Navegando por Palavras-chave "Mental Health Services"
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- ItemAcesso aberto (Open Access)Access, equity and social cohesion: evaluation of intersectoral strategies for people experiencing homelessness(Universidade de São Paulo, Escola de Enfermagem, 2014-12-01) Borysow, Igor Da Costa; Furtado, Juarez Pereira [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Objective To understand and evaluate the work of intersectoral assistance on the insertion and the flow of people in situation of street with severe mental illness in public services of Mental Health. Method A case study developed from ten visits to a night shelter between March and April 2012. For data collection, the participant observation and semi-structured interviews were carried out with four sheltered individuals, as well as non-directive group interviews with five technicians of the social-assistance services. Results Were analyzed using Content Analysis and developing a Logic Model validated with the professionals involved. Conclusion The social assistance services are the main entry of this clientele in the public network of assistance services, and the Mental Health services have difficulty in responding to the specificities of the same clientele and in establishing intersectoral work.
- ItemAcesso aberto (Open Access)Atenção Psicossocial em tempos de pandemia: transformações no cotidiano de usuários de serviços de saúde mental da cidade de Santos, São Paulo, Brasil(Universidade Federal de São Paulo, 2023-10-13) Silva, Beatriz Venancia Dias Gonçalves [UNIFESP]; Moreira, Maria Inês Badaró [UNIFESP]; http://lattes.cnpq.br/1186084305231587; http://lattes.cnpq.br/4046567134780890; Universidade Federal de São Paulo (UNIFESP)Objetivo: Compreender as transformações no cotidiano dos usuários inseridos em um Centro de Atenção Psicossocial na cidade de Santos, São Paulo, Brasil. Métodos: Trata-se de pesquisa qualitativa, de referencial hermenêutico-dialético, que utilizou a observação participante, entrevistas semiestruturadas e o acompanhamento de uma usuária-guia. A entrada em campo se deu nos meses de outubro e novembro de 2022, privilegiando os espaços de convivência e as atividades coletivas. Os encontros com a usuária-guia eram diários e tinham como objetivo o compartilhamento do cotidiano e o acompanhamento de suas movimentações e relações no território. Para análise, o material foi composto pelos diários de campo e as transcrições das entrevistas, e utilizando categorias de sentido que organizaram os resultados. Resultados: Os principais impactos da pandemia de COVID-19 para os usuários estão relacionados ao agravamento das vulnerabilidades nos territórios, influenciando as possibilidades de ocupação do espaço urbano e as condições de moradia. A experiência dos usuários revela que o esvaziamento do espaço do CAPS como espaço de sociabilidade trouxe a vivência de solidão e tristeza no período de isolamento social, ainda, destaca-se as transformações nos planos de cuidado, o impacto nas relações familiares e nas redes sociais, além de uma percepção de um agravamento do sofrimento durante a pandemia. Os resultados apontam também a importância de fortalecimento das políticas, da articulação das redes e do trabalho territorial na superação das dificuldades colocadas para o campo da saúde mental pela COVID-19.
- ItemAcesso aberto (Open Access)Atenção psicossocial em tempos de pandemia: um olhar para o trabalhador de saúde mental(Universidade Federal de São Paulo, 2022-10-21) Pontes, Érica Sanches [UNIFESP]; Moreira, Maria Inês Badaró [UNIFESP]; http://lattes.cnpq.br/1186084305231587; http://lattes.cnpq.br/6093705434196252; Universidade Federal de São Paulo (UNIFESP)Esta dissertação trata-se de uma pesquisa de estudo de caso e tem como objetivo geral compreender o impacto da pandemia de Covid-19 na oferta de cuidados em saúde mental em um Centro de Atenção Psicossocial, sob a ótica dos trabalhadores desse serviço. Parte da hipótese que as alterações na rotina do CAPS e do cotidiano, em geral, ocasionadas pela pandemia de COVID-19 podem ter reflexos na saúde destas pessoas e no modo de agir profissional. Primordialmente, pretende registrar o impacto na assistência psicossocial e na manutenção da continuidade do cuidado em face às adaptações dos serviços de saúde frente à pandemia, analisar as transformações ocorridas no cotidiano da atenção psicossocial e elucidar estratégias de enfrentamento acionadas pelos trabalhadores. Esse é um estudo de caráter qualitativo e o método escolhido para entender esse período de transformações foi o estudo de caso. Para a produção dos dados utilizamos a observação participante e as entrevistas com os trabalhadores. Foi utilizada a análise de conteúdo que segundo Bardin (2011) é “um conjunto de técnicas de análise das comunicações que utiliza procedimentos sistemáticos e objetivos de descrição do conteúdo das mensagens”. Foram encontrados cinco temas principais para análise: estratégias utilizadas no cuidado, sentimentos vividos e pontos positivos, impactos da pandemia/isolamento social, desafios do trabalho em rede e em adição, situações de adoecimento. Os achados sugerem situações de agravo dos problemas estruturais anteriores à pandemia, como falta de profissionais, aumento da demanda e insalubridade. Pode-se concluir que existe a necessidade de fortalecimento da rede de atenção psicossocial e implementação de estratégias para renovação dos serviços pós-pandemia.
- ItemAcesso aberto (Open Access)Avaliação da rede de centros de atenção psicossocial: entre a saúde coletiva e a saúde mental(Faculdade de Saúde Pública da Universidade de São Paulo, 2009-08-01) Onocko Campos, Rosana Teresa; Furtado, Juarez Pereira [UNIFESP]; Passos, Eduardo; Ferrer, Ana Luiza; Miranda, Lilian; Gama, Carlos Alberto Pegolo da; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP); Universidade Federal FluminenseOBJECTIVE: To analyze the assistance, management and workers' education models of a network of psychosocial healthcare services (CAPS). METHODS: This is a qualitative evaluation research, supported by the Gadamerian hermeneutics, carried out in the city of Campinas, Southeastern Brazil, in 2006-2007. Data were collected through 20 focus groups in centers known as CAPS III, with different groups of stakeholders (workers, municipal managers, users, family members and local managers). After the transcription of each group's recorded material, narratives were constructed following Ricoeur's theoretical framework. At the second stage of the focus groups, these narratives were presented to the participants, who could contest, correct and validate them. The preliminary results were discussed in workshops, with the aim of developing a good practice guide in CAPS III. RESULTS: The study identified strong points and weaknesses concerning the care provided during the crisis, articulation with the primary care network, formulation of therapeutic projects, management and organization in reference teams, educational background and psychological distress. CONCLUSIONS: The network of psychosocial care centers in Campinas stands out due to its originality in the implementation of six CAPS III and to its efficacy in providing comprehensive assistance to users and family members in the moment of crisis and in rehabilitation. The organization in reference technician and/or team prevails, as well as the development of therapeutic projects. Night teams reduction is the most important problem and the main source of workers' stress. The professionals' education proved to be insufficient to deal with the challenges faced by these services.
- ItemAcesso aberto (Open Access)Clinical and demographic profile of cancer patients in a consultation-liaison psychiatric service(Associação Paulista de Medicina - APM, 2003-01-01) Citero, Vanessa de Albuquerque [UNIFESP]; Nogueira-Martins, Luiz Antonio [UNIFESP]; Lourenço, Maria Teresa; Andreoli, Sergio Baxter [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital do Câncer AC Camargo Treatment and Research CenterABSTRACT CONTEXT: An almost 50% prevalence of psychiatric disorders among cancer patients has prompted a series of studies on consultation-liaison psychiatry. Nonetheless, there are few reports on the epidemiological factors involving comorbidity between cancer and psychiatric disorders. OBJECTIVE: To evaluate the epidemiological profile of cancer inpatients referred to the consultation-liaison psychiatric service in an oncology hospital during its first year of activity. TYPE OF STUDY: Descriptive study. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: 319 patients referred 412 times to the consultation-liaison psychiatry service. PROCEDURES: From August 97 to July 98, an appraisal was made of data on all admissions registered at the Hospital do Câncer, and also all referrals registered at the consultation-liaison psychiatry service. MAIN MEASUREMENTS: The demographics and patients' clinical data, the type and flow of the request, and the evaluation conducted by the service were analyzed and comparisons with the hospital data were made. The distribution of the number of referrals was used to construct a profile of patients who had repeatedly used the service. RESULTS: Psychiatric diagnoses were found in 59% of the cases. Forty-three percent of these required medication, 18.3% needed psychotherapy, 22.1% family intervention and 20.5% guidance from the staff. Over 22.8% of the consultations were reevaluations, mainly involving younger male patients with worst prognoses. These patients required lengthier and more elaborate intervention, and had higher prevalence of depressive and behavioral disorders. CONCLUSION: A younger and mainly male population of non-surgical oncological cases was referred to the consultation-liaison psychiatric service during its first year of activity. The psychiatric disorder prevalence was higher than expected, and consisted predominantly of mood disorders. We detected a priority group, namely the reevaluated patients, who deserved special attention throughout the psychiatric interventions.
- ItemAcesso aberto (Open Access)A compreensão dos profissionais dos CAPSij da Região Metropolitana da Baixada Santista a respeito da intersetorialidade(Universidade Federal de São Paulo, 2021-02-12) Varanda, Caroline Ciardi [UNIFESP]; Jurdi, Andrea Perosa Saigh [UNIFESP]; http://lattes.cnpq.br/4140547211703368; http://lattes.cnpq.br/0521241285668785; Universidade Federal de São Paulo (UNIFESP)A política de saúde mental infantojuvenil inclui em sua elaboração uma rede de atenção psicossocial e o Centro de Atenção Psicossocial infantojuvenil (CAPSij) é um dos serviços dessa rede. Um dos princípios dessa política é a articulação dos diversos setores, cabendo ao CAPSij a articulação de ações intersetoriais para as diferentes demandas de saúde mental de crianças e adolescentes nos territórios que estão inseridos. A garantia do direito à saúde de crianças e adolescentes só é efetivada na interdependência dos setores e no alinhamento das ações entre os mesmos. Diante isso, o objetivo desse estudo foi analisar a compreensão dos profissionais sobre as ações intersetoriais realizadas pelos CAPSij localizados nas cidades pertencentes à Região Metropolitana da Baixada Santista (RMBS). Trata-se de uma pesquisa quanti-qualitativa que teve como instrumento um questionário online, contendo nove questões abertas e onze questões fechadas. O período da coleta se deu no segundo semestre de 2019 e primeiro semestre de 2020. Foi realizada análise descritiva das variáveis categóricas e as variáveis numéricas foram apresentadas por meio de média e desvio-padrão. Além disso, foram elencadas categorias temáticas para analisar as respostas abertas. Participaram 36 profissionais de nível superior que atuam como técnicos nos CAPSij da RMBS. Os resultados apontam que os profissionais compreendem as ações intersetoriais como um trabalho de rede, que envolve reuniões e articulação dos serviços, sendo uma prática de cuidado necessária. Os benefícios e desafios abordados pelos profissionais nesta pesquisa são semelhantes aos vivenciados por profissionais de outros CAPSij. Os participantes entendem como benefício o trabalho colaborativo que possibilita menos sobrecarga e efetivação de um cuidado mais integral. Entre as dificuldades elencadas em relação a essa articulação destacam-se as condições do trabalho e externas a ele, como a lógica vigente da patologização. Os dados dessa pesquisa revelam que por mais que ações intersetoriais sejam tidas como extremamente relevantes pelos profissionais dos CAPSij da Baixada Santista, elas geralmente acontecem de forma pontual e são sustentadas por inciativas pessoais de alguns profissionais, notando-se um distanciamento entre discurso e prática.
- ItemAcesso aberto (Open Access)Concepções E Práticas De Cuidado Em Saúde Mental A Partir De Diferentes Formações Profissionais(Universidade Federal de São Paulo (UNIFESP), 2017-03-13) Guimaraes, Lislaine Santos [UNIFESP]; Lima, Laura Camara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The study originated from a daily discomfort of the researcher and psychologist of the Psychosocial Care Center I (NAPS I), in Santos-SP, about the different understandings of Mental Healthcare among multiprofessional team's members causing splits within the team itself about their behaviors; divisions which interfered in the effectiveness of the work. The raised hypothesis was that Mental Healthcare conceptions and practices as well as the understanding of mental illness would not be the same among these workers and professional qualification would be one of the factors that would determine these differences. The general objective of the research was to understand and problematize the different conceptions and practices of Mental Healthcare among service workers. The specific objectives were to understand how the professionals of the surveyed Psychosocial Care Center understand mental illness; investigate how professionals from different backgrounds conceive and practice Mental Healthcare; discuss and expand the repertoire of Mental Healthcare; mobilize processes of Permanent Education in the service. The non-probabilistic sample consists half of the service workers (n= 13). The sample subjects were selected to represent all the qualification, the diversity of service time and the different work shift of the health team. The volunteered approached had at least three months of experience at work, at the time of data collection. A script was created by the researcher, containing questions about the choose of the area, qualification, education, experience, vision, understanding, difficulties. The interviews were recorded, transcribed, read and analyzed based on the research objectives, using the thematic content analysis method. Final considerations: the hypothesis that professional qualification could predominantly determine the conceptions and practices of care was not confirmed. Time spent in the area, daily practice with users, personal values and political and ideological positioning seem to be more determinant than professional qualification. In this case, Permanent Education actions would be pertinent to qualify teams. Although workers have recently won a weekly self-managed space for Permanent Education, there is still resistance by some professionals of the nursing staff to participate in these meetings. Thus, as UNIFESP's Professional Master degree requires the development of a product, I decided to invite these subjects to participate of Operative Groups, in which the results of the research will be shared and serve as triggers of other discussions. The goal is to listen to them and invite them to participate of the meetings of Permanent Education, so that the agreement of the work can, finally, be carried out collectively and that the knowledge and practices of each worker can be shared, improved and made available for all (health team and patients).
- ItemSomente MetadadadosConcepções e práticas de cuidado em saúde mental a partir de diferentes formações profissionais(Universidade Federal de São Paulo (UNIFESP), 2017) Guimarães, Lislaine Santos [UNIFESP]; Lima, Laura Camara [UNIFESP]; Casetto, Sidnei José [UNIFESP]; http://lattes.cnpq.br/3498118188722873; http://lattes.cnpq.br/6277780648747957; http://lattes.cnpq.br/4521161682800800; Universidade Federal de São Paulo (UNIFESP)The study originated from a daily discomfort of the researcher and psychologist of the Psychosocial Care Center I (NAPS I), in Santos-SP, about the different understandings of Mental Healthcare among multiprofessional team's members causing splits within the team itself about their behaviors; divisions which interfered in the effectiveness of the work. The raised hypothesis was that Mental Healthcare conceptions and practices as well as the understanding of mental illness would not be the same among these workers and professional qualification would be one of the factors that would determine these differences. The general objective of the research was to understand and problematize the different conceptions and practices of Mental Healthcare among service workers. The specific objectives were to understand how the professionals of the surveyed Psychosocial Care Center understand mental illness; investigate how professionals from different backgrounds conceive and practice Mental Healthcare; discuss and expand the repertoire of Mental Healthcare; mobilize processes of Permanent Education in the service. The non-probabilistic sample consists half of the service workers (n= 13). The sample subjects were selected to represent all the qualification, the diversity of service time and the different work shift of the health team. The volunteered approached had at least three months of experience at work, at the time of data collection. A script was created by the researcher, containing questions about the choose of the area, qualification, education, experience, vision, understanding, difficulties. The interviews were recorded, transcribed, read and analyzed based on the research objectives, using the thematic content analysis method. Final considerations: the hypothesis that professional qualification could predominantly determine the conceptions and practices of care was not confirmed. Time spent in the area, daily practice with users, personal values and political and ideological positioning seem to be more determinant than professional qualification. In this case, Permanent Education actions would be pertinent to qualify teams. Although workers have recently won a weekly self-managed space for Permanent Education, there is still resistance by some professionals of the nursing staff to participate in these meetings. Thus, as UNIFESP's Professional Master degree requires the development of a product, I decided to invite these subjects to participate of Operative Groups, in which the results of the research will be shared and serve as triggers of other discussions. The goal is to listen to them and invite them to participate of the meetings of Permanent Education, so that the agreement of the work can, finally, be carried out collectively and that the knowledge and practices of each worker can be shared, improved and made available for all (health team and patients).
- ItemAcesso aberto (Open Access)Correlation between depressive symptoms and quality of life in users of psychoactive substances(Universidade de São Paulo, Escola de Enfermagem, 2014-08-01) Marcon, Samira Reschetti; Xavier, Jéssica Saraiva; Barcelon, Ariane Aguillar; Espinosa, Mariano Martinez; Barbosa, Dulce Aparecida [UNIFESP]; Universidade Federal de Mato Grosso Nursing Faculty; Universidade Federal Mato Grosso Department of Statistics; Universidade Federal de São Paulo (UNIFESP)Objectives: To evaluate the correlation between the presence of depressive symptoms and quality of life in users of psychoactive substances from Psychosocial Attention Centers in Mato Grosso. Method: A cross-sectional analytical study, conducted in Psychosocial Attention Centers, with 109 users. The instruments used were: Medical Outcomes Study 36, Beck Depression Inventory, socio-demographic variables and the use of psychoactive substances. A Tukey analysis and a Spearman correlation were conducted with a significance level of α<0,05. Results: The most affected domains of quality of life were emotional, social and mental health aspects, besides the strong correlation between depressive symptoms and quality of life. Conclusion: The use of psychoactive substances and the presence of symptoms significantly interfere in the life of users, which can compromise the motivation to the treatment, negatively affecting the quality of life in this population.
- ItemSomente MetadadadosA critical view on singular therapeutic projects(Univ Sao Paulo, Escola De Enfermagem De Ribeirao Preto, 2016) Kinker, Fernando Sfair [UNIFESP]This article discusses the issue of unique therapeutic projects within the mental health services built in the Brazilian psychiatric reform process. Starting from the concepts that have gained strength in both the psychiatric reform as in the collective health, this study proposes that current notions of the therapeutic project still are influenced by biological, psychological or social paradigms that simplify the complexity of the experience suffered by the subjects. Despite therapeutic projects are an essential achievement for the qualification of mental health care, it is still necessary to produce an epistemological rupture in the relationship with mental suffering so that they can achieve the greatest potential for transformation. Therefore, the article suggests that the practice of therapeutic projects should hold discussions with the reality of users life of and their relationships in the territories of existence, to transform the relations of power and knowledge that reproduce the subjects annulment. Thus, it is possible to dialogue with the complexity of the mental suffering experience, producing changes in the scenes that produce it.
- ItemAcesso aberto (Open Access)O cuidado em liberdade na vivência dos moradores de Serviços Residenciais Terapêuticos(Universidade Federal de São Paulo (UNIFESP), 2018-03-16) Massa, Paula Andréa [UNIFESP]; Moreira, Maria Inês Badaró [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Com o objetivo de entender a vivência de cuidado à saúde em liberdade dos moradores de Serviços Residenciais Terapêuticos (SRT), realizou-se uma pesquisa social em saúde com abordagem qualitativa. Trata-se de uma pesquisa participante que efetuou quatro encontros de grupo focal narrativo, a construção coletiva de um ecomapa para o mapeamento da rede social e a observação participante da circulação social cotidiana. Os dez participantes são metade do sexo feminino, com idade média de 60 anos, tempo médio de sete anos de internação psiquiátrica e são moradores de dois SRTs da cidade de São Bernardo do Campo. Na perspectiva dos participantes, ter saúde é sentir prazer e ser feliz. Cuidar da saúde é um projeto de felicidade e ter planos futuros. Seis diferentes componentes da Rede de Atenção Psicossocial são acessados pelos participantes, mas a maioria dos lugares que compõem a rede social são serviços comerciais e de lazer; mais da metade dos participantes resgatou os laços familiares. Foram observadas 12 cenas do cotidiano dos participantes. Constatou-se que no cuidado em liberdade pode ocorrer a vivificação do eu, definido como um caminho de reapropriação do corpo, da casa e da rua em busca de incorporação. Concluiu-se que as práticas e táticas cotidianas e as práticas narrativas, estas na perspectiva do construcionismo social, são recursos para o cuidado em liberdade. Na vivência dos participantes, a construção social dos corpos feminino e masculino e o poder aquisitivo foram identificados como circunstâncias que devem ser consideradas na construção dos arranjos de moradia e cuidado em liberdade nos diferentes cenários.
- ItemAcesso aberto (Open Access)Desenvolvimento do cuidado em saúde mental no contexto de consolidação da reforma psiquiátrica: a experiência de um CAPS em Santos(Universidade Federal de São Paulo (UNIFESP), 2017) Wagner, Natália Cyrillo [UNIFESP]; Kinker, Fernando Sfair [UNIFESP]; http://lattes.cnpq.br/9428178474782359; http://lattes.cnpq.br/2700328910260497; Universidade Federal de São Paulo (UNIFESP)By the end of the 1980s, with the creation of the Unified Health System (SUS), the first initiatives to replace mental asylums in Brazil took place. The city of Santos pioneered the process of creating the first network of territorial services for mental health. In this sense, within a process of paradigm change, it was expected that daily work routine presented difficulties and potentialities in the development and implementation of the psychosocial care model. It is also believed that the way of reflection of the practice makes possible the implementation of care actions wich contributes to overcome the challenges encountered, allowing the expansion of citizenship exercise, autonomy development and improvement of life quality of the users served, at the same time finding more effective ways to share these experiences among professionals and among the Psychosocial Care Network services. The aim of this research was to investigate the professionals' perception about their practice, organized by the understanding, construction and use of the Singular Therapeutic Project (PTS) as a strategy to direct care. Through the qualitative approach, a case study was carried out in a Psychosocial Care Center. The aim was to identify in this service, through semi-structured interviews applied to team professionals, the promotion of the changes advocated by the Movement of Anti-Asylum and Psychiatric Reform. Thus, a cut was used as a strategies organization resources used by care team, which consists of the Singular Therapeutic Project, the product of this mobilization process. The set of data produced was explored from the perspective of the Thematic Content Analysis. In the experience was a dynamic process composed of multiple understandings and several ways to deal in practice with the Singular Therapeutic Projects question. Finally, it was verified the importance of efforts aimed at the training of health workers, while valuing the prior knowledge of these professionals, as a strategy to strengthen practice, in an attempt to produce transformations not only within the services, but also in all social contexts where psychic suffering is produced and lived. Nevertheless, it is known that the training processes do not solve all the questions, but they can foment the learning that occurs in the daily practice.
- ItemSomente MetadadadosDesenvolvimento Do Cuidado Em Saúde Mental No Contexto De Consolidação Da Reforma Psiquiátrica: A Experiência De Um Caps Em Santos(Universidade Federal de São Paulo (UNIFESP), 2017-08-21) Wagner, Natalia Cyrillo [UNIFESP]; Kinker, Fernando Sfair [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)By the end of the 1980s, with the creation of the Unified Health System (SUS), the first initiatives to replace mental asylums in Brazil took place. The city of Santos pioneered the process of creating the first network of territorial services for mental health. In this sense, within a process of paradigm change, it was expected that daily work routine presented difficulties and potentialities in the development and implementation of the psychosocial care model. It is also believed that the way of reflection of the practice makes possible the implementation of care actions wich contributes to overcome the challenges encountered, allowing the expansion of citizenship exercise, autonomy development and improvement of life quality of the users served, at the same time finding more effective ways to share these experiences among professionals and among the Psychosocial Care Network services. The aim of this research was to investigate the professionals' perception about their practice, organized by the understanding, construction and use of the Singular Therapeutic Project (PTS) as a strategy todirect care. Through the qualitative approach, a case study was carried out in a Psychosocial Care Center. The aim was to identify in this service, through semi- structured interviews applied to team professionals, the promotion of the changes advocated by the Movement of Anti-Asylum and Psychiatric Reform. Thus, a cut was used as a strategies organization resources used by care team, which consists of the Singular Therapeutic Project, the product of this mobilization process. The set of data produced was explored from the perspective of the Thematic Content Analysis. In the experience was a dynamic process composed of multiple understandings and several ways to deal in practice with the Singular Therapeutic Projects question. Finally, it was verified the importance of efforts aimed at the training of health workers, while valuing the prior knowledge of these professionals, as a strategy to strengthen practice, in an attempt to produce transformations not only within the services, but also in all social contexts where psychic suffering is produced and lived. Nevertheless, it is known that the training processes do not solve all the questions, but they can foment the learning that occurs in the daily practice.
- ItemAcesso aberto (Open Access)Direct medical costs associated with schizophrenia relapses in health care services in the city of São Paulo(Faculdade de Saúde Pública da Universidade de São Paulo, 2011-02-01) Daltio, Claudiane Salles [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Ferraz, Marcos Bosi [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To assess direct medical costs associated with schizophrenia relapses in mental health services. METHODS: The study was conducted in three health facilities in the city of São Paulo: a public state hospital; a Brazilian National Health System (SUS)-contracted hospital; and a community mental health center. Medical records of 90 patients with schizophrenia who received care in 2006 were reviewed. Information on inpatient expenditures was collected and used for cost estimates. RESULTS: Mean direct medical cost of schizophrenia relapses per patient was US$ 4,083.50 (R$ 8,167.58) in the public state hospital; US$ 2,302.76 (R$ 4,605.46) in the community mental health center; and US$ 1,198.50 (R$ 2,397.74) in the SUS-affiliated hospital. The main component was daily inpatient room rates (87% - 98%). Medication costs varied depending on the use of typical or atypical antipsychotic drugs. Atypical antipsychotic drugs were more often used in the community mental health center. CONCLUSIONS: Costs associated with schizophrenia relapses support investments in antipsychotic drugs and strategies to reduce disease relapse and the need for mental health inpatient services. Treating patients in a community mental health center was associated with medium costs and added the benefit of not depriving these patients from family life.
- ItemSomente MetadadadosEducação permanente em saúde mental: pesquisa intervenção em um CAPSad(Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Coelho, Marina Pinto [UNIFESP]; Maximino, Viviane Santalucia [UNIFESP]; Liberman, Flávia [UNIFESP]; http://lattes.cnpq.br/8790313628912498; http://lattes.cnpq.br/4009544927681281; http://lattes.cnpq.br/7618293337631531; Universidade Federal de São Paulo (UNIFESP)The Psychosocial Care Centers (CAPS) are fundamental part in the process of the Brazilian Psychiatric Reform. It was only from the establishment of these places that was possible the beginning, in a concrete way, of the organization of a substitute network for psychiatric hospitals in the country. However, there are many challenges for the teams that work in these services and several studies point out that there is a great mismatch between the theoretical/technical/conceptual qualification of the professionals, their practices and the national mental health policies. In this scenario, the current study investigated, from the perspective of the multidisciplinary team of a Center for Psychosocial Care Alcohol and Other Drugs (CAPSad), which actions have been developed, what are the existing needs, as well as the improvements proposals of the processes of Permanent Education, from the critical reflection upon the local reality and daily difficulties of this work. This was a intervention’s research with a qualitative approach. For data collection, semi-structured interviews were conducted with CAPSad coordination and focus groups with the team's healthcare professionals. The data were submitted to content thematic analysis. After the data analysis, a workshop was conducted to give for the research participants a feedback about the collected material. During the intervention research, other workshops with the team were proposed, using group dynamics and materials, for a greater understanding and exploration of the theme of Permanent Education, as well as the attendance to some needs identified by the professionals. At the end of this process, it was noticed that many challenges remain in the path for the implementation of Permanent Education practices in the CAPSad context. In the face of CAPSad practices complexity, it was noticed the need for investment in training of the professionals, in addition to the technical and scientific skills and abilities, to provide an ethical and reflexive attitude about health and care conceptions and which stimulates the professionals to lead the production of knowledge from their own experiences. It is expected that the results of this research, as well as the performed intervention, may be used as an axis for improvement, offering new elements, producing displacements and new approaches to observe the processes of Permanent Education for the professionals who work in CAPSad.
- ItemAcesso aberto (Open Access)Encontros entre trabalhadores de saúde e pessoas em situação de rua no Centro Histórico de Salvador, Bahia: violências, potências e insurgências(Universidade Federal de São Paulo, 2021-08-09) Oliveira, João André Santos de [UNIFESP]; Andreazza, Rosemarie [UNIFESP]; Furtado, Lumena Almeida Castro [UNIFESP]; http://lattes.cnpq.br/3418180766317317; http://lattes.cnpq.br/1447772258702244; http://lattes.cnpq.br/1483924551038632Objetivo: Esta tese objetivou analisar os efeitos dos encontros para a produção do cuidado nos corpos dos usuários e trabalhadores saúde de dois serviços acessados intensamente por pessoas em situação de rua no território do Centro Histórico de Salvador, Bahia. Método: É uma pesquisa qualitativa, em uma perspectiva cartográfica, realizada com um Centro de Atenção Psicossocial Álcool e outras Drogas e um Consultório na Rua, entre 2017 e 2019, e que acompanhou a caminhada de um trabalhador de saúde afetado, e em mútua produção, pelos encontros com as pessoas que habitam esses serviços. Parte do reconhecimento do conhecimento como uma produção que se dá a partir dos afetos e das ressonâncias que os mesmos provocam nos nossos corpos. Foram construídos mapas utilizandose diferentes estratégias, como a confecção de diários cartográficos e encontros com as equipes para a construção de narrativas individuais e coletivas em relação à experiência de cuidado com as pessoas em situação de rua, colocandose em análise os efeitos das experiências produzidas rizomaticamente por esses sujeitos em suas relações com o mundo. Uma análise de implicação permeou toda a tese, o que possibilitou a produção de visibilidade para as implicações que habitam meu corpo de pesquisador branco, professor e médico. Resultados: As situações de violência vividas em um dos serviços tornaramse importantes analisadores, apontando para a produção de outros mapas da cartografia, como o lugar das drogas na produção das existências; o papel do Centro de Atenção Psicossocial Álcool e outras Drogas no cuidado às pessoas em situação de rua; a produção do sofrimento dessas pessoas atravessado pela necropolítica, humilhação social e pelo racismo estrutural; o sofrimento dos trabalhadores de saúde e suas implicações, afetados pela precarização produzida pelo neoliberarlismo contemporâneo, pelo sofrimento e “demandas vorazes” trazidas pelos usuários, e atravessados pelo modo de subjetivação colonialcapitalístico hegemônico. Conclusões: Este trabalho propõe (ou reconhece) o conceitoferramenta “existências insurgentes” como forma de apontar a necessidade de instauração de novos modos de existências para trabalhadores de saúde e pessoas em situação de rua, deslocando o lugar da droga do centro da vida para um dos agenciamentos das várias vidas em produção. Fortalece a necessidade, no campo da saúde, de engravidar o sentido da produção do cuidado como produção de mais vida, assim como deslocar os conceitos pobres de “profissionais de saúde” e de “pessoas em situação de rua” como formas de representar essas existências que são multiplicidade e potência, que se encontram e se produzem mutuamente por múltiplas linhas de força que agenciam suas formas de viver.
- ItemAcesso aberto (Open Access)Influência dos modelos inovadores paulistas na Política Brasileira de Saúde Mental(Assoc Brasileira Enfermagem, 2016) Vieira, Marcia do Nascimento [UNIFESP]; Marcolan, Joao Fernando [UNIFESP]Objective: to analyze the influence of two Sao Paulo State experiences in the choice of psychosocial care centers as guiding service providers for the national mental health policy. Method: qualitative, exploratory, and descriptive study using oral history as a methodology and theoretical reference. Results: eight professionals involved in the deployment of the mental health policy in the cities of Santos and Sao Paulo between the years 1989 and 1992 were interviewed. Data were analyzed after treating the narratives and grouping the most significant content. Two central themes emerged: development of the local-regional model, and the model's influence on the choice of the psychosocial care center. Conclusion: due to greater insertion of the Santos experience group in the spheres of the federal government, its influence on the choice of the substitute model was higher in ideological terms, whereas the Sao Paulo model had its influence restricted for political reasons.
- ItemAcesso aberto (Open Access)Participação, produção de conhecimento e pesquisa avaliativa: a inserção de diferentes atores em uma investigação em saúde mental(Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2008-11-01) Furtado, Juarez Pereira [UNIFESP]; Onocko Campos, Rosana Teresa; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)This article reflects on the interrelations between participation, knowledge production, and public policy evaluation in light of issues from our own experience with evaluative research on a municipal network of Psychosocial Care Centers (CAPS) in Brazil. The article discusses the coordination of the complex process and the potentials and limits of partnerships for conducting qualitative evaluative studies in mental health with participation by different social actors. The authors conclude that qualitative evaluative research aligned with the perspective of including different points of view representing various segments is the best approach for understanding the numerous spin-offs from the implementation of services linked to the Brazilian psychiatric reform movement, given the inherent specificities of the mental health field.
- ItemAcesso aberto (Open Access)Redução de danos (RD): suas implicações e contradições no Centro de Atenção Psicossocial " Álcool e outras Drogas ( CAPS-AD) de Santos(Universidade Federal de São Paulo (UNIFESP), 2018-08-30) Souza, Rafael Ferreira de [UNIFESP]; Kinker, Fernando Sfair [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Inicialmente voltada para a prevenção de infecções sexualmente transmissíveis (IST) em usuários de drogas injetáveis (UDI), a Redução de Danos (RD) amplia suas ações buscando minimizar as consequências prejudiciais do uso de substâncias psicoativas. Com a Política para a Atenção Integral a Usuários de Álcool e Outras Drogas (2003), do Ministério da Saúde, a RD migra para o campo da saúde mental e se torna diretriz dos Centros de Atenção Psicossocial – Álcool e Outras Drogas (CAPS-AD). Considerando a importância desse tema para a prática do cuidado, a presente pesquisa teve o objetivo de investigar como os profissionais da equipe multidisciplinar do CAPS-AD de Santos/SP compreendem a RD e quais ações desenvolvem nessa perspectiva. Para o alcance dos objetivos foi realizada pesquisa-intervenção com produção de dados por meio da realização de dois grupos focais com 11 profissionais de 5 profissões/funções diferentes, atuantes há mais de 1 ano no CAPS-AD do município e por meio dos relatos de experiência do autor como Acompanhante Terapêutico (AT) do serviço. Os dados produzidos foram analisados por meio da análise de conteúdo do tipo temática e as categorias construídas transformadas em capítulos divididos em dois grupos: implicações e contradições. A pesquisa indicou que a Redução de Danos é entendida pelos profissionais participantes da pesquisa como paradigma e como prática de cuidado em saúde, realizada por meio de ações voltadas para a autonomia e autocuidado dos usuários. No entanto, coexistem diferentes concepções de RD e diferentes práticas, mesclando posturas emancipatórias, que apostam na autonomia dos usuários, com posturas mais proibicionistas e ações pautadas pelo paradigma da abstinência, como os encaminhamentos às Comunidades Terapêuticas, as parcerias com os grupos de mútua ajuda e a medicamentalização. As diferentes perspectivas de RD refletem as divergências e disputas entre as políticas de drogas, as concepções científicas e as demais forças que atravessam e influenciam o modo como a sociedade aborda a questão das drogas, que se atualizam na prática dos profissionais do CAPS-AD. A pesquisa indica que se faz necessário o aprofundamento da reflexão em equipe da perspectiva de redução de danos adotada, levando em consideração os usuários e os contextos em que as ações seinserem, de modo a trabalhar com as contradições e enriquecer a prática de cuidado.
- ItemSomente MetadadadosResidência Médica Em Centro De Atenção Psicossocial: Reflexões Sobre Uma Formação Singular Em Psiquiatria Santos(Universidade Federal de São Paulo (UNIFESP), 2017-11-07) Unzueta, Leandro Bernardello [UNIFESP]; Uchôa-Figueiredo, Lúcia da Rocha [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Inaugurated in 2014 in the city of São Bernardo do Campo, a medical residency in psychiatry with a unique format until then, which is developed entirely within the scope of psychiatric reform, using the units of the Psychosocial Attention Network (RAPS) as training spaces. In addition, it is also a medical residency associated with a Municipal Health Department and not a Higher Education Institution (HEI), a unique difference that brings important singularities to the formation. The main objective of this research is to analyze and discuss the training experience of these residents through the analysis of their respective discourses. For this, semi-structured interviews were conducted with all residents of the first and second year, and the first academic year was given almost exclusively in a Psychosocial Care Center (CAPS). The collected data were analyzed using Discourse Analysis, in an attempt to identify contradictory, contrasting or similar meanings of dispute or partnership, thus evidencing the discursive positioning of the residents and their learning in the course of their experience. It is based on the hypothesis that there are differences between the traditional medical training, based on the guidelines of the Flexner Report, with the training model experienced in the CAPS that differs by its structure and practice. The results point out that a CAPS training provides greater challenges, as well as greater opportunities for learning and reflection according to the present characteristic elements, which we tried to highlight in this research. As a consequence, there is a training model that provides the psychiatrist with a broader perception of health users, as well as a more critical perspective on their actions.