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El siguiente artículo indaga las condiciones de articulación de la red socio-sanitaria en las prácticas de salud mental infanto-juvenil en el subsector público de salud en la Ciudad de Buenos Aires, siguiendo el hilo de políticas específicas de continuidad de cuidados en la red de servicios de salud mental en los últimos veinte años y las derivas presentes en la recepción de la llamada niñez en riesgo en sus recorridos de vida, singulares y colectivos. (AU)

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El presente informe tiene la intención de dar cuenta de las actividades desarrolladas y aprendizajes en el marco de la Rotación Electiva en la Residencia Interdisciplinaria en Salud Mental en el Hospital Nacional en Red "Lic. Laura Bonaparte", especializado en Salud Mental y Adicciones. La institución se encuentra en la Ciudad Autónoma de Buenos Aires, siendo de dependencia nacional. El período de rotación es del 11/01/2021 al 19/03/2021, y los objetivos perseguidos en la rotación fueron los adquirir conocimientos y herramientas acerca de la atención en salud desde las perspectivas de Salud Mental Comunitaria, y de Salud Integral; y la capacitación y reflexión en torno al campo de Salud Mental desde una perspectiva interdisciplinaria. (AU)

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Los trastornos del desarrollo intelectual (TDI) son un grupo de alteraciones del desarrollo caracterizadas por una notable limitación de las funciones cognitivas, trastornos del aprendizaje y de las habilidades y conductas adaptativas. Anteriormente agrupados bajo el término discapacidad intelectual, constituyen un problema poco estudiado y cuantificado en América Latina. Los afectados están ausentes en las políticas públicas y no se benefician de las estrategias gubernamentales de desarrollo social y reducción de la pobreza. En este artículo se aporta una visión crítica de los TDI y se describe una nueva taxonomía. Además, se propone reconocerlos como problema de salud pública, promover la profesionalización de la atención, y sugerir una agenda de investigación y acción regional. En América Latina no hay consenso sobre los criterios diagnósticos de los TDI. Pocos programas de rehabilitación cubren una proporción importante de las personas que los padecen, no se ofrecen servicios basados en la evidencia científica y las directrices de atención no se han evaluado. Los manuales de diagnóstico psiquiátrico conceden más importancia a la identificación de los TDI graves, favorecen su subregistro y clasificaciones erróneas. Su estudio no se ha priorizado desde las perspectivas jurídica, de las ciencias sociales y de la salud pública. Por ello escasean las pruebas científicas sobre estos trastornos. Faltan competencias específicas y profesionalización para el cuidado de estas personas y es indispensable realizar intervenciones de prevención, rehabilitación, integración comunitaria e inclusión laboral.

Intellectual development disorders (IDDs) are a set of development disorders characterized by significantly limited cognitive functioning, learning disorders, and disorders related to adaptive skills and behavior. Previously grouped under the term "intellectual disability," this problem has not been widely studied or quantified in Latin America. Those affected are absent from public policy and do not benefit from government social development and poverty reduction strategies. This article offers a critical look at IDDs and describes a new taxonomy; it also proposes recognizing IDDs as a public health issue and promoting the professionalization of care, and suggests an agenda for research and regional action. In Latin America there is no consensus on the diagnostic criteria for IDDs. A small number of rehabilitation programs cover a significant proportion of the people who suffer from IDDs, evidence-based services are not offered, and health care guidelines have not been evaluated. Manuals on psychiatric diagnosis focus heavily on identifying serious IDDs and contribute to underreporting and erroneous classification. The study of these disorders has not been a legal, social science, or public health priority, resulting in a dearth of scientific evidence on them. Specific competencies and professionalization of care for these persons are needed, and interventions must be carried out with a view to prevention, rehabilitation, community integration, and inclusion in the work force.

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Common mental disorders pose tremendous health and social burdens in the poorest countries. This Open Forum describes a planning framework to advance effective, sustainable design and implementation of mental health services in these settings. It builds on research in treatment dissemination and on the authors' experience in several initiatives-including the Millennium Villages Project in sub-Saharan Africa and the Partners In Health system in Haiti (Zanmi Lasante). The authors describe a "pyramid of care" approach that specifies five key skill packages to address common mental disorders in low-resource settings and five implementation rules: assess context first; identify priority care pathways and map them across skill packages; specify decision supports, supervision, and triage rules; use quality improvement practices; and plan for sustainability and capacity building. The framework addresses the need for a shared vocabulary and a set of tools to coordinate and compare efforts to scale-up mental health treatment across diverse settings.

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OBJETIVO: Descrever e analisar a situação atual de desenvolvimento da política pública brasileira de saúde mental infantil e juvenil, com foco nos Centros de Atenção Psicossocial Infanto-juvenil e na rede intersetorial potencial de atenção à saúde mental infantil e juvenil que engloba outras políticas relacionadas à criança e ao adolescente em âmbito nacional. MÉTODO: Análise de publicações e dados oficiais do governo brasileiro sobre a implantação e/ou distribuição de serviços públicos nacionais relacionados à criança e ao adolescente. RESULTADOS: A política brasileira de saúde mental infantil e juvenil tem como ação central a implementação de Centros de Atenção Psicossocial Infanto-Juvenil para atendimento dos casos de transtornos mentais que envolvem prejuízos funcionais severos e persistentes. Existe uma rede intersetorial potencial de cuidado que pode se efetivar com a articulação das ações específicas de saúde mental infantil e juvenil nos setores da saúde geral/atenção básica, educação, assistência social e justiça/direitos. Esta articulação será de grande importância para o atendimento de problemas mais freqüentes, que envolvem prejuízos mais pontuais. DISCUSSÃO: No Brasil, o incremento do sistema de cuidados depende da expansão da rede de serviços de saúde mental infantil e juvenil, dos mais aos menos especializados, e de sua articulação efetiva com outros setores públicos dedicados ao cuidado da infância e adolescência.

OBJECTIVE: To describe and analyze current developments in the Brazilian child and adolescent mental health public policy, focusing on the Centers for Psychosocial Care for Children and Adolescents and in a potential child and adolescent mental health care system, derived from other child and adolescent public policies in the national context. METHOD: Examination of publications and official data produced by the Brazilian government about the implementation and/or distribution of public services for children and adolescents in the country. RESULTS: The Brazilian child and adolescent mental health policy has as one of its main strategies the implementation of Centers for Psychosocial Care for Children and Adolescents to cover persistent child psychiatric disorders with severe levels of impairment. In addition, there is a potential intersectorial system which would become effective once specific child mental health actions are articulated with the sectors of general health, education, child welfare and justice/rights. This articulation will play an important role in responding to psychiatric disorders which are frequent with impairment of very specific areas of functioning. DISCUSSION: In Brazil, improvement of the child and adolescent mental health care system relies upon the expansion of the mental health specialty sector as well as in its articulation with other public sectors responding to child and adolescent needs.

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OBJECTIVE: To describe and analyze current developments in the Brazilian child and adolescent mental health public policy, focusing on the Centers for Psychosocial Care for Children and Adolescents and in a potential child and adolescent mental health care system, derived from other child and adolescent public policies in the national context. METHOD: Examination of publications and official data produced by the Brazilian government about the implementation and/or distribution of public services for children and adolescents in the country. RESULTS: The Brazilian child and adolescent mental health policy has as one of its main strategies the implementation of Centers for Psychosocial Care for Children and Adolescents to cover persistent child psychiatric disorders with severe levels of impairment. In addition, there is a potential intersectorial system which would become effective once specific child mental health actions are articulated with the sectors of general health, education, child welfare and justice/rights. This articulation will play an important role in responding to psychiatric disorders which are frequent with impairment of very specific areas of functioning. DISCUSSION: In Brazil, improvement of the child and adolescent mental health care system relies upon the expansion of the mental health specialty sector as well as in its articulation with other public sectors responding to child and adolescent needs.

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Antecedentes: El cierre de asilos e instituciones para pacientes con enfermedades mentales, acompañado de las políticas gubernamentales que se centran en la reducción del número de camas hospitalarias para los pacientes con enfermedades mentales graves y que están a favor de la prestación de asistencia en una variedad de ámbitos extrahospitalarios, respalda el fundamento para la atención comunitaria. Un paso importante hacia la atención comunitaria ha sido el desarrollo de equipos comunitarios de salud mental (ECSM). Objetivos: Evaluar la efectividad de los Equipos Comunitarios de Salud Mental (ECSM) en el tratamiento de cualquier tipo de enfermedad mental grave en comparación con el tratamiento estándar de estas enfermedades sin estos equipos. (AU)

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OBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41% (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5% of the budget in 1995 and 49% in 2005, and the expenses with community services and medication have increased 15% each. As a whole, the expenses in mental health decreased by 26.7% (2.66 to 1.95 US$ per capita). CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged.

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OBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41 percent (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5 percent of the budget in 1995 and 49 percent in 2005, and the expenses with community services and medication have increased 15 percent each. As a whole, the expenses in mental health decreased by 26.7 percent (2.66 to 1.95 US$ per capita). CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged.

OBJETIVO: Investigar o desenvolvimento da infra-estrutura de serviço de saúde mental e do seu financiamento no Brasil. MÉTODO: Os dados sobre número de leitos, centros comunitários de saúde mental, profissionais de saúde mental e custos, no período de 1995 a 2005, foram coletados no sítio de internet de livre acesso do DATASUS. RESULTADOS: Em 10 anos, houve uma redução de 41 por cento no número de leitos psiquiátricos (5,4 a 3,2 por 10.000 habitantes), enquanto os serviços comunitários aumentaram nove vezes (0,004 to 0,037 por 10.000). Psicólogos e assistentes sociais foram contratados três e duas vezes mais do que psiquiatras, respectivamente. As internações psiquiátricas representavam 95,5 por cento do total de gastos com saúde mental em 1995, passando para 49 por cento em 2005. Por outro lado, as despesas com serviços comunitários e medicação aumentaram 15 por cento cada. Em relação ao total de gastos, as despesas com saúde mental diminuíram 26,7 por cento (2,66 a 1,95 US$ per capita). CONCLUSÃO: Existe um claro movimento de transformação do modelo dos cuidados psiquiátricos no Brasil, passando do hospital psiquiátrico para os serviços comunitários. O sistema tem disponibilizado um maior número de modalidades de tratamento, incluindo o acesso gratuito aos psicotrópicos. A cobertura dos serviços comunitários, entretanto, ainda é precária e a reforma da assistência psiquiátrica não foi acompanhada pelo aumento do investimento público em saúde mental. A reforma psiquiátrica não é uma estratégia de redução de custos; ela necessariamente implica no aumento de investimentos se os países decidirem melhorar os cuidados em saúde para aqueles em desvantagens.

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BACKGROUND: The number of homeless people of any country is a major social and health issue, but to date only a few descriptive and focused studies have been undertaken in Brazil on the matter. METHOD: In order to fill this gap, a cross-sectional study was carried out in a random representative sample (n=330) out of 1,977 homeless people lodged in the five public hostels of the Rio de Janeiro metropolitan area. Full data were collected by two trained researchers in a face-to-face interview with 319 (96.7 %) out of the 330 lodgers, using the CIDI (Composite International Development Interview) to assess psychiatric diagnosis. RESULTS: The main findings concern prevalence rate of major mental illness, which was 19.4% for the 12 months before data collection, and 22.6% lifetime prevalence rate. Other 12-month prevalence rates were 31% for alcohol abuse/dependence, 4.1% for drug abuse/addiction, 15% for severe cognitive impairment, and 49.2% for any mental disorder. The rate was 65.2% when organic mental disorders were added. Moreover, 23.9% of the sampled lodgers reported previous psychiatric admission. Their demographic characteristics were a mean age of 44.8 years old, 75.8% of them were male, 78.9% were single, 94.7% had a low level of schooling, and 79.2% were long-term unemployed. CONCLUSIONS: This study demonstrates the high rates of psychiatric morbidity in the homeless, but these rates are exceeded by the apparent poverty and illiteracy of the sample. Given the lack of delivery of community services now in Brazilian cities, this group is likely to be marginalized. Some special teams to assess the hostel residents need to be created.

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As a result of public law 99-166 the Department of Veterans Affairs Medical Center in San Juan (DVAMC), Puerto Rico engaged in a planned de-institutionalization of psychiatric veteran patients who had been treated in two contracted psychiatric hospitals in the community. This research seeks to determine whether they were receiving treatment after the deinstitutionalization effort was completed, the types of psychosocial problems they were facing and the resources utilized to cope with them. The authors found that the veterans were receiving treatment for their psychosocial problems, they relied to a great extent on DVAMC for services and that the psychosocial problems of those veterans over age 55 were less and differed from those under age 55.

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As a result of public law 99-166 the Department of Veterans Affairs Medical Center in San Juan (DVAMC), Puerto Rico engaged in a planned de-institutionalization of psychiatric veteran patients who had been treated in two contracted psychiatric hospitals in the community. This research seeks to determine whether they were receiving treatment after the deinstitutionalization effort was completed, the types of psychosocial problems they were facing and the resources utilized to cope with them. The authors found that the veterans were receiving treatment for their psychosocial problems, they relied to a great extent on DVAMC for services and that the psychosocial problems of those veterans over age 55 were less and differed from those under age 55

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A two-stage epidemiologic survey was carried out on a probability sample of the population aged 4 through 16 years in Puerto Rico. The survey used the Child Behavior Checklist as a screening instrument, and prevalence rates were estimated on the basis of clinical diagnoses and other measures provided by child psychiatrists during the second stage. Maladjustment was operationally defined through the use of combined measures, including DSM-III diagnosis and a scale of functional impairment. Data were provided on the demographic correlates of maladjustment and on the comorbidity of DSM-III diagnostic domains. The prevalence rates obtained vis-à-vis the availability of mental health services on the island reflected a major public health problem.

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The lifetime prevalence of specific DSM-III-defined psychiatric disorders among 1243 Mexican-American and 1309 non-Hispanic white residents of two Los Angeles communities is reported from the Los Angeles site of the Epidemiologic Catchment Area (ECA) research study. Results from household interviews in response to the National Institute of Mental Health Diagnostic Interview Schedule revealed overall rates of disorders for the total Los Angeles sample and ethnic subsamples that were similar to rates reported from the initial three ECA sites. Non-Hispanic whites reported far more drug abuse/dependence and more major depressive episodes than Mexican Americans. Young non-Hispanic white women reported high rates of major depressive episodes and drug abuse/dependence. Alcohol abuse/dependence is highly prevalent among Mexican-American and non-Hispanic white men of any age. Mexican-American women infrequently abuse or become dependent on drugs or alcohol at any age. Dysthymia, panic disorder, and phobia are somewhat more prevalent among Mexican-American women over 40 years of age compared with both non-Hispanic white women over and Mexican-American women under 40 years of age. Antisocial personality is predominantly a disorder of young men of both ethnic groups.

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