This work discusses the experience of caring for a family member with a mental illness, including the concepts surrounding the subject and its handling in Brazil’s recent psychiatricreform. As a strategy for analyzing data, and based on the theory of object relations developed by Winnicott (1975), the work is structured by means of two categories: the carer’s concepts and experiences of mental illness and the burden experienced. The results of the research pointed to ambiguous feelings in the relationship with the family member suffering from the mental illness; a reverting to internment as the main course of action in times of crisis; neglect or ineffective support for families from public services; and a sense of burden marked by concerns, fear and demands for care that exceed the families’ capabilities. The article concludes by reinforcing the need to support the families of patients with mental illnesses in the public network of primary healthcare and mental health. Based on the premise that the roots of mental health lie in relations of trust and the adaptation of the environment to the subject with immature emotional development (Winnicott, 1979), it may be understood that not just users, but also their family members, ought to be welcomed and “managed” by multi-professional teams committed to the main principles and policies set out in the PsychiatricReform.
Mental health policy in Volta Redonda had been under development since the municipal intervention in the CSVR in 1994. At that time, there were municipal government powers to train workers and managers through a partnership between CESAM and the Franco Basaglia Institute (Instituto Franco Basaglia - IFB), which provided consulting and legal advice to professionals, about their role in the transition from the traditional psychiatry model to the territorial base model, because there were few people who knew about the PsychiatricReform movement in Brazil. Such an effort was in line with the national scenario of the era of development and redirection of care in mental health.
Abstract T This article presents a historical and epistemological study of the construction of public policies about mental health and psycho- social care in Brazil´s Unified Health System, the SUS. To that end, it proposes an approach that identifies actions and strategies related to social participation in the construction of policies, one of the founding principles of SUS, seeking to de- lineate its importance in the specific trajectory of the psychiatricreform process. Subsequently, it highlights the originality and importance of ac- tions that used culture as a means and as an end, in the sense of not restricting psychiatricreform to a transformation limited to public services or health in the strict sense of the term, emphasizing the principle of construction of a new locus in so- ciety for madness. Finally, it provides a historical follow-up of the promulgation of mental health policies in Brazil, identifying the most important initiatives and their impacts on the transforma- tion of the care model, and concludes by question- ing the conservative restructuring that is currently taking place.
Madness over time was seen as something that should be isolated from the society that had the expected and normal behavioral patterns, so for a long time it was segregated in psychiatric institutions. In these institutions, individuals with some mental disorder suffered every type of torture / experimental treatment imaginable, treatments that almost never aimed at recovering the subject, but rather at easing the symptoms that caused discomfort in others. Nowadays, after the questions that have arisen with the psychiatricreform, we seek a more humane look towards the subject with mental disorders, still trying to give him back that individual status that for a long time was removed from him. In this study, cinema was used as a didactic and inclusion method for CAPS patients in Itumbiara-GO. Eight meetings were held with the showing of films that could work with factors such as self-concept, emotions, resilience, among others with patients, in addition to rounds of conversations after each session. It is important to seek to develop projects and workshops in this sense, as CAPS users have shown great interest in the arts in general. And why not use cinema as a way of reintegrating this individual into society, which, after all, can be a step in the direction of what we are so looking for with psychiatricreform.
Health Division (DINSAM/MS) are emblematic. The “crisis at DINSAM” had great repercussions after manifestations of known entities in the na- tional scene (OAB, ABI, CNBB, among others). The episode concerns the mobilization of fel- lowship holders and residents of the psychiatric hospitals of the Ministry of Health (MH), where the conditions were extremely precarious. As the result of a letter sent to the Minister of Health with complaints and claims, 260 professionals were laid off, unleashing a new complaints pro- cess, demonstrations and articles published in the press for several months. This all took place in the context of democratization and the fight against the dictatorship, relating to specific hu- man rights struggles for the victims of psychiatric violence with the violence of the autocratic State, which became the most important social actor in the psychiatricreform (PR) process. Such a fact will influence in a meaningful way the construc- tion of public policies, not only in health, but in other sectors (such as culture, justice, human rights, labor and social security).
Objective: To analyze the conceptions of psychiatricreform present in the discourse of professionals from a CAPS, from the theoretical-conceptual, pre-defined Paulo Amarante. This study integrates research Evaluation of CAPS in southern Brazil (capsule), held in 2006. Methods: This is a case study descriptive and analytical, with a qualitative approach. We used the database of qualitative research CAPSUL, and elect the case study of São Lourenço do Sul / RS, including interviews with 11 professionals. Results: Data were grouped in Field Theoretical Concept - concepts for restructuring change practices. The design on the reform psychiatry is related to disruption of the insulation care as a way of madness and transformation of practice. Conclusion: The restructuring of the concepts it is important for the construction of new forms of care. Descriptors: Mental health, Health care reform, Health services.
J. res.: fundam. care. online 2016. jan./mar. 8(1):3740-3757 3755 The studies in this review showed the importance of substitutive services in assisting individuals with mental disorders, and that these are insufficient and often suffer in fulfilling its primary forward role to the various types of disabilities, whether structural or organizational policies, generated by interference in the implementation of mental health policies and the misapplication of funds, which directly affects the success of the psychiatricreform process.
In the well-known adage of Wittgenstein “the riddle does not exist,” it is because if a question can be put at all, then it can also be answered. Psychiatricreform, and its practical implementation in Brazil and in public policy – which we refer to as psychosocial care – has had immense difficulties in exploiting and broadening its treasure trove of ‘riddles.’ There are barriers that limit the production of knowledge in this field due to the fragility in terms of structure and process of the network of mental health services of the Unified Health System (SUS). This may also be due to the limited availability of stricto sensu post-graduate programs in this area or the lack of an agenda of research priorities created under the aegis of public policy in mental health. The funding policy of research in Brazil favors areas that are already consolidated (such as biomedicine and epidemiology), and is extremely restrictive to the development of new issues.
Through the statements presented one is able to observe that there are dificulties in implement- ing the psychiatricreform as it relates to the socio- cultural magnitude, highlighting stigma, prejudice and exclusion. In this case, it would be important to invest in the health network, strengthening the bonds of solidarity and identifying potential resources of the territory in the psychosocial re- habilitation process. In this context, it is observed that nurses play a signiicant role in this process and may act as educators/counselors; however, to work with the community one must know that this happens slowly because it involves culture and rooted (pre)notions, especially those related to the lack of capability and use of the person with the mental disorder.
The Brazilian national mental health policy resulting from the psychiatricreform has produced subjective and objective changes in the lives of men and women who have their life experiences crossed by it. Such a policy brings together some levels, which can be situated between the institutional level and the level of the singular experiences, in which the gender has been shown as an important political dimension configuring the relations of power. We start from the understanding of gender as a sociocultural, historical and relational construction that establishes hierarchies, configures relations of power and constitutes modes of subjectivation.
In this sense the article by Luzio & L´Abbate, “ Brazilian PsychiatricReform: historical and techno- assistential aspects of the experiences of São Paulo, Santos and Campinas”, brings us the powerful story of confrontations, inventions, ruptures with old care models, the boldness of, in neo-liberal times, moving forward with a public health policy project that includes madness as experience. This is the story of a policy that is made from and with experiences, as the authors show. This is a policy that came to make us vibrate, red, colors and light...and because it is made of these parts it is possible to reinvent and maintain the shine in the eyes that look beyond a `dangerous lucidity`.
The objective of this investigation was to understand what family members know about the rights of individuals aff ected by mental illness. To this end, a qualitative exploratory study was conducted. A semi-structured interview was used for data collection. Eighteen family members were interviewed at a psychosocial care center (CAPS) and a civil society organization (CSO) located in a municipality in the state of São Paulo, Brazil, between March and September 2013. Data were analyzed using thematic content analysis and the following categories were constructed: mental health services and the rights of individuals aff ected by mental illness. We were able to infer that in addition to drug-based therapy, mental health services must provide therapeutic activities. Family members of those aff ected by mental illness were unaware of the Brazilian PsychiatricReform Law and mentioned the following rights: welfare beneﬁ ts, free public transport, basic food basket and medications.
We also consider that, in addition to increasing the num- bers of specialist nurses, there are a few aspects inherent to the PsychiatricReform process that must guide profes- sional education, and these regard accessibility and equity, with the following necessities: a dense, varied and effec- tive healthcare network, to provide care for the person with severe and persistent disorders; the necessity of services directed towards people who need mental care, but do not suffer from serious disorders; rearrangement of resources due to the existence of services that concentrate resources and have low coverage rates (hospital and outpatient clin- ics); articulating and enlarging mental healthcare in the pri- mary services; inter-sectorial articulation of healthcare for drug addicts, especially those in situations of co-morbid- ity; and qualification, supervision and professional educa- tion, especially for those who live far from educational and research institutions.
In the perspecive of a new health care model, it was also necessary for the administrators to de- velop a new look in order to create new coverage and as- sessment instruments. The indicators that were limited to bed/person medical appointment/person now deined the coverage in the community, among other aspects. It was also necessary to implement funding mechanisms of a net- work that could truly meet the needs of the naional policy. Therefore, this aricle makes a brief retrospecive and analysis of the administraion mechanisms that have per- mited the PsychiatricReform to advance.
Thus, Nursing, together with other members of the health team, is responsible for implementing the changes foreseen by the PsychiatricReform in favor of the care that has historically transformed the mental health care model. Finally, it is concluded that in spite of all the progress observed from the study, nursing professionals do not recognize the Brazilian PsychiatricReform as a transforming agent of their care nor do they value the care provided before, during and after ECT, essential for the success of treatment with this therapy.
ABSTRACT: Introduction: The Brazilian PsychiatricReform, an ongoing process, and its developments involve the construction of new ways of seeing the subject in illness, establishing the mental health ield in a new way of understanding the social determinants that relect in the deinstitutionalization and social inclusion. Objective: This study, multidimensional analysis of the relationship between social determinants and deinstitutionalization in mental health focusing on a community movement in Northeast Brazil, whose proposed work is subjective and psychosocial dimensions, aims to explore and analyze how the experiences in course of the Movement highlights the importance of social determinants, the perspective of professionals. Methods: The methodological approach outlined in the qualitative approach in the form of case studies, employing techniques such as interviews and focus groups. The categorization of analytical information was built from the relationship established between a model based on the constituent dimensions of the psychiatricreform, covering diferent planes, namely epistemological, healthcare, legal and socio-political, and social determinants of health — living conditions, and work environment, community networks and support, economic, cultural and environmental behaviors and lifestyles. Results: The results show emphasis on the social subject, making the processing and knowledge of professionals, adding new ways to produce health; dialogue with multiple stakeholders, building autonomy, participative management, concern for professionalization; reorganizing the work process; appreciation of the everyday activities that weave and; invention of a new social site, among other elements in close interface with the determinants of health. Conclusion: These elements indicate that care practices woven into the daily life of the Movement involve the disassembling the traditional model of mental health care, stimulating new forms of citizenship, thus contributing to the institutionalization and promoting equality of income, social cohesion and participation policy for the promotion and protection of health. Keywords: Social determinants of health. Health. Desintitutionalization. Care. Health professionals. Qualitative research.
The nine papers analyzed enabled featur- ing the assistance practices in the Mental Health Care Network in Brazil, synthesizing them into two thematic categories: developed activities and principles of psychiatricreform. In the developed activities in mental health category there are therapeutic groups, home care, screening, refer- rals, medications, psychiatric consultations, and nursing consultations. In the psychiatricreform principles category interpersonal and humanized relation emerged, also a concern about self-esteem, and an inter-professional dialogue.