RESUMEN

The stepped care model (SCM) is a patient-centred approach to mental health care, offering a range of services from least to most intensive, tailored to individual needs. This scoping review examines the adoption, effectiveness, challenges and implications associated with applying SCM within primary mental health service delivery. Evidence from global sources suggests the model is viable, effective and useful. This review explores the literature available, clarifies fundamental concepts and identifies existing knowledge gaps. The literature search included CINAHL, MEDLINE, PsycINFO, Scopus, the Federation University library, Google and Google Scholar databases. A systematic keyword-based search using terms like "stepped care model," "mental health," and "primary care"; and a combination of keywords and subject headings, were used. The search strategy was refined by considering factors such as relevance, publication date, objectives and outcomes. This strategy yielded 20 papers compiled in this review. They include randomised controlled trials and cross-sectional studies. The review supports SCM adoption in primary mental health care but acknowledges the need for further research. Key inclusions of the review include cost-effectiveness, diverse diagnoses, efficacy and the model's structural configuration. Clear treatment details, delivery methods, intervention durations and chronological sequences are essential. This systematic approach enhances generalisability across different SCM models and areas, strengthening reliable inferences. In summary, the SCM holds promise for enhancing mental health service delivery. However, there is a need to further examine the factors that determine its effectiveness and understand the different ways in which SCM is implemented. Such inquiry forms the foundation for implementing and advancing mental health care services in Australia and internationally.

RESUMEN

BACKGROUND: Current policies to reduce the use of involuntary admissions are largely oriented towards specialist mental health care and have had limited success. We co-created, with stakeholders in five Norwegian municipalities, the 'Reducing Coercion in Norway' (ReCoN) intervention that aims to reduce involuntary admissions by improving the way in which primary mental health services work and collaborate. The intervention was implemented in five municipalities and is being tested in a cluster randomized control trial, which is yet to be published. The present study evaluates the implementation process in the five intervention municipalities. To assess how the intervention was executed, we report on how its different elements were implemented, and what helped or hindered implementation. METHODS: We assessed the process using qualitative methods. Data included detailed notes from quarterly progress interviews with (i) intervention coordinators and representatives from (ii) user organisations and (iii) carer organisations. Finally, an end-of-intervention evaluation seminar included participants from across the sites. RESULTS: The majority of intervention actions were implemented. We believe this was enabled by the co-creating process, which ensured ownership and a good fit for the local setting. The analysis of facilitators and barriers showed a high degree of interconnectedness between different parts of the intervention so that success (or lack thereof) in one area affected the success in others. Future implementation should pay attention to enhanced planning and training, clarify the role and contribution of service user and carer involvement, and pay close attention to the need for implementation support and whether this should be external or internal to services. CONCLUSIONS: It is feasible to implement a complex intervention designed to reduce the use of involuntary admissions in general support services, such as the Norwegian primary mental health services. This could have implications for national and international policy aimed at reducing the use of involuntary care.

RESUMEN

To develop and pilot-test a feasible and meaningful evaluation framework to support the ongoing improvement and performance measurement of services and systems in Latin America regarding Collaborative Mental health Care (CMHC). This mixed methods study, guided by a developmental evaluation approach, included: (1) a critical review of the literature; (2) an environmental scan at three selected health networks in Mexico, Nicaragua and Chile; (3) a Delphi group with experts; (4) a final consultation in the three sites; and (5) a pilot-test of the framework. A comprehensive evaluation framework was developed and successfully piloted. It considers five levels, 28 dimensions and 40 domains, as well as examples of indicators and an implementation plan. This evaluation framework represents an important effort to foster accountability and quality regarding CMHC in Latin America. Recommendations to build upon current capacity and to effectively address the existing implementation challenges are further discussed.

Asunto(s)

RESUMEN

Introduction: People with severe mental illness often have a small or no network of friends and limited contact with their family and live social isolated lives. We developed a social skills training programme to be administered by public mental health professionals in helping those with mental illness to overcome their social isolation. Methods: The programme was developed over 3 years in close collaboration among psychologists, service users, municipal mental health professionals, mental health service researchers and a local firm providing virtual reality (VR) training. We started with the simplest available equipment, that is, a cardboard headset combined with a smartphone, then we used Oculus Quest and now Oculus Quest 2. Results: The resulting programme is comprised of eight steps from: 1) identify service user's primary and secondary goals to 8) three-month follow-up. Conclusion: Several factors made adoption and implementation of VR technology possible in a relatively short timeframe: namely, the municipality and service users were involved from the beginning of the development process, efforts were made to introduce VR to mental health professionals and allow them to reflect on its usability, solutions were low-tech and low cost, and the long-term research collaboration was established without municipal financial obligations.

RESUMEN

Background: This study investigated the trends in primary mental health care (PMHC) service use and hospital-treated self-harm in Western Sydney (Australia). Methods: A data linkage study and descriptive ecological study of PMHC referrals investigated the trends in referrals, treatment attendance, hospital-treated self-harm, and health care practitioners (HCPs) for the period of 2013−2018 (n = 19,437). Results: There was a substantial increase in referrals from 2016. The majority of referrals were females (60.9%), those aged <45 years (71.3%), and those presenting with anxiety or affective disorders (78.9%). Referrals of those at risk of suicide increased from 9.7% in 2013 to 17.8% in 2018. There were 264 (2.2%) cases of subsequent hospital-treated self-harm, with higher rates among those at risk of suicide and those who attended <6 sessions. The number of HCPs per referral also increased from 2013, as did waiting times for treatment initiation. Conclusion: Individuals presenting to PMHC services at risk of suicide, and who subsequently presented to a hospital setting following self-harm, were more likely to either not attend services following a referral or to attend fewer services. This trend occurred in the context of an increase in the number of clients per HCP, suggesting workforce capacity has not kept pace with demand.

Asunto(s)

RESUMEN

Objective: Paths toward referral to involuntary psychiatric admission mainly unfold in the contexts where people live their everyday lives. Modern health services are organized such that primary health care services are often those who provide long-term follow-up for people with severe mental illness and who serve as gatekeepers to involuntary admissions at the secondary care level. However, most efforts to reduce involuntary admissions have been directed toward the secondary health care level; interventions at the primary care level are sparse. To adapt effective measures for this care level, a better understanding is needed of the contextual characteristics surrounding individuals' paths ending in referrals for involuntary admission. This study aims to explore what characterizes such paths, based on the personal experiences of multiple stakeholders. Method: One hundred and three participants from five Norwegian municipalities participated in individual interviews or focus groups. They included professionals from the primary and secondary care levels and people with lived experience of severe mental illness and/or involuntary admission and carers. Data was subject to constant comparison in inductive analysis inspired by grounded theory. Results: Four main categories emerged from the analysis: deterioration and deprivation, difficult to get help, insufficient adaptation of services provided, and when things get acute. Combined, these illustrate typical characteristics of paths toward referral for involuntary psychiatric admission. Conclusion: The results demonstrate the complexity of individuals' paths toward referral to involuntary psychiatric admission and underline the importance of comprehensive and individualized approaches to reduce involuntary admissions. Furthermore, the findings indicate a gap in current practice between the policies to reduce involuntary admissions and the provision of, access to, and adaptation of less restrictive services for adults with severe mental illness at risk of involuntary admissions. To address this gap, further research is needed on effective measures and interventions at the primary care level.

RESUMEN

Female Genital Mutilation (FGM) has been identified as one of the most serious human rights violations women are exposed to in many countries, in spite of national and international efforts. The actual implementation of preventive strategies and support of victims faces a number of challenges that can only be addressed by an interdisciplinary approach integrating public health and legal considerations. FGM in the context of women as refugees who left their country to escape FGM has rarely been covered in this context. This article summarizes the most important international standards and initiatives against FGM, highlights the medical, legal, and psychological factors identified so far, and explores the interdisciplinary considerations in changing a country and society to permit safe return of those escaping FGM to third countries and support public health in the country.

Asunto(s)

RESUMEN

Over the past two decades, the value and benefits of integrated mental health care services have been increasingly recognised. Despite the potential benefits, barriers exist at primary care level to receiving mental health care services, interfering with continuity of care. We conducted semi-structured interviews with mental healthcare users at a primary care clinic in South Africa, to explore their experiences of receiving mental health care services. A convenience sample of 15 participants identified challenges such as limited infrastructure, organisation, medication, services in local communities, allied mental health care services, communication and long waiting times. Mental health care users felt uncared for and disrespected, especially if they were treated by unskilled and overworked staff. Mental health care users described clinic visits as stressful and frustrating. Mental health care users described marked challenges in mental health care service provision in a South African primary health care setting.

Asunto(s)

RESUMEN

OBJECTIVE: Continued engagement with primary mental health services has been associated with the prevention of subsequent suicidal behaviour; however, there are few studies that identify determinants of treatment disengagement among those at risk of suicide in primary care settings. This study investigated determinants of treatment disengagement of those at risk of suicide who were referred to primary mental health care services in Western Sydney, Australia. METHOD: This study used routinely collected data of those referred for suicide prevention services provided through primary mental health care services between July 2012 and June 2018. Associations between sociodemographic, diagnostic, referral- and service-level factors and treatment non-attendance and early treatment cessation were investigated using a series of multivariable generalised estimation equations. RESULTS: There were 1654 suicidal referrals for 1444 people during the study period. Those identified with a risk of suicide were less likely to never attend treatments (16.14% vs 19.77%), but were more likely to disengage earlier from subsequent service sessions (16.02% vs 12.41%), compared to those with no risk of suicide. A higher likelihood of non-attendance to any primary mental health care service sessions was associated with those aged 25-44, lower socioeconomic status, a presentation for substance use and a referral from acute care (either emergency department or hospital). Among those who attended an initial treatment session, younger age (18-24 years) and a longer waiting time for an initial follow-up appointment were associated with a higher likelihood of early treatment cessation from primary mental health care services. CONCLUSION: These findings can inform potential strategies in routine primary mental health care practice to improve treatment engagement among those at risk of suicidal behaviour. Youth-specific interventions, behavioural engagement strategies and prompt access to services are policy and service priorities.

Asunto(s)

RESUMEN

Guided by international best practice and evidence-based medicine, the Qatar mental health service has undergone a major transformation in the last two decades, replacing the institution-based service with an accessible multidisciplinary community-based service. In this paper, we provide a brief historical background to mental health services in Qatar, and the progress and development towards community-based mental health-care provision. We also explore the challenges facing this new model of care in Qatar including social and cultural sensitivities, and the various solutions adopted to overcome these challenges. We outline the comprehensive plans envisaged to further develop Qatar community mental health services, including the provision of accessible, integrated and multimodal mental health care within primary care settings.

RESUMEN

The current system of mental health care in Greece was created in accordance with the European Union and other international principles for mental health care provisions. Whereas Greece has been reforming its system of mental health care since at least the 1980s, the main recent Greek effort has been "Psychargos", a program which began in 2000 and is still in effect. During the last two decades the Greek mental health system has been gradually shifting to a community-based system of care. Various services with unique, yet intertwined, responsibilities have been introduced. The Greek system of mental health care still faces challenges, and the mental health reform is ongoing. Future goals should be to improve the current framework of care and access to care by establishing community mental health services across the country that are fit for purpose, enhancing multidisciplinary collaboration and patient involvement, integrating community mental health care with physical and social care services, and ensuring that service development is driven by need. Crucially, such aims demand the adoption of a culture of clinical governance and a consistent shift from traditional therapeutic care to person-centred psychiatry and preventive psychiatry.

RESUMEN

BACKGROUND: Reducing involuntary psychiatric admissions has been on the international human rights and health policy agenda for years. Despite the last decades' shift towards more services for adults with severe mental illness being provided in the community, most research on how to reduce involuntary admissions has been conducted at secondary health care level. Research from the primary health care level is largely lacking. The aim of this study was to explore mental health professionals' experiences with factors within primary mental health services that might increase the risk of involuntary psychiatric admissions of adults, and their views on how such admissions might be avoided. METHODS: Qualitative semi-structured interviews with thirty-two mental health professionals from five Norwegian municipalities. Data were analysed according to the Systematic Text Condensation method. RESULTS: Within primary mental health care professionals experienced that a number of factors could increase the risk of involuntary psychiatric admissions. Insufficient time and flexibility in long-term follow-up, limited resources, none or arbitrary use of crisis plans, lack of tailored housing, few employment opportunities, little diversity in activities offered, limited opportunities for voluntary admissions, inadequate collaboration between services and lack of competence were some of the factors mentioned to increase the risk of involuntary psychiatric admissions. Several suggestions on how involuntary psychiatric admissions might be avoided were put forward. CONCLUSIONS: Mental health professionals within primary mental health care experienced that their services might play an active part in preventing the use of involuntary psychiatric admissions, suggesting potential to facilitate a reduction by intervening at this service level. Health authorities' incentives to reduce involuntary psychiatric admissions should to a greater extent incorporate the primary health care level. Further research is needed on effective interventions and comprehensive models adapted for this care level.

RESUMEN

BACKGROUND: Adolescents' self-defined concerns about their mental health are understudied. Yet gaining insight into the individual concerns of this group could be helpful in providing better services to the adolescent population. In this study, an idiographic procedure called Assert was used to increase our knowledge of which concerns are reported by adolescents as the most salient, in a primary mental health care situation. METHOD: 231 unique concerns were reported by 70 adolescents in a primary mental health context in Norway. These concerns were analysed qualitatively by a group of experts, to define categories. The distribution of these categories, and differences in gender and age, were analysed quantitatively. The alleviation experienced on the subjective concerns over the course of counselling was measured. Two linear multilevel models were analysed, to examine whether alleviation on self-defined concerns, as measured with Assert, differed-based on the main category of the concern or the number of times Assert was used. RESULTS: Three main categories of concerns emerged, related to (1) Self, (2) Relationships and (3) Life domains; as well as nine sub-categories: (1a) Autonomy, (1b) Mental health, (1c) Somatic health, (2a) Improving of relationships, (2b) Feeling safe from people around them, (2c) Taking responsibility for others, (3a) School, (3b) Work and (3c) Spare time. Girls reported fewer Life domain concerns than boys. Younger adolescents (12-16) more frequently reported no Self concerns, and older adolescents (17-23) more frequently reported no Relationship concerns. The adolescents felt less bothered by their subjective concerns after counselling, and there were some differences in alleviation depending on the category of concern. CONCLUSIONS: The adolescents defined their own concerns at the start of counselling and were less troubled by these concerns after counselling. The content of the concerns might suggest that these adolescents experienced a need to improve across several arenas: personal, relational and academic. Research to extend the current study, to understand individual adolescent concerns, should include contextual and social factors and personal characteristics-and explore how counselling interventions can best help alleviate these personal concerns.

Asunto(s)

RESUMEN

Recently, mental health and ill health have been reframed to be seen as a continuum from health to ill health, through the stages of being asymptomatic 'at risk', to experiencing 'mental distress', 'sub-syndromal symptoms' and finally 'mental disorders'. This new conceptualisation emphasised the importance of mental health promotion and prevention interventions, aimed at reducing the likelihood of future disorders with the general population or with people who are identified as being at risk of a disorder. This concept generated discussion on the distinction between prevention and treatment interventions, especially for those mental health conditions which lie between psychological distress and a formal psychiatric diagnosis. The present editorial aims to clarify the definition of promotion, prevention and treatment interventions delivered through a task-shifting approach according to a global mental health perspective.

Asunto(s)

RESUMEN

BACKGROUND: Regionally-specific approaches to primary mental health service provision through Primary Health Networks (PHNs) have been a feature of recent national mental health reforms. No previous studies have been conducted to investigate local patterns of primary mental health care (PMHC) services in Western Sydney. This study is designed to (i) understand the socio-demographic and economic profiles (ii) examine the inequalities of service access, and (iii) investigate the service utilisation patterns, among those referred to PMHC services in Western Sydney, Australia. METHODS: This study used routinely collected PMHC data (2005-2018), population-level general practice and Medicare rebates data (2013-2018) related to mental health conditions, for the population catchment of the Western Sydney PHN. Sex- and age-specific PMHC referrals were examined by socio-demographic, diagnostic, referral- and service-level factors, and age-specific referrals to PMHC services as a percentage of total mental health encounters were investigated. RESULTS: There were 27,897 referrals received for 20,507 clients, of which, 79.19% referrals resulted in follow-up services with 138,154 sessions. Overall, 60.09% clients were female, and median age was 31 years with interquartile ranged 16-46 years. Anxiety and depression were the predominant mental health condition, and 9.88% referred for suicidal risk. Over two-thirds of referrals started treatments during the first month of the referral and 95.1% of the total sessions were delivered by face to face. The younger age group (0-24) had greater referral opportunities as a percentage of total visits to a general practitioner and Medicare rebates, however demonstrating poor attendance rates with reduced average sessions per referral compared with older adults. CONCLUSION: Children and young adults were more likely to be referred to PMHC services than older adults, but were less likely to attend services. Further research is needed to identify the strategies to address these differences in access to PMHC services to optimise the effectiveness of services.

RESUMEN

BACKGROUND: The subject of how the initial allocation of the primary mental health professional (PMHP) in community mental health services is made and the frequency and management of users' requests to choose and/or change their allocated PMHPs has been scarcely investigated. The present paper is aimed at exploring the experiences and opinions of directors of community mental health centers (CMHC) on this topic. METHODS: A cross-sectional survey was conducted. Electronic ad hoc questionnaires with both multiple choice and open-ended questions were e-mailed to the institutional addresses of CMHC directors in the Emilia-Romagna Region (Northern Italy) with the consent of their heads of department and the Ethical Committee. Quantitative data were analysed by means of Microsoft Excel software and STATA 14.2 (College Station, TX), while the qualitative analysis was performed using the Nvivo12 software. RESULTS: Twenty-eight questionnaires were collected (response rate: 71.8%) that were equally distributed between males and females. For the initial PMHP allocation, casual allocation by "fixed-rota" was commonly performed (39.3%). Moreover, hope for a change of prescription by a different psychiatrist was the most frequent reason for users' requests to change their PMHP. In two mental health departments only (Parma and Bologna), written guidelines to manage users' requests of change of PMHP were available. In this context, most participants classified the explored topics as relevant and believed that written policies, especially if shared with users, could be useful. CONCLUSIONS: In Emilia-Romagna CMHCs, neither users nor professionals were generally involved in the initial choice of the PMHP. Further national-level studies should be conducted in order to confirm this finding. Additionally, written and shared guidelines for managing users' request to choose/change their PHMP may be useful.

RESUMEN

BACKGROUND: The recovery model in mental health care emphasizes users' right to be involved in key decisions of their care, including choice of one's primary mental health professional (PMHP). AIMS: The aim of this article was to provide a scoping review of the literature on the topic of users' choice, request of change and preferences for the PMHP in community mental health services. METHOD: A search of the PubMed, Cochrane Library, Web of Science and PsycINFO for papers in English was performed. Additional relevant research articles were identified through the authors' personal bibliography. RESULTS: A total of 2,774 articles were screened and 38 papers were finally included. Four main aspects emerged: (1) the importance, for users, to be involved in the choice of their PMHP; (2) the importance, for users, of the continuity of care in the relationship with their PMHP; (3) factors of the user/PMHP dyad influencing users' preferences; and (4) the effect of choice on the treatment outcomes. CONCLUSION: While it is generally agreed that it is important to consider users' preferences in choosing or requesting to change their PMHP, little research on this topic is available. PMHPs' and other stakeholders' views should also be explored in order to discuss ethical and practical issues.

Asunto(s)

RESUMEN

A presente tese descreve uma investigação sobre "A Inserção da Saúde Mental na Atenção Primária: um estudo qualitativo das práticas de profissionais na cidade de Manaus". As temáticas propostas para este estudo, Saúde Mental e Atenção Primária, foram tomadas em uma concepção de interdependência, pois em si carregam seus próprios princípios. No entanto, entendemos que não é possível pensar uma separada da outra, para a análise dos desafios que propõem suas inter-relações quando inseridas no desenvolvimento de práticas de cuidado por profissionais de saúde. As estratégias metodológicas utilizadas incluíram pesquisa documental e entrevistas, buscando delinear a construção da política e a articulação das práticas em saúde. Neste contexto o objetivo central foi investigar a integração da Saúde Mental na Atenção Primária a partir da análise das práticas de profissionais, que atuam neste nível de atenção na cidade de Manaus, a fim de subsidiar a discussão do cuidado em saúde mental. Os profissionais, embora em muitos casos, tenham abertura para a formação e ampliação dos conhecimentos da inter-relação entre saúde mental e atenção primária, esbarram nas dificuldades trazidas pelo cotidiano do serviço, e a distância temporal entre uma discussão e outra, que tenha como temática a saúde mental e o cuidado no primeiro nível da atenção em saúde do SUS. Quatro conceitos foram fundamentais na execução da pesquisa, o conceito de Saúde Mental, tomado em sua multidimensionalidade e complexidade; Atenção Primária como porta de entrada ao SUS; as Práticas Profissionais, como previstas nos documentos oficiais; e criamos um conceito de Cuidado em Saúde Mental que consiste em acolher os sujeitos em suas demandas, identificar os meios necessários para atende-las e possibilitar o desenvolvimento da autonomia para que os mesmos encontrem as alternativas para viver as suas subjetividades e os meios de lidar com o cotidiano da vida em sua potencialidade. Foi realizada pesquisa de abordagem qualitativa da qual participaram 35 profissionais de saúde vinculados à Atenção Primária à Saúde. O método de análise das informações foi o Método Temático de Conteúdo. Os resultados mostraram a fragilidade do processo de integração da Saúde Mental na Atenção Primária em Manaus, a partir da análise das práticas profissionais. O estudo concluiu que embora desenvolvam as práticas previstas nos documentos oficiais, e em determinadas situações façam investimento pessoal na sua resolução, estão distantes de representar o cuidado em Saúde Mental conforme descrito nos manuais ou nos estudos baseados em evidências. No entanto, há um esforço conjunto e compartilhado, entre os profissionais de saúde, comprometidos com a defesa do SUS, de desenvolver estratégias e criar os recursos necessários para consolidar a integração da Saúde Mental na Atenção Primária na cidade de Manaus

This thesis describes an investigation about "insertion mental health into primary care: a qualitative study of the practices of the professionals of the city of Manaus". The central thematic axes, proposed for this study, are mental health and primary health care; They were taken in a design of interdependence and carry their own epistemological principles. However, we understand that it is not possible to think of one, separated from the other, for the analysis of the challenges that are inter-related, when they are inserted in the practices of development of the care, in mental health. Methodological strategies include research and interviews, seeking to delineate the construction of policies and the articulation of mental health practices in primary care. In this context, the main objective was to investigate the integration of mental health, in primary care, based on the analysis of the professional practices that work in this level of health care, in the city of Manaus, in order to subsidize the proposed discussion. The professional people interviewed, although in many cases have been open to training and the expansion of knowledge regarding the interrelation between mental health and primary care, face the difficulties of the daily life of service to the Users and the temporary distance between one discussion and another, which are part of the topic of mental health and care in the first level of health care of the SUS (Sistema Único de Saúde). Four concepts were instrumental in the application of research: the concept of mental health, in its multidimensionality and complexity; Primary health care, as a gateway to theirs; The professional practices provided for in the official documents; And it created a concept of primary mental health care that consists in accepting the subjects in their demands, to identify the means to respond and to allow the development of the autonomy, so that the user people find the alternatives to live their subjectivities and the means of Dealing with daily life, in its full potential. Qualitative research was carried out through several techniques, where 35 professionals were involved in primary health care. The method of information analysis was the thematic content method. The results demonstrated the fragility of the process of integrating mental health, in primary care, based on the analysis of professional practices currently being exercised in Manaus. The study concludes that while the development of practices, contemplated in official documents and in certain situations, make personal investments in their resolution, they are far from representing the primary mental health care, as described in the manuals or Evidence-based studies. However, there is a joint and shared effort in health professionals, committed to the defense of their, who generate strategies and create the resources necessary to gradually consolidate the integration of mental health in primary care of health, in the city of Manaus, Brazil

Esta tesis describe una investigación acerca de "La inserción de la salud mental en la atención primaria: un estudio cualitativo de las prácticas de los profesionales de la ciudad de Manaus". Los ejes temáticos centrales, propuestos para este estudio, son la salud mental y la atención primaria de la salud; se tomaron en un diseño de interdependencia y conllevan sus propios principios epistemológicos. Sin embargo, entendemos que no es posible pensar a uno, separado del otro, para el análisis de los retos que están inter-relacionados, cuando se insertan en las prácticas de desarrollo de la atención, en salud mental. Las estrategias metodológicas incluyen la investigación y entrevistas, buscando delinear la construcción de las políticas y la articulación de las prácticas de salud mental, en la atención primaria. En este contexto, el objetivo principal fue investigar la integración de la salud mental, en la atención primaria, a partir del análisis de las prácticas profesionales que se trabajan en este nivel de atención de la salud, en la ciudad de Manaus, con el fin de subsidiar la discusión propuesta. Las personas profesionales entrevistadas, aunque en muchos casos se han abierto a la formación y la expansión del conocimiento con respecto a la interrelación entre la salud mental y la atención primaria, afrontan las dificultades de la vida diaria del servicio a las personas usuarias y la distancia temporal entre un discusión y otra, que son parte de tema de la salud mental y la atención en el primer nivel de atención de salud del SUS (Sistema Único de Salud). Cuatro conceptos fueron instrumentales en la aplicación de la investigación: El concepto de salud mental, en su multidimensionalidad y complejidad; el de atención primaria de la salud, como puerta de entrada a SUS; Las prácticas profesionales, previstas en los documentos oficiales; y se creó un concepto de salud mental que consiste en acoger los temas en sus demandas, identificar los medios para responder y permitir el desarrollo de la autonomia, para que las personas usuarias encuentren las alternativas para vivir sus subjetividades y los medios de ocuparse de la vida diária, en todo su potencial. La investigación cualitativa se llevó a cabo a través de técnicas varias, donde asistieron 35 profesionales vinculados a la atención primaria de la salud. El método de análisis de la información fue el método de contenido temático. Los resultados demostraron la fragilidad del proceso de integración de la salud mental, en la atención primaria, a partir del análisis de las prácticas profesionales que se ejercen en la actualidad, en Manaus. El estudio concluye que mientras que el desarrollo de las prácticas, contempladas en documentos oficiales y en ciertas situaciones, hacen inversiones personales en su resolución, distan de representando a la salud mental, como se describe en los manuales o en los estudios, basada en la evidencia. Sin embargo, hay un esfuerzo conjunto y compartido en los profesionales de la salud, comprometidos con la defensa de SUS, quienes generan estrategias y crean los recursos necesarios para consolidar paulatinamente la integración de la salud mental, en atención primaria de la salud, en la ciudad de Manaus, Brasil.

Asunto(s)

RESUMEN

BACKGROUND:  Mental health legislation (MHL) is required to ensure a regulatory framework for mental health services and other providers of treatment and care, and to ensure that the public and people with a mental illness are afforded protection from the often-devastating consequences of mental illness. AIMS:  To provide an overview of evidence on the significance of MHL for successful primary care for mental health and community mental health servicesMethod: A qualitative review of the literature on the significance of MHL for successful primary care for mental health and community mental health services was conducted. RESULTS:  In many countries, especially in those who have no MHL, people do not have access to basic mental health care and treatment they require. One of the major aims of MHL is that all people with mental disorders should be provided with treatment based on the integration of mental health care services into the primary healthcare (PHC). In addition, MHL plays a crucial role in community integration of persons with mental disorders, the provision of care of high quality, the improvement of access to care at community level. Community-based mental health care further improves access to mental healthcare within the city, to have better health and mental health outcomes, and better quality of life, increase acceptability, reduce associated social stigma and human rights abuse, prevent chronicity and physical health comorbidity will likely to be detected early and managed. CONCLUSION:  Mental health legislation plays a crucial role in community integration of persons with mental disorders, integration of mental health at primary health care, the provision of care of high quality and the improvement of access to care at community level. It is vital and essential to have MHL for every country.

Asunto(s)

RESUMEN

The worldwide burden of mental disorders is considerable, and on the rise, putting pressure on health care systems. Current reforms aim to improve the efficiency of mental health care systems by increasing service integration in communities and strengthening primary mental health care. In this context, mental health care professionals (MHPs) are increasingly required to work on interdisciplinary teams in a variety of settings. Little is known, however, about the profiles of MHPs in relation to their perceived work role performance. MHPs in Quebec (N = 315) from four local service networks completed a self-administered questionnaire eliciting information on individual and team characteristics, as well as team processes and states. Profiles of MHPs were created using a two-step cluster analysis. Five profiles were generated. MHPs belonging to profiles labelled senior medical outpatient specialized care MHPs and senior psychosocial outpatient specialized care MHPs perceived themselves as more performing than MHPs in other profiles. The profile labelled low-collaborators was significantly less performing than all other groups. Two other profiles were identified, positioned between the aforementioned groups in terms of the perceived performance of MHPs: the junior primary care MHPs and the diversified specialized care MHPs. Seniority within the team, delivering specialized type of care, and positive team processes were all features associated with profiles where perceived work performance was high. Overall, this study supports the case for initiatives aimed at improving stability and interdisciplinary collaboration in health teams, especially in primary care.

Asunto(s)