Maria Cristina Ventura Couto

A saúde mental infantil na Saúde Pública brasileira: situação atual e desafios

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.

Censo dos pacientes internados em uma instituição asilar no Estado do Rio de Janeiro: dados preliminares

O Estado do Rio de Janeiro concentra uma das maiores redes de hospitais psiquiatricos do pais, sendo um deles a Casa de Saude Dr. Eiras/Paracambi (CSDE-P). A atual Assessoria de Saude Mental da Secretaria de Estado de Saude do Estado do Rio de Janeiro, realizou em fins de 2000, o Censo Clinico e Psicossocial dos Pacientes Internados na CSDE-P. Encontrou uma populacao de 1494 individuos, com predominio de homens (53,4%), solteiros (81,6%), faixa etaria produtiva (66,4%) e baixa escolaridade (11,5% com primeiro grau completo ou mais). A maioria tinha um tempo de internacao superior/igual a 2 anos (77,6%), recebiam visitas de familiares (60,5%) mas nao saiam de licenca (73,8%). Os diagnosticos predominantes foram as esquizofrenias (53,6%) e o retardo mental (26,4%). A principal abordagem terapeutica foi a psiquiatrica (84,1%). Realizavam atividades sistematicas durante o dia 13,3% dos pacientes, embora cerca de 36% apresentassem bons indicativos de condicoes de autonomia. A CSDE-P e um macro hospital, onde a maioria dos pacientes encontra-se desterritorializada e com lacos sociais precarios, exigindo a construcao de estrategias de cuidados que levem em conta essa particularidade.Rio de Janeiro State has one of the largest networks of psychiatric hospitals in Brazil, one of them the Dr. Eiras Paracambi Hospital (CSDE-P). In late 2000, the current Mental Health Advisory Division of the Rio de Janeiro State Health Department conducted a clinical and psychosocial census of patients hospitalized in the CSDE-P. The hospital population consisted of 1,494 individuals, the majority men (53.4%), single (81.6%), working-age (66.4%), and with limited schooling (only 11.5% with a complete primary education or more). Most had been in hospital for at least two years (77.6%), received visits from relatives (60.5%), but did not have hospital leave (73.8%). The predominant diagnoses were schizophrenia (53.6%) and mental retardation (26.4%). The main therapeutic approach was psychiatric (84.1%). Only 13.3% took part in systematic activities during the day, although 36% were in a condition to do so. CSDE-P is a mega-hospital where most patients have precarious social links, demanding treatment strategies which take this characteristic into account.

Crianças e adolescentes na agenda política da saúde mental brasileira: inclusão tardia, desafios atuais

Basado en el argumento de que hasta finales del siglo XX no era posible reconocer, en el contexto brasileno, una politica de salud mental para ninos y adolescentes (SMNA), este articulo analizar los determinantes para el retraso de insercion de la salud mental de ninos y adolescentes (SMNA) en la agenda de la salud publica en Brasil, ademas de identificar y describirlas dos acciones prioritarias elegidas por el Sistema Unico de Salud (SUS), a inicios del siglo XXI, para empezar la construccion de redes de atencion en SMNA: la implantacion de los Centros de Atencion Psicosocial para Ninos y Adolescentes (CAPSi) y el desarrollo de estrategias de cooperacion intersectores entre la salud mental y educacion, asistencia social, justicia, sectores historicamente involucrados en la atencion de ninos y jovenes. La creacion de CAPSi y la cooperacion intersectores se consideran las principales acciones para la introduccion de una red publica ampliada en SMNA, con ubicacion en el territorio, capaz de adaptarse a los diferentes ordenes de problemas relacionados con la SMNA y de ampliar el acceso a la atencion.

Atenção básica e cuidado colaborativo na atenção psicossocial de crianças e adolescentes: facilitadores e barreiras

Considering the care gap in child and youth psychosocial care, the articulation of the intra-sectoral network is an important strategy to promote less fragmented care flows. The study analyzes facilitators and obstacles to collaborative care between the Family Health Strategy (ESF) and a Child and Youth Psychosocial Care Center (CAPSi) in Rio de Janeiro/RJ. This is an exploratory study with a qualitative approach, which main methodological tools were focus and intervention groups. From the proposed thematic axes, we identified that the perception of child and adolescent mental health problems by ESF workers was named by the behavioral changes located in a context of vulnerability. The main obstacles to implementing actions were lack of knowledge about how to provide care, work process-related issues and network disarticulation. Even if ESF professionals are able to identify mental health problems of children and adolescents, care actions are fragile and network articulation is practically nonexistent. Collaborative care was recognized as a strategy to validate child psychosocial care.Considering the care gap in child and youth psychosocial care, the articulation of the intra-sectoral network is an important strategy to promote less fragmented care flows. The study analyzes facilitators and obstacles to collaborative care between the Family Health Strategy (ESF) and a Child and Youth Psychosocial Care Center (CAPSi) in Rio de Janeiro/RJ. This is an exploratory study with a qualitative approach, which main methodological tools were focus and intervention groups. From the proposed thematic axes, we identified that the perception of child and adolescent mental health problems by ESF workers was named by the behavioral changes located in a context of vulnerability. The main obstacles to implementing actions were lack of knowledge about how to provide care, work process-related issues and network disarticulation. Even if ESF professionals are able to identify mental health problems of children and adolescents, care actions are fragile and network articulation is practically nonexistent. Collaborative care was recognized as a strategy to validate child psychosocial care.

Repercussões do processo de reestruturação dos serviços de saúde mental para crianças e adolescentes na cidade de Campinas, São Paulo (2006-2011)

This paper aims to describe and analyze the changes made in child and adolescent mental health services inCampinas, Sao Paulobetween 2006 and 2011. During this time period, different actions were taken to reorganize the health care services provided. Focusing on the Centers for Psychosocial Care, this exploratory research addresses issues related to the access and delivery of health care in order to identify the improvements and challenges resulting from the reorganization of the health services. Data and information were collected from medical records and documents in two child and adolescent mental health services. It was found that the reorganization process provided better liaison with the primary care, led to improvements in the community-based organization, and caused a relative decrease in the referrals from the justice system. Further studies are necessary to assess the impact of these changes made to improve the access to mental health care for children/adolescents.

Contributions of Activity Ergonomics to Design a Virtual Tool for Sharing Mental Health Care

The goal of this paper is to illustrate the contributions generated by Activity Ergonomics (AE) to the participatory design process of an EHR created to support collaborative mental health care of children and youth in the city of Rio de Janeiro. It is qualitative research based on the theoretical framework of AE. In this paper we will present the results of the first step of this research. This preliminary stage used as a form of data collection interviews with professionals from three sectors of the mental health care network of children and youth within Brazil. An analysis of the interviews demonstrated that mental health collaborative care encompasses an intersectoral network of services that are articulated in the construction of therapeutic projects. This type of organization requires an intense exchange of information between experts from distinct fields, like social workers, educators and health care professionals. In fostering the diverse professional realities, there is a difficulty to overcome the challenge of sharing information, due in part to the combination and inundation of the individual accounts. In addition, the difficulties identified in the use of the old device were: fear of wrongly inputting the data into the system, rework, incomprehension of the codes used as landmarks to cases. The useful features identified by the workers for a new tool were: access through smartphones, possibility of choosing to consult a summary of the cases or more detailed information, dynamic communication between the services and generation of alerts for urgent situations.

Missão e efetividade dos Consultórios na Rua: uma experiência de produção de consenso

RESUMO Este e um relato da experiencia de uma Oficina realizada com profissionais de Consultorios na Rua do estado do Rio de Janeiro, que inclui a apresentacao do cotidiano do trabalho, discussao acerca da efetividade do cuidado oferecido e construcao de consenso por meio da Tecnica Delphi. A Oficina concluiu que o Consultorio na Rua e um facilitador da chegada dos usuarios a Atencao Basica, que o uso da reducao de danos e comum a todos os servicos desse tipo, e que ha algum grau de integracao dos Consultorios na Rua com a saude, a saude mental e o intersetor, sendo essa integracao, mesmo problematica, fundamental para o trabalho.

Salud mental de niños y adolescentes en la agenda de salud pública en Brasil: inicio tardío y retos actuales

Basado en el argumento de que hasta finales del siglo XX no era posible reconocer, en el contexto brasileno, una politica de salud mental para ninos y adolescentes (SMNA), este articulo analizar los determinantes para el retraso de insercion de la salud mental de ninos y adolescentes (SMNA) en la agenda de la salud publica en Brasil, ademas de identificar y describirlas dos acciones prioritarias elegidas por el Sistema Unico de Salud (SUS), a inicios del siglo XXI, para empezar la construccion de redes de atencion en SMNA: la implantacion de los Centros de Atencion Psicosocial para Ninos y Adolescentes (CAPSi) y el desarrollo de estrategias de cooperacion intersectores entre la salud mental y educacion, asistencia social, justicia, sectores historicamente involucrados en la atencion de ninos y jovenes. La creacion de CAPSi y la cooperacion intersectores se consideran las principales acciones para la introduccion de una red publica ampliada en SMNA, con ubicacion en el territorio, capaz de adaptarse a los diferentes ordenes de problemas relacionados con la SMNA y de ampliar el acceso a la atencion.

Mental health of children and adolescents in the Brazilian public health agenda: late onset and current challenges

Basado en el argumento de que hasta finales del siglo XX no era posible reconocer, en el contexto brasileno, una politica de salud mental para ninos y adolescentes (SMNA), este articulo analizar los determinantes para el retraso de insercion de la salud mental de ninos y adolescentes (SMNA) en la agenda de la salud publica en Brasil, ademas de identificar y describirlas dos acciones prioritarias elegidas por el Sistema Unico de Salud (SUS), a inicios del siglo XXI, para empezar la construccion de redes de atencion en SMNA: la implantacion de los Centros de Atencion Psicosocial para Ninos y Adolescentes (CAPSi) y el desarrollo de estrategias de cooperacion intersectores entre la salud mental y educacion, asistencia social, justicia, sectores historicamente involucrados en la atencion de ninos y jovenes. La creacion de CAPSi y la cooperacion intersectores se consideran las principales acciones para la introduccion de una red publica ampliada en SMNA, con ubicacion en el territorio, capaz de adaptarse a los diferentes ordenes de problemas relacionados con la SMNA y de ampliar el acceso a la atencion.