Thesis (M.A.)--University of South Florida, 2003. / Title from PDF of title page. Document formatted into pages; contains 60 pages. Includes bibliographical references.

Este estudo tem por objetivo analisar as categorias de cidadania e inclusão social na política de desinstitucionalização nos sujeitos em sofrimento psíquico diante do processo de individualização na teoria social contemporânea. Assume como hipótese que a saída do hospital psiquiátrico por si só não garante a inclusão social e nem o livre exercício da cidadania. Considerado o objetivo desta pesquisa, optou-se por fazer uma pesquisa bibliográfica como procedimento metodológico. O material de estudo foi dividido em três conjuntos: (1) 56 artigos científicos, visando a compreender a visão da academia; (2) um conjunto de legislação, composto de 10 leis que implementaram a política de desinstitucionalização no Brasil e a reforma dos serviços de saúde psiquiátrica, visando a compreender as ações do Estado; (3) quatro Relatórios Finais das quatro Conferências Nacionais de Saúde Mental, para também compreender a participação da sociedade civil. Para a análise do material, utilizou-se uma combinação de duas técnicas complementares: leitura bibliográfica com a análise de conteúdo. Dentre os vários processos que caracterizam a sociedade contemporânea, optou-se por analisar a individualização que impacta nas formas de exercício da cidadania e na inclusão social. Na análise dos resultados da categoria de cidadania foram identificadas associações em relação à interdição civil, liberdade, moradia, saúde, trabalho, educação e participação política. Relacionadas à categoria de inclusão social foram identificadas as referências à família, estigma, laços sociais, autonomia, contratualidade e trabalho. Os resultados obtidos indicam que o campo da saúde mental não está em completa consonância com as transformações da sociedade contemporânea, o que provoca um descolamento da realidade social da própria politica de desinstitucionalização e, portanto, maior dificuldade para a efetiva inclusão social e o exercício da cidadania desses indivíduos. / This study aims to analyze the categories of citizenship and social inclusion related to the deinstitutionalization policy of individuals in psychological distress, considering the individualization process in the contemporary social theory. The hypothesis is that leaving the psychiatric hospital does not guarantee the social inclusion and the exercise of citizenship. Considered the objective of this research, it was decided to do a literature review as a methodological procedure. The object of this study has been divided into three groups: (1) 56 scientific papers reviewed in order to identify how the academy deals with this issue; (2) a set of legislation, made up of 10 laws that have implemented deinstitutionalization policy in Brazil and the reform of psychiatric health services analyzed in order to understand the State\'s actions; (3) Reading of the four Final Reports of the Fourth National Conference of Mental Health, to understand how the civil society has been participating in this process. As a research tool to analyze the material mentioned above, we used a technique of reading literature focusing on content analysis. Among the various processes that characterize contemporary society, we chose to examine the individualization that affects the forms of citizenship and social inclusion. In analyzing the citizenship category, associations between the civil interdiction, freedom, housing, health, work, education and political participation were found. Related to the category of social inclusion were identified references to family, stigma, social ties, autonomy, contractually and work. The result of this study shows that the field of mental health is not in complete harmony with the changes of contemporary society, which causes a detachment of the social reality of the deinstitutionalization policy and therefore it is more difficult to guarantee an effective social inclusion and the exercise of citizenship of these individuals.

A política de saúde mental preconiza a diminuição da oferta de leitos psiquiátricos e a criação de serviços na comunidade deslocando a responsabilidade pelo seguimento do tratamento da doença mental das equipes hospitalares para as equipes comunitárias, o doente mental e seus familiares. Pacientes com transtornos mentais e seus familiares vivenciam momentos cíclicos de controle e diminuição sobre situações problema, as quais podem ou não resultar em internação psiquiátrica. A família passa a ser a principal provedora de cuidados e apoio aos pacientes psiquiátricos, no meio extra-hospitalar, fator este que pode gerar sobrecarga na família.A sobrecarga familiar é definida como \"um estado psicológico que advém da combinação de trabalho físico, emocional e pressão social\". O período pós a alta hospitalar pode gerar a família grande impacto que ao longo do tempo se modifica. O presente estudo tem como objetivo descrever e comparar a sobrecarga objetiva e subjetiva do familiar cuidador de pacientes no primeiro mês de alta hospitalar e após três meses deste período. Método - Foi aplicada a escala FBIS-BR nos neste primeiros mês e após três meses deste período. Foram entrevistados 26 familiares de pacientes que realizavam seguimento em um serviço de saúde mental ambulatorial na cidade de Ribeirão Preto. Os dados foram analisados através de freqüência e porcentagem e o teste não paramétrico de Wilcoxon-teste t- foi aplicado para identificar os itens da FIBS-BR que se destacaram na sobrecarga familiar. Resultados e discussão:.Os familiares dos 63 pacientes que compareceram as consultas foram convidados a participar do estudos e destes somente 26 aceitaram participar .Os pacientes desta amostra são em sua maioria homens, casados e completaram o ensino fundamental .Com relação aos cuidadores a maioria eram mulheres e mães com média de idade de 51 anos .Os participantes deste estudo são pertencentes a classe social mais baixa. Os diagnósticos mais prevalentes no estudo foram dos seguintes agrupamentos: \"Esquizofrenia, transtornos esquizotípicos,Transtornos delirantes e Transtornos de Humor\" .Os resultados demonstraram que a sobrecarga objetiva destaca-se da subjetiva nos dois momentos analisados. Indicando que os familiares são sobrecarregados com atividades de cuidado do doente, porém não se sentem prejudicados por isso. Possivelmente este resultado indica que os familiares preferem responder que não se incomodam porque entendem que é sua obrigação cuidar do familiar.A sobrecarga do cuidado objetiva e subjetiva diminuiu do primeiro para o terceiro mês e três aspectos podem explicar este resultado : 1- Paciente ainda com sintomas da doença no primeiro mês após a alta hospitalar 2- Readaptação da família após três meses de alta hospitalar; 3- Estratégia de visitas domiciliares pela equipe de saúde. Considerações Finais: Este estudo aponta para a importância e necessidade de acompanhamento dos pacientes egressos e seus familiares. A visita domiciliar é uma estratégia importante pois consegue manter um vinculo mais estreito entre o doentes, sua família e o serviços de saúde mental. A visita domiciliar é parte das atividades do enfermeiro sendo portanto, um dos profissionais da equipe que pode contribuir muito para melhorar as condições de doentes e famílias. / The mental health policy calls for the reduced supply of psychiatric beds and the creation of services in the community by shifting responsibility for monitoring the treatment of mental illness of hospital staff to community teams, the mentally ill and their families. Patients with mental disorders and their families experience moments cyclic control and reduction of problem situations, which may or may not result in psychiatric hospitalization. The family becomes the primary provider of care and support to psychiatric patients in the middle-ofhospital, a factor that can lead to overload in the family. The family burden is defined as \"a psychological state that arises from the combination of physical work, emotional and social pressure\". The post hospital discharge to the family can generate great impact over time changes. The present study aims to describe and compare the objective and subjective burden of family caregivers of patients in the first month of hospital discharge and after three months of this period. Method - was applied FBIS-BR scale in this first month and after three months of this period. Were interviewed 26 relatives of patients who were performing a follow-up outpatient mental health services in Ribeirão Preto. Data were analyzed using frequency and percentage and the nonparametric Wilcoxon t-test was used to identify items of FIBS-BR that stood out in the family burden. Results and discussion: The relatives of 63 patients who attended the consultations were invited to participate in these studies and only 26 agreed to participate. The patients in this sample are mostly male, married and completed their primary education. With respect to most caregivers were women and mothers with an average age of 51 years. The participants in this study are belonging to lower social class. The most prevalent diagnosis in the study were the following groupings: \"Schizophrenia, schizotypal disorder, delusional disorders and mood disorders\". The results showed that the overhead lens stands out in two moments of subjective analysis. Indicating that family members are overwhelmed with patient care activities, but do not feel harmed by it. Possibly this result indicates that family members prefer to answer that do not bother because they understand that it is his duty to take care of the family. The burden of care objectively and subjectively decreased from first to third month and three aspects may explain this result: 1 - The patient has symptoms of the disease in the first month after hospital discharge; 2 Hospital - Rehabilitation of the family after three months of hospital discharge; 3 - Strategy of home visits by health teams. Final Thoughts: This study highlights the importance and necessity of patient follow up graduates and their families. The home visit is an important strategy because it can maintain a closer link between the patient, his family and mental health services. The home visit is part of the activities of nurses and therefore, a team of professionals that can do much to improve conditions for patients and families.

De acordo com os pressupostos da Reforma Psiquiátrica, a assistência ao sofrimento psíquico deve ocorrer em uma rede de cuidados que esteja, preferencialmente, na comunidade, ou seja, de base territorial Nesta rede deve estar contemplado todo e qualquer recurso que o território disponha, seja ele de saúde ou não, incluindo a Atenção Básica. Desta forma, este estudo teve por objetivo analisar o significado do Apoio Matricial em saúde mental desenvolvido na rede de Atenção Básica de Saúde de Campinas (SP), por meio das falas dos profissionais que estão vivenciando tal prática. O Apoio Matricial em saúde mental é um arranjo organizacional implantado com a intenção de reorientar as ações de saúde mental na saúde básica, ampliando as possibilidades de o usuário ser atendido de forma integral; tal arranjo busca desconstruir a lógica da referência/contra-referência, instituindo uma noção de co-responsabilização pelos usuários e suas famílias, produzindo, assim, maior resolutividade nos casos que se apresentam. Para a análise do significado do Apoio Matricial em saúde mental, utilizou-se a pesquisa qualitativa e, o referencial lógico-conceitual que respaldou tal análise foi a Reforma Psiquiátrica Brasileira. Da apreensão das falas, emergiram quatro categorias empíricas para a análise, a saber: Apoio Matricial em Saúde Mental; Processo Saúde-Doença Mental; Processo de Trabalho e Política Nacional de Saúde Mental, tais categorias permitiram maior compreensão teórica da realidade e, foram operacionalizadas pela categoria analítica: Representação Social. Diante da análise feita, conclui-se que o Apoio Matricial é um arranjo de fundamental importância na atenção aos usuários e na capacitação/suporte das equipes de saúde, potencializando a desinstitucionalização e, ao mesmo tempo, sendo ferramenta importante para evitar internações arbitrárias. Assim, faz-se necessário a implantação e implementação de equipes de saúde mental matriciadoras para a atenção básica e, conseqüente articulação destas com as equipes dos Centros de Atenção Psicossocial e dos outros recursos da comunidade / According to the presupposition of the Psychiatric Reform, the assistance to the psychic suffering must occur in a net of attention in which must be preferentially in the community, in other words, in a territorial ground. All and any kind of resource the territory has must be in this net, being from health or not, including Basic Care. This way, this study had as objective to analyze the meaning of the Matrix Support in mental health developed at the Basic Health Attention Net of Campinas (SP), thought the speech of the professionals who are living such practice. The Matrix Support in mental health is an organizational arrangement implanted with the intention of keeping the actions of mental health and basic health, enlarging the possibilities of the user to be attended in a integral way; such arrangement searches for the deconstruction of the logic of reference/counter-reference, establishing a notion of co-responsibility among users and their families, thus, producing more results in the cases presented. For the analysis of the meaning of the Matrix Support in mental health, it has been used qualitative research and the Brazilian Psychiatric Reform was the logic-conceptual reference that held such analysis. From the understanding of the speeches, four empirical categories emerged from the analysis, to wit: Matrix Support in mental Health; Process Mental Health-Disease; Process of Work and National Politics of Mental Health. Such categories permitted a larger theoretical understanding of reality and they have been practiced by the analytical category: Social Representation. In the face of the analysis made, it could have been concluded that the Matrix Support is an arrangement of fundamental importance in the attention to the users and the qualification/support of the health staff, strengthening the deinstitutionalization and at the same time being important tool to avoid arbitrary internment. Therefore, it is necessary the implantation and implementation of staffs of mental health matrix for the basic attention and their consequent articulation with the staffs of the Psychosocial Attention Centers and other resources of the community

Between 1955 and 1985 the United States reduced the population confined in its public mental hospitals from around 600,000 to less than 110,000. This dissertation provides a novel analysis of the movement that advocated for psychiatric deinstitutionalization. To do so, it reconstructs the unfolding setting of the movement’s activity historically, at a number of levels: namely, (1) the growth of private markets in the care of mental illness and the role of federal welfare policy; (2) the contested role of states as actors in driving the process by which these developments effected changes in the mental health system; and (3) the context of relevant events visible to contemporaries. Methods of computational text analysis help to reconstruct this social context, and thus to identify the closure of key opportunities for movement action. In so doing, the dissertation introduces an original method for compiling textual corpora, based on a word-embedding model of ledes published by The New York Times from 1945 to the present. The approach enables researchers to achieve distinct, but equally consistent, actor-oriented descriptions of the social world spanning long periods of time, the forms of which are illustrated here. Substantively, I find that by the early 1970s, the mental health system had disappeared from public view as a part of the field of general medicine — and with it a target around which the existing movement on behalf of the mentally ill might have effectively reorganized itself. Drawing together the case and the method, conceptually, is the idea of a standpoint: a framework within which objects obtain significance.

This dissertation employs an organizational approach to examine how reentry organizations seek to provide social value as public-private partnerships with the mission statement of aiding the reintegration of the formerly incarcerated. With the help of a case study of a reentry organization in Cleveland, Ohio, I examine the sociological significance of the discursive “brokerage metaphor” of reentry organizations as brokers of the social and cultural capital the formerly incarcerated require as catalysts for their reintegration back into society. Based on ethnographic data and in-depth field interviews collected over a period of 16 months in Cleveland, Ohio, my research finds that the “brokerage metaphor” for reentry elides important factors which play an integral role in the organizational behavior of reentry organizations and the sociological experience of reentry for the formerly incarcerated. These other factors notably include the competitive and regulatory organizational environment of the reentry organization, and the intersectional identities of formerly incarcerated women. These external factors reveal the paradox of the public-private partnership represented by the reentry organization wherein some obstacles that stymie the objectives of the reentry organization might be attributed to its public partner, the government. Furthermore, my research finds that besides the brokerage of social and cultural capital, reentry organizations as public-private partnerships provide other tangible benefits for achieving the reentry of the formerly incarcerated, such as a remove from the carceral continuum that invites participation and creates the space for community-building. This dissertation research advances a new direction for the study of public-private partnerships wherein the lens of inquiry is not merely on the private partner, rather, the spotlight is also trained on the external impediments that prevent the organization from achieving full social value. This direction for research bodes well for determining appropriate and effective ethical policy interventions to addressing pressing social problems through public-private partnerships and social enterprise.

Este estudo tem por objetivo analisar as categorias de cidadania e inclusão social na política de desinstitucionalização nos sujeitos em sofrimento psíquico diante do processo de individualização na teoria social contemporânea. Assume como hipótese que a saída do hospital psiquiátrico por si só não garante a inclusão social e nem o livre exercício da cidadania. Considerado o objetivo desta pesquisa, optou-se por fazer uma pesquisa bibliográfica como procedimento metodológico. O material de estudo foi dividido em três conjuntos: (1) 56 artigos científicos, visando a compreender a visão da academia; (2) um conjunto de legislação, composto de 10 leis que implementaram a política de desinstitucionalização no Brasil e a reforma dos serviços de saúde psiquiátrica, visando a compreender as ações do Estado; (3) quatro Relatórios Finais das quatro Conferências Nacionais de Saúde Mental, para também compreender a participação da sociedade civil. Para a análise do material, utilizou-se uma combinação de duas técnicas complementares: leitura bibliográfica com a análise de conteúdo. Dentre os vários processos que caracterizam a sociedade contemporânea, optou-se por analisar a individualização que impacta nas formas de exercício da cidadania e na inclusão social. Na análise dos resultados da categoria de cidadania foram identificadas associações em relação à interdição civil, liberdade, moradia, saúde, trabalho, educação e participação política. Relacionadas à categoria de inclusão social foram identificadas as referências à família, estigma, laços sociais, autonomia, contratualidade e trabalho. Os resultados obtidos indicam que o campo da saúde mental não está em completa consonância com as transformações da sociedade contemporânea, o que provoca um descolamento da realidade social da própria politica de desinstitucionalização e, portanto, maior dificuldade para a efetiva inclusão social e o exercício da cidadania desses indivíduos. / This study aims to analyze the categories of citizenship and social inclusion related to the deinstitutionalization policy of individuals in psychological distress, considering the individualization process in the contemporary social theory. The hypothesis is that leaving the psychiatric hospital does not guarantee the social inclusion and the exercise of citizenship. Considered the objective of this research, it was decided to do a literature review as a methodological procedure. The object of this study has been divided into three groups: (1) 56 scientific papers reviewed in order to identify how the academy deals with this issue; (2) a set of legislation, made up of 10 laws that have implemented deinstitutionalization policy in Brazil and the reform of psychiatric health services analyzed in order to understand the State\'s actions; (3) Reading of the four Final Reports of the Fourth National Conference of Mental Health, to understand how the civil society has been participating in this process. As a research tool to analyze the material mentioned above, we used a technique of reading literature focusing on content analysis. Among the various processes that characterize contemporary society, we chose to examine the individualization that affects the forms of citizenship and social inclusion. In analyzing the citizenship category, associations between the civil interdiction, freedom, housing, health, work, education and political participation were found. Related to the category of social inclusion were identified references to family, stigma, social ties, autonomy, contractually and work. The result of this study shows that the field of mental health is not in complete harmony with the changes of contemporary society, which causes a detachment of the social reality of the deinstitutionalization policy and therefore it is more difficult to guarantee an effective social inclusion and the exercise of citizenship of these individuals.

This thesis is based on a research project that explored the deinstitutionalisation and eventual closure of a large residential facility for people with an intellectual disability. The thesis is focused on family experiences of deinstitutionalisation in order to understand how families interacted with this major process of social change, and pays specific attention to the role of adult siblings within this context. Unstructured interviews were held with thirty-five families who had family members with an intellectual disability who were being resettled from an institution to alternative disability support services. Families were interviewed at three specific phases during the deinstitutionalisation process: prior to the resettlement of their family member; 1-3 months following resettlement; and one year after resettlement. In keeping with the constructivist paradigm that underpinned this qualitative study, repeated contact with families enabled me to develop some insights into how families made decisions relevant to their family members� transitions from the institutional environment. The study findings highlight the complexity and heterogeneity of families. While families who participated in this study were found to have shared a similar journey toward institutionalisation, their responses and reactions to deinstitutionalisation and the decision-making associated with such a process were more diverse. My analysis presents the notion that taking a constructivist approach to theorising can facilitate an understanding of how families are influenced in their decision-making with regards to the resettlement of a family member with an intellectual disability. That is, we may be able to gain greater understanding of families� perceptions of their family members who have an intellectual disability and, subsequently, the decisions that families make regarding the care of that person by exploring the meanings they assign to their world. Ascertaining how families come to construct their understandings of disability is, in my view, critical to responding appropriately to families� needs within the context of disability support and service provision.

The purpose of this project was to explore how ex-offenders collectively leverage personal and community assets to transcend passivity and powerlessness in the face of reentry barriers, as well as to identify the personal milestones that signal social and community re-integration, post-incarceration. A qualitative inquiry utilizing interviews and a support group structure modeled on action research was used to generate two distinct products. The first product concerned a peer-group model that could be employed by ex-offenders as a form of community capacity building. The second product sought to identify reentry milestones utilized in the development of effective support programs to aid ex-offenders in the areas of employment and housing. Data collection points included the narratives elicited from participants during the intake and exit interviews, a grounded theory analysis fostered during each support group session with the intent to identify group curriculum, and the life stories revealed in the reflective journals all participants are asked to maintain. Narrative analysis was employed to understand the meaning participants provide to the work of the support group as well as the volunteer work they are asked to do to illustrate their commitment to community building. The participants utilized a grounded theory analysis to examine transcripts of group discussions in an effort to explicate the most important components of a peer-group model. / text

During the last 50 years, there has been a transfer of care for individuals living with mental disorders from predominately institutional settings to predominately community settings. The purpose of this research was to document the closure of Brandon Mental Health Centre (BMHC) and to look at long-term outcomes for discharged individuals. These objectives were met by interviewing key people involved in the closure and through analysis of administrative data. To support individuals after BMHC closed, new services were developed in four priority areas: adult inpatient and crisis response services, adult rehabilitation and consumer support services, psychogeriatric services, and child and adolescent services. Visits to a general practitioner for a mental disorder by individuals discharged from BMHC decreased significantly over the follow-up period while visits to a psychiatrist increased significantly. Mortality rates, physician visits, and hospital admissions were higher in former BMHC residents than in a matched cohort.