Pedro Gabriel Godinho Delgado

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.

Política de Saúde Mental no Brasil: evolução do gasto federal entre 2001 e 2009

OBJETIVO: Analisar a evolucao de estimativas do gasto federal com o Programa de Saude Mental desde a promulgacao da lei nacional de saude mental. METODOS: O gasto federal total do Programa de Saude Mental e seus componentes de gastos hospitalares e extra-hospitalares foi estimado a partir de 21 categorias de gastos de 2001 a 2009. Os valores dos gastos foram atualizados para valores em reais de 2009 por meio da aplicacao do Indice de Precos ao Consumidor Amplo. Foi calculado o valor per capita/ano do gasto federal em saude mental. RESULTADOS: Observou-se o crescimento real de 51,3% do gasto em saude mental no periodo. A desagregacao do gasto revelou aumento expressivo do valor extra-hospitalar (404,2%) e decrescimo do hospitalar (-39,5%). O gasto per capita teve crescimento real menor, embora expressivo (36,2%). A serie historica do gasto per capita desagregado mostrou que em 2006, pela primeira vez, o gasto extra-hospitalar foi maior que o hospitalar. O valor per capita extra-hospitalar teve o crescimento real de 354,0%; o valor per capita hospitalar decresceu 45,5%. CONCLUSOES: Houve crescimento real dos recursos federais investidos em saude mental entre 2001 e 2009 e investimento expressivo nas acoes extra-hospitalares. Houve inversao no direcionamento dos recursos, a partir de 2006, na direcao dos servicos comunitarios. O componente do financiamento teve papel crucial como indutor da mudanca de modelo de atencao em saude mental. O desafio para os proximos anos e sustentar e aumentar os recursos para a saude mental num contexto de desfinanciamento do Sistema Unico de Saude.OBJECTIVE To analyze the evolution of estimates of federal spending in Brazils Mental Health Program since the promulgation of the national mental health law. METHODS The total federal outlay of the Mental Health Program and its components of hospital and extra-hospital expenses were estimated based on 21 expenses categories from 2001 to 2009. The expenses amount was updated to values in reais of 2009 by means of the use of the Índice de Preços ao Consumidor Amplo (Broad Consumer Price Index). The per capita/year value of the federal expenditure on mental health was calculated. RESULTS The outlay on mental health rose 51.3% in the period. The breakdown of the expenditures revealed a significant increase in the extra-hospital value (404.2%) and a decrease in the hospital one (-39.5%). The per capita expenditures had a lower, but still significant, growth (36.2%). The historical series of the disaggregated per capita expenditures showed that in 2006, for the first time, the extra-hospital expenditure was higher than the hospital one. The extra-hospital per capita value increased by 354.0%; the per capita hospital value decreased by 45.5%. CONCLUSIONS There was a significant increase in federal outlay on mental health between 2001 and 2009 and an expressive investment in extra-hospital actions. From 2006 onwards, resources allocation was shifted towards community services. The funding component played a crucial role as the inducer of the change of the mental health care model. The challenge for the coming years is maintaining and increasing the resources for mental health in a context of underfunding of the National Health System.

Mental Health Policy in Brazil: federal expenditure evolution between 2001 and 2009

OBJETIVO: Analisar a evolucao de estimativas do gasto federal com o Programa de Saude Mental desde a promulgacao da lei nacional de saude mental. METODOS: O gasto federal total do Programa de Saude Mental e seus componentes de gastos hospitalares e extra-hospitalares foi estimado a partir de 21 categorias de gastos de 2001 a 2009. Os valores dos gastos foram atualizados para valores em reais de 2009 por meio da aplicacao do Indice de Precos ao Consumidor Amplo. Foi calculado o valor per capita/ano do gasto federal em saude mental. RESULTADOS: Observou-se o crescimento real de 51,3% do gasto em saude mental no periodo. A desagregacao do gasto revelou aumento expressivo do valor extra-hospitalar (404,2%) e decrescimo do hospitalar (-39,5%). O gasto per capita teve crescimento real menor, embora expressivo (36,2%). A serie historica do gasto per capita desagregado mostrou que em 2006, pela primeira vez, o gasto extra-hospitalar foi maior que o hospitalar. O valor per capita extra-hospitalar teve o crescimento real de 354,0%; o valor per capita hospitalar decresceu 45,5%. CONCLUSOES: Houve crescimento real dos recursos federais investidos em saude mental entre 2001 e 2009 e investimento expressivo nas acoes extra-hospitalares. Houve inversao no direcionamento dos recursos, a partir de 2006, na direcao dos servicos comunitarios. O componente do financiamento teve papel crucial como indutor da mudanca de modelo de atencao em saude mental. O desafio para os proximos anos e sustentar e aumentar os recursos para a saude mental num contexto de desfinanciamento do Sistema Unico de Saude.OBJECTIVE To analyze the evolution of estimates of federal spending in Brazils Mental Health Program since the promulgation of the national mental health law. METHODS The total federal outlay of the Mental Health Program and its components of hospital and extra-hospital expenses were estimated based on 21 expenses categories from 2001 to 2009. The expenses amount was updated to values in reais of 2009 by means of the use of the Índice de Preços ao Consumidor Amplo (Broad Consumer Price Index). The per capita/year value of the federal expenditure on mental health was calculated. RESULTS The outlay on mental health rose 51.3% in the period. The breakdown of the expenditures revealed a significant increase in the extra-hospital value (404.2%) and a decrease in the hospital one (-39.5%). The per capita expenditures had a lower, but still significant, growth (36.2%). The historical series of the disaggregated per capita expenditures showed that in 2006, for the first time, the extra-hospital expenditure was higher than the hospital one. The extra-hospital per capita value increased by 354.0%; the per capita hospital value decreased by 45.5%. CONCLUSIONS There was a significant increase in federal outlay on mental health between 2001 and 2009 and an expressive investment in extra-hospital actions. From 2006 onwards, resources allocation was shifted towards community services. The funding component played a crucial role as the inducer of the change of the mental health care model. The challenge for the coming years is maintaining and increasing the resources for mental health in a context of underfunding of the National Health System.

Psicopatologia da autonomia: a importância do conhecimento psicopatológico nos novos dispositivos de assistência psiquiátrica

O lugar que o conhecimento psicopatologico tem ocupado, e pode vir a ocupar na pratica clinica dos centros de atencao psicossocial (CAPS) - servicos comunitarios destinados ao tratamento de pacientes com transtornos mentais graves, persistentes, em quadros agudos ou nao - e a questao central deste artigo. Analisam-se brevemente as consequencias da hegemonia da psicopatologia descritiva para o desenho das intervencoes nesses servicos e discutese se a psicopatologia do ser social poderia ser ferramenta para o construcao de cuidado que visa promover a autonomia possivel para os pacientes viverem em comunidade.

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.

Estudo de comorbidade: sofrimento psíquico e abuso de drogas em pessoas em centros de tratamento, Macaé - Brasil

Study of prevalence and psychological distress among people attending a public day care service and two private in patientsservicesinthecityofMacae,�RiodeJaneiro,�Brazil.�Cross-sectionalstudy.�AquestionnaireadaptedbytheformEULAC-CICAD� was applied to characterize the participants. The scale of Kessler-10 was used as a screening tool for psychological distress. The sample was 60 people: 88.3% men and 51.5% between 24-39 years old. Depression was referred as the most important previous diagnosis in 35%, followed by anxiety in 33.33%. During the current treatment this relationship changed: anxiety was the main diagnosis in 38.3%, followed by depression in 28.3%. The 34% of the sample had severe psychological distress and 27.2% very severe psychological distress. The levels of psychological distress severe and very severe in 61.2% screened by K-10, a scale especially sensitive to anxiety and depression, are similar to international studies on this population. dEsCriptors: Comorbidity. Substance use-related disorders. Psychological distress. Mental health assistance.Study of prevalence and psychological distress among people attending a public day care service and two private in patients services in the city of Macae, Rio de Janeiro, Brazil. Cross-sectional study. A questionnaire adapted by the form EULAC-CICAD was applied to characterize the participants. The scale of Kessler-10 was used as a screening tool for psychological distress. The sample was 60 people: 88.3% men and 51.5% between 24-39 years old. Depression was referred as the most important previous diagnosis in 35%, followed by anxiety in 33.33%. During the current treatment this relationship changed: anxiety was the main diagnosis in 38.3%, followed by depression in 28.3%. The 34% of the sample had severe psychological distress and 27.2% very severe psychological distress. The levels of psychological distress severe and very severe in 61.2% screened by K-10, a scale especially sensitive to anxiety and depression, are similar to international studies on this population. dEsCriptors: Comorbidity. Substance use-related disorders. Psychological distress. Mental health assistance. Estudio dE la Comorbilidad: distrEs psiColOgiCo Y abuso dE drogas En pErsonas En CEntros dE tratamiEnto, maCae – brasil rEsumEn: Estudio de prevalencia de distres psicologicos entre personas que acuden a los servicios publicos de atencion de dia y dos centros de hospitalizacion privada en la ciudad de Macae, Rio de Janeiro, Brasil. Estudio transversal. Se aplico un cuestionario adaptado de lo formulario de la EULAC-CICAD para caracterizar a los participantes. Para la deteccion de los distres psicologicos se utilizo la escala de Kessler-10. Participaron 60 personas, y los hombres eran 88.3%. De la muestra total, el 51.5% tenian entre 24 a 39 anos de edad. La depresion fue el principal diagnostico relatado en 35%, seguido de la ansiedad en 33.33%. Durante el tratamiento actual la ansiedad fue el diagnostico principal en 38.3%, seguido de depresion en 28.3%. De los encuestados el 34% tenian niveles graves de distres psicologicos y el 27.2% niveles muy graves. Las conclusiones de que los niveles de distres psicologico grave y muy grave en 61.2% identificados pela escala K-10, especialmente sensibles a la ansiedad y la depresion, son similares a los estudios internacionales de esta poblacion. dEsCriptorEs: Comorbilidad. Distres psicologico. Trastornos relacionados con sustancias. Atencion en salud mental.

Sobrecarga do cuidado, solidariedade e estratégia de lida na experiência de familiares de Centros de Atenção Psicossocial

Os familiares de usuarios de servicos de saude mental que assumem a tarefa do cuidado cotidiano sao frequentemente submetidos a sobrecarga objetiva e subjetiva. Estrategias praticas de lidar com a tarefa do cuidado e acoes de solidariedade entre familiares podem contribuir para a melhora da qualidade de vida de cuidadores e usuarios. Este estudo descreve e analisa estrategia desenvolvida junto a servicos comunitarios de saude mental (CAPS), em colaboracao com os familiares, de modo a conhecer melhor a experiencia da sobrecarga e apoiar iniciativas de ajuda mutua, educacao em saude e promocao da autonomia. A coleta e analise dos dados utilizou metodologia qualitativa, como observacao e grupos focais. Resultados preliminares identificam altos niveis de sobrecarga, boa resposta dos familiares a participacao em grupos de ajuda mutua e atividades de educacao em saude, e a necessidade de aperfeicoar e intensificar as acoes desenvolvidas pelos CAPS para apoio e orientacao dos familiares.

Experiências brasileiras sobre participação de usuários e familiares na pesquisa em saúde mental

O objetivo deste artigo e analisar o Programa de Alimentacao Escolar sob a otica dos alunos atendidos na rede estadual de ensino de Minas Gerais. Trata-se de estudo transversal, quali-quantitativo, com amostra de 1500 alunos, representativa do universo da rede estadual de ensino de Minas Gerais, utilizando questionario semiestruturado analisado por meio de frequencia simples, media, desvio padrao, teste exato de Fisher, teste qui-quadrado e regressao logistica (p < 0,05; IC 95%). Houve efetiva aceitacao de 28,8% e efetiva adesao de 45,1% ao Programa. A aceitacao foi significativamente maior entre alunos do sexo masculino e entre aqueles que apresentaram menor consumo de alimentos extrainstitucionais. A aceitacao e a adesao foram significativamente maiores entre alunos do grupo etario mais velho e entre aqueles que referiram participar de atividades de Educacao Alimentar e Nutricional. No total, 73,5% dos alunos sugeriram melhorias para a Alimentacao Escolar. Muitos principios e diretrizes do programa nao estao sendo cumpridos. A aceitacao da Alimentacao Escolar mostrou-se negativamente influenciada pelo consumo de alimentos extrainstitucionais e positivamente influenciada pelas acoes de Educacao Alimentar e Nutricional.In this paper the authors describe and contextualize the participation of users and family members in mental health research in Brazil, addressing the recent tradition of the experiences of recovery and empowerment to define the analysis of some Brazilian experiences of evaluative research and intervention projects, which count on these social actors to act as researchers. The experiences of Self-Help Groups and the Guide to Autonomous Medication Management are described briefly, in order to analyze the limits and possibilities of participation of users and their family members in research, which is still incipient and sporadic in the Brazilian reality. The authors also recommend the creation of an agenda in public health policy that encourages this participation.In this paper the authors describe and contextualize the participation of users and family members in mental health research in Brazil, addressing the recent tradition of the experiences of recovery and empowerment to define the analysis of some Brazilian experiences of evaluative research and intervention projects, which count on these social actors to act as researchers. The experiences of Self-Help Groups and the Guide to Autonomous Medication Management are described briefly, in order to analyze the limits and possibilities of participation of users and their family members in research, which is still incipient and sporadic in the Brazilian reality. The authors also recommend the creation of an agenda in public health policy that encourages this participation.

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.