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Trata de um documento que aborda a ampliação do acesso à atenção psicossocial da população da Macrorregião de Saúde Norte no Estado do Tocantins. Tem os objetivos de dimensionar os vazios assistenciais; propor novos pontos da Rede de Atenção Psicossocial; Definir e organizar a Rede de Atenção Psicossocial. Alcança as metas de: Implantar 13 novos serviços dos componentes da Rede de Atenção Psicossocial na Macrorregião Norte nos próximos dois anos e de qualificar trabalhadores da Rede de Atenção Psicossocial.

It deals with a document that addresses the expansion of access to psychosocial care for the population of the Northern Health Macroregion in the State of Tocantins. It has the objectives of dimensioning the gaps in care; propose new points of the Psychosocial Care Network; Define and organize the Psychosocial Care Network. It achieves the goals of: Implementing 13 new services from the components of the Psychosocial Care Network in the North Macro-region over the next two years and qualifying workers in the Psychosocial Care Network.

Se trata de un documento que aborda la ampliación del acceso a la atención psicosocial de la población de la Macrorregión de Salud Norte del Estado de Tocantins. Tiene los objetivos de dimensionar las brechas en la atención; proponer nuevos puntos de la Red de Atención Psicosocial; Definir y organizar la Red de Atención Psicosocial. Logra las metas de: Implementar 13 nuevos servicios de los componentes de la Red de Atención Psicosocial en la Macrorregión Norte en los próximos dos años y calificar a los trabajadores de la Red de Atención Psicosocial.

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INTRODUCTION: The COVID-19 pandemic is having an impact on multiple levels, one being the way of providing mental health care services. A study was proposed in order to identify the standpoints regarding the role we must assume as psychiatrists in the setting of this pandemic in Colombia. METHODS: A study was developed employing a Delphi-type methodology. Three types of psychiatrist were included for the application of the instrument: directors of academic psychiatry programmes, directors of mental health institutions and private practitioners. RESULTS: Responses were collected over the course of a month (between April and May) by 24 participants corresponding to 14 private practitioners (58.3%), 6 heads of academic programmes (25.1%) and 4 directors of mental health services (16.6%). The results, grouped around the psychiatric work, describe the impact generated by the pandemic and the possible role of the specialist. CONCLUSIONS: Consistency was identified around the need to provide a differential approach according to the vulnerabilities of each group of people exposed to the pandemic; as well as the remote provision of health care through technology, often using videoconferencing.

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This article addresses recent political, legal and welfare changes to mental health policies in Brazil, demonstrating their effects of Psychiatric Counter-Reform. Based on documentary analysis, we explain the tensions generated by this process, with its repercussions for the complex process of Brazilian Psychiatric Reform, particularly for the Psychosocial Healthcare Network. We discuss the paradoxical case of Counter-Counter-Reform, using the state of Bahia as an example because of its recent proposal to close psychiatric hospitals with the announced aim of deinstitutionalizing people who have been hospitalized, which does not coincide with this moment of change in Brazilian mental health policy. We conclude that the risk of the worsening of the sanitary, social and economic crisis in the country requires increased advocacy and mobilization measures, in order to prevent the loss of social protection mechanisms, which also include mental health. This crisis simultaneously poses a threat to human rights and to the inclusion of people in psychological distress, at the same time as it presents an opportunity to reinvigorate a reform that was at the peak of activity.

Este artigo aborda as mudanças político-legais e assistenciais no âmbito das políticas públicas de saúde mental no Brasil, demonstrando seus efeitos de Contrarreforma Psiquiátrica. Com base em uma análise documental, foi possível explicitar as tensões geradas nesse processo, com suas repercussões sobre a Reforma Psiquiátrica Brasileira, enquanto processo complexo, especialmente sobre a Rede de Atenção Psicossocial. É discutido, como um caso paradoxal de Contra-Contrarreforma, o exemplo do estado da Bahia, pela sua recente proposta de fechamento dos hospitais psiquiátricos, na direção de uma anunciada intenção de desinstitucionalização das pessoas internadas, que não coincide com o momento da mudança de política de saúde mental brasileira. Conclui-se que o risco de aprofundamento da crise sanitária, social e econômica em todo o território nacional demanda o incremento de medidas de advocacy e mobilização, no sentido de evitar perdas de mecanismos de proteção social, o que também contempla a saúde mental, que simultaneamente se coloca como ameaça aos direitos humanos e à inclusão de pessoas em sofrimento psíquico, mas também como uma oportunidade de reimpulsionar uma reforma que estava em pleno devir.

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An interview with Jorge Luis Pellegrini, psychiatrist, founder of Institutional Groups against Alcoholism. Among other distinctions, in 2005 he received the Geneva Prize for Human Rights in Psychiatry.

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OBJECTIVE: To describe the highlights in the personal, professional, and political life of the first Brazilian Professor of Psychiatry. METHODS: The article draws on a wide range of documents: newspaper articles, documents of Brazilian medical institutions, scientific articles, theses, and books. RESULTS: João Carlos Teixeira Brandão was a distinguished 19th-century Brazilian psychiatrist and leader of the institutionalization and consolidation of the field of Psychiatry in Brazil. He contributed to the recognition of the professional jurisdiction of the "alienist", a specialized professional, qualified in clinical practice, diagnosis, and the definition of the boundaries between sanity and madness, based on scientific criteria, in the late 19th and early 20th centuries. CONCLUSION: This article highlights the key moments in the professional and political career of Professor João Carlos Teixeira Brandão, from his graduation from the Rio de Janeiro School of Medicine in 1877 to his death in 1921, when he was still active in national politics.

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ABSTRACT Aim: To describe the highlights in the personal, professional, and political life of the first Brazilian Professor of Psychiatry. Methods: The article draws on a wide range of documents: newspaper articles, documents of Brazilian medical institutions, scientific articles, theses, and books. Results: João Carlos Teixeira Brandão was a distinguished 19th-century Brazilian psychiatrist and leader of the institutionalization and consolidation of the field of Psychiatry in Brazil. He contributed to the recognition of the professional jurisdiction of the "alienist", a specialized professional, qualified in clinical practice, diagnosis, and the definition of the boundaries between sanity and madness, based on scientific criteria, in the late 19th and early 20th centuries. Conclusion: This article highlights the key moments in the professional and political career of Professor João Carlos Teixeira Brandão, from his graduation from the Rio de Janeiro School of Medicine in 1877 to his death in 1921, when he was still active in national politics.

RESUMO Descrever os principais pontos da vida pessoal, profissional e política do primeiro professor brasileiro de Psiquiatria. Métodos: Todas as fontes de documentos - artigos de jornais, documentos das instituições médicas brasileiras, artigos médicos, teses e livros. Resultados: João Carlos Teixeira Brandão foi um ilustre psiquiatra brasileiro do século XIX e líder da institucionalização e consolidação do campo de Psiquiatria no Brasil. Contribuiu para o reconhecimento da jurisdição profissional do "alienista", um profissional especializado, qualificado em prática clínica, diagnóstico e definição dos limites entre sanidade e loucura, com base em critérios científicos, no final do século XIX e início do século XX. Conclusões: Este artigo destaca os momentos-chave da carreira profissional e política do professor João Carlos Teixeira Brandão, desde sua graduação na Faculdade de Medicina do Rio de Janeiro em 1877 até sua morte em 1921, enquanto ainda atuava na política nacional.

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This article traces the battle over Freud within Cuban psychiatry from its pre-1959 origins through the "disappearance" of Freud by the early 1970s. It devotes particular attention to the visit of two Soviet psychiatrists to Cuba in the early 1960s as part of a broader campaign to promote Pavlov. The decade-long controversy over Freud responded to both theoretical and political concerns. If for some Freud represented political conservatism and theoretical mystification, Pavlov held out the promise of a dialectical materialist future. Meanwhile, other psychiatrists clung to psychodynamic perspectives, or at least the possibility of heterogeneity. The Freudians would end up on the losing side of this battle, with many departing Cuba over the course of the 1960s. But banishing Freud did not necessarily make for stalwart Pavlovians-or vanguard revolutionaries. Psychiatry would find itself relegated to a handmaiden position in the work of revolutionary mental engineering, with the government itself occupying the vanguard.

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Although family research supports family-centered care for all medical specialties, the benefit of family-centered care has not been fully realized in outpatient practice. Physicians, including psychiatrists, are not routinely taught how to work with families and may not be aware of the evidence-base for family interventions. However, some medical specialties, such as family medicine and palliative care, have a clinical practice that routinely includes the family. Clinicians working in medical clinics, such as diabetes clinics, know that successful management of chronic illness requires family involvement. Psychiatric clinics, such as The Family Center for Bipolar Disorder at Beth Israel Medical Center in New York City, also have a family-centered practice and show improved patient outcomes. This article provides guidelines, including clinical interview questions, to help psychiatrists practice family-centered care, either in a private office or in a general psychiatric outpatient clinic. The guidelines include questions that identify when to seek an in-depth family assessment or consultation. Family-centered care will become more useful when health care reimbursement focuses on patient outcome.

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A lacuna de cuidados em Saúde Mental (SM) é um problema mundial. A Atenção Primária à Saúde (APS) é a base para estruturação da rede assistencial integral que o solucione. Sua integração com a Psiquiatria é parte deste desafio. Partindo da pergunta norteadora "Como vem sendo desenvolvida a inserção da APS no cuidado em Saúde Mental através da integração com a Psiquiatria pelo Matriciamento?", este artigo analisa a participação da Psiquiatria na organização da assistência em saúde mental centrada na APS, dentro de um modelo integral de cuidado em saúde. Foi utilizada metodologia qualitativa baseada na problematização da integração do Psiquiatra com as equipes da Estratégia de Saúde da Família no processo de matriciamento, sistematizam-se as experiências e conhecimento desenvolvidos pelos autores nos projetos do Laboratório Interdisciplinar de Pesquisa em APS da Universidade do Estado do Rio de Janeiro. A partir dos referenciais conceituais dos Cuidados Colaborativos, Apoio Matricial, Matriciamento e Cuidado Integral, e da caracterização das demandas clínicas de SM mais frequentes na APS, discutem-se as repercussões destes na estruturação do cuidado em SM, na formação médica e na transformação da Psiquiatria. Conclui-se que a APS é um novo campo de atuação da Psiquiatria trazendo desafios importantes para a formação e a assistência em SM...

The gap in Mental Health Care is a worldwide problem. Primary Health Care (PHC) is the framework basis for providing integrated care. Integrating Psychiatry into PHC is fundamental to solve this problem. Based on the issue of how integration of PHC into Mental Health Care is being developed with matrix support from psychiatrists, this paper investigates the role of Psychiatry in the organization of PHC, within a health comprehensive model approach. Problem-based analysis was used to systematize the knowledge and experiences gained by the authors during the execution of several research projects developed at the Laboratory of Interdisciplinary Research in Primary Health Care (LIPAPS) of Rio de Janeiro State University. Conceptual references such as Comprehensive Care, Collaborative Care and the Brazilian Model of Matrix Support Teams, as well as the most frequent Mental Health demands in PHC are reviewed, while discussing their influence on mental health care, medical education and changes imposed on Psychiatry. In conclusion, PHC may be considered as a new scenario for Psychiatry that raises important challenges related to mental health education and services...

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BACKGROUND: Given decreasing resident duty hours, subspecialty hospitalist models have emerged to help compensate for the restructured presence of residents. We sought to examine the impact of our pediatric oncology hospitalist model on the oncology unit staff. PROCEDURE: The survey was developed after a literature review of subspecialty hospitalist models. The final surveys were designed using a 5-point Likert scale. Descriptive statistics were used to compile baseline demographic characteristics of respondents and overall responses to survey questions. RESULTS: Respondents agreed that house physicians provide better continuity of care (96.8%), are more comfortable with the experience level of the physician (98.4%), and are better able to answer questions (92%). Respondents also agreed that house physicians serve as backup for system-related and patient-related questions and found security knowing an experienced provider was on the floor (87.5%). Responses to open-ended questions indicated that the house physician model has impacted fellow education. CONCLUSIONS: Our oncology house physician model helps account for decreased residency duty hours. This can serve as a model for other institutions requiring subspecialty inpatient coverage, given resident work hour restrictions. Adjustments in the clinical education of hematology/oncology fellows need to be considered in the setting of competent, consistent, and experienced front-line providers.

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Significant challenges exist in providing safe, effective, and culturally sound mental health and psychosocial services when an unforeseen disaster strikes in a low-resource setting. We present here a case study describing the experience of a transnational team in expanding mental health and psychosocial services delivered by two health care organizations, one local (Zanmi Lasante) and one international (Partners in Health), acting collaboratively as part of the emergency response to the 2010 Haiti earthquake. In the year and a half following the earthquake, Zanmi Lasante and Partners in Health provided 20,000 documented individual and group appointments for mental health and psychosocial needs. During the delivery of disaster response services, the collaboration led to the development of a model to guide the expansion and scaling up of community-based mental health services in the Zanmi Lasante health care system over the long-term, with potential for broader scale-up in Haiti. This model identifies key skill packages and implementation rules for developing evidence-based pathways and algorithms for treating common mental disorders. Throughout the collaboration, efforts were made to coordinate planning with multiple organizations interested in supporting the development of mental health programs following the disaster, including national governmental bodies, nongovernmental organizations, universities, foreign academic medical centers, and corporations. The collaborative interventions are framed here in terms of four overarching categories of action: direct service delivery, research, training, and advocacy. This case study exemplifies the role of psychiatrists working in low-resource settings as public health program implementers and as members of multidisciplinary teams.

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Pretende-se situar o discurso dos sujeitos envolvidos no processo de Reforma Psiquiátrica no município de Joinville/SC. Os discursos e as práticas necessitam ser elucidados e desvelados, pois na práxis cotidiana se constrói o conhecimento e se transforma a realidade. Como caminho metodológico utilizamos a pesquisa qualitativa, tipo estudo de caso, realizada por meio de entrevista aberta com roteiro semiestruturado. Os sujeitos envolvidos contribuíram com suas experiências e reflexões expressando suas opiniões e convicções quanto ao processo em curso. As considerações finais, baseadas na análise de discurso, apontam críticas pontuais, ora são mais polêmicas e políticas, ora são mais conservadoras e tradicionais, revelando um certo enviesamento e reducionismo do processo, porém novos espaços vêm sendo ocupados e as práticas de alguns profissionais têm se alterado.

This paper aimed to put into place the discourse of the subjects involved in the psychiatric reform process in the municipality of Joinville, Santa Catarina. The discourse and practices needed to be elucidated and revealed because knowledge is constructed and realities are transformed in daily practice. Qualitative investigation of case study type was the methodological route, and it was carried out by means of open interviews with a semistructured script. The subjects involved contributed their experiences and reflections through expressing their opinions and convictions about the current process. The final considerations, based on discourse analysis, indicated some criticisms: the discourse was sometimes more controversial and political and sometimes more conservative and traditional, thus revealing a certain degree of bias and reductionism in the process. Nonetheless, new spaces are being occupied, and some professionals' practices have been transformed.

Se trata de situar el discurso de los sujetos vinculados al proceso de Reforma Psiquiátrica en el municipio de Joinville. Es preciso elucidar y desvelar discursos y prácticas pues en la práctica cotidiana se construye el conocimiento y se transforma la realidad. Como camino metodológico utilizamos la pesquisa cualitativa, tipo estudio de caso, realizada por medio de entrevista abierta con guión semi-estructurado. Los sujetos consultados han contribuido con sus experiencias y reflexiones, expresando sus opiniones y convicciones en cuanto al proceso en curso. Las consideraciones finales, basadas en el análisis del discurso, ofrecen críticas puntuales; a veces más polémicas y políticas y otras más conservadoras y tradicionales, revelando cierta distorción y reduccionismo del proceso aunque nuevos espacios van siendo ocupados y las prácticas de algunos profesionales se han alterado.

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