos e avanços, , São Paulo: Moraes;Botega, N.J., Schechtman, A., Censo Nacional de Unidades de Psiquiatria em Hospitals Gerais: Situação atual e tendências (1997) Rev ABP-APAL, 19 (3), pp. 79-86Botega, N.J., Psychiatric units in Brazillian general hospitals: A growing philanthropic field (2002) Int J Soc Psychiatry, 48, pp. 97-102Botega, N.J., (2006) Prática psiquiátrica no hospital geral: Interconsulta a emergência, , 2a ed. Porto Alegre: Artes Médicas;De Francisco, D., Anderson, D., Pantano, R., Kline, F., The relation between length of hospital stay and rapid-readmission rates (1980) Hosp Community Psychiatry, 31, pp. 134-139Larrobia, C., Botega, N.J., Restructuring mental health: A South American survey (2001) Soc Psychiatry Psychiatr Epidemiol, 36, pp. 256-259Minayo, M.C.S., (1999) O desafio do conhecimento: Pesquisa qualitativa em saúde, , 6a ed. São Paulo: Hucitec;Turato, E.R., (2003) Tratado da metodologia da pesquisa clínico-qualitativa: Construção teórico-epistemológica, discussão comparada e aplicação nas áreas da saúde e humanas, , 2a ed. Petrópolis: Vozes;World Health Organization. Mental health care in developing countries: a critical appraisal of research findings. Geneva1984. [Technical Report Series, 698

Restructuring Mental Health: A South American Survey.

There is little information available on the changes in mental health services in South American countries following the social and political upheavals of recent decades. A postal survey was conducted of all South American countries (health ministries, national psychiatric associations and key informants) to assess the development of mental health programs and the organization of alternative psychiatric care centers such as the psychiatric units in general hospitals (PUGH). Most of the mental health programs were implemented during the 1980s and 1990s, and aimed at incorporating psychiatric care into primary health care, as well as relocating provision from large hospitals to decentralized services. Most of the countries surveyed have less than 0.5 psychiatric beds per 1000 inhabitants. This change reflects a tendency to reduce the total number of psychiatric beds and increase the number of PUGH. Over the last 10 years this increase was significant in some countries (50-75%), but was not reflected in the availability of adequate human and material resources. A transition from a system based on large mental hospitals to alternative service provision is on the way in South American countries. Intensive efforts have to be made to collect and disseminate information, as well as to monitor the development and outcome of the mental health programs in these countries.36256-