CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A arte tem sido utilizada como estratÃgia e recurso de promoÃÃo à saÃde que vai ao encontro das prÃticas desinstitucionalizadas. Por outro lado, verifica-se que a utilizaÃÃo deste recurso, algumas vezes, desmerece as pessoas com transtorno mental. Este estudo tem como objetivo geral compreender os sentidos de arte no cuidado em saÃde mental, atribuÃdos por pessoas com transtornos mentais acompanhadas pelo Movimento de SaÃde Mental ComunitÃria do Bom Jardim (MSMCBJ), em Fortaleza, CearÃ, que desenvolve atividades na Ãrea de saÃde mental e tem uma cogestÃo com a Prefeitura Municipal de Fortaleza para administraÃÃo do Centro de AtenÃÃo Psicossocial (CAPS) no acompanhamento dos participantes da pesquisa. Tal experiÃncia suscita questionamentos que norteiam esta investigaÃÃo pois este Movimento foge de prÃticas tradicionais pinelianas, ainda fortemente veiculadas ao tratamento em saÃde que utilizam eminentemente a medicaÃÃo como tratamento. Neste contexto, a arte surge como instrumento e via de promoÃÃo em saÃde como, dentre outros tipos de recursos. Para compreender como esta estratÃgia tem reverberado na saÃde dos usuÃrios a partir de seus prÃprios pontos de vista, foi utilizado como suporte teÃrico Rotelli, Merhy, Amarante, Duarte Junior, Dimenstein e Boff no que diz respeito à temÃtica da saÃde e prÃticas de cuidado. Em relaÃÃo à arte, esta pesquisa teve como base teÃrica as ideias de Paz, Ostrower e Vygotsky. Na perspectiva histÃrico-cultural, Vygotsky, Pino, Lane, Molon, Aguiar e Namura foram abordados. Metodologicamente, foram utilizadas a pesquisa qualitativa e a abordagem histÃrico-cultural, em um estudo de caso do Movimento de SaÃde Mental ComunitÃria do Bom Jardim (MSMCBJ). No decorrer da pesquisa foram criados dois grupos focais com usuÃrios dos serviÃos de saÃde do MSMCBJ. O primeiro ocorreu em agosto e o segundo em outubro de 2009. O primeiro grupo foi constituÃdo por nove pessoas e teve como temÃtica o cuidado em saÃde mental; e o segundo, com seis pessoas, utilizou a temÃtica da arte como cuidado. Em ambos os momentos uma das pessoas era acompanhante de um dos participantes da pesquisa. A anÃlise de conteÃdo foi utilizada como mÃtodo examinatÃrio dos dados deste estudo. Os resultados apontaram para uma perspectiva dos usuÃrios de valorizaÃÃo de uma prÃtica de cuidado cuja forma de acolhimento pedia determinadas especificidades para a construÃÃo das relaÃÃes entre profissionais e pacientes as quais foram relatadas como: exercÃcio de liberdade de expressÃo, prÃtica de autonomia, exercÃcio de valorizaÃÃo de si mesmo e interaÃÃo com outros sujeitos, com o consequente desenvolvimento dos participantes como sujeitos sociais. A utilizaÃÃo da arte no cuidado em saÃde mental mostrou fundamental importÃncia na significaÃÃo deste cuidado em saÃde mental. As caracterÃsticas do contexto de trabalho com arte aparecem como facilitadoras de relaÃÃes saudÃveis entre os usuÃrios e profissionais. / The art has been adopted as strategy and resource to health promotion that meets the practice of deinstitutionalization. On the other hand, it appears that the use of such resource sometimes disparage people with mental disorders. This study has as overall objective understand the meaning of art in mental health care given by people with mental disorder, accompanied by the Bom Jardimâs Communitarian Mental Health Care Movement (MSMCBJ) in Fortaleza, Ceara, acting jointly with the Municipality of Fortaleza through the Center for Psychosocial Care (CAPS) in the monitoring of this studyâs participants. Such experience raises questions that guide this research because this Movement aims beyond the traditional pinelians practices still strongly conveyed to health treatment which uses essentially the medication as treatment. In this matter, art arises as a tool and way of health promoting, among other features. To understand how this strategy has reverberated in the health of users of health services from their own points of view, it was used as theoretical support Rotelli, Merhy, Amarante, Duarte Junior, Dimenstein and Boff with regard to the issue of health care practices. In relation to art, this survey was based on the theoretical support ideas from Paz, Ostrower and Vygotsky. In the historical-cultural perspective, Vygotsky, Pino, Lane, Molon, Aguiar and Namura were addressed. Methodologically, it was utilized qualitative research and cultural-historical approach in a case study of the Bom Jardimâs Communitarian Health Care Movement (MSMCBJ). The frame time of the survey was developed two focal groups. The first occurred in August 2009 and the second in October 2009. The two focal groups were conducted with the participation of users of the health service of MSMCB. The first focal group was conducted with nine people. This groupâs theme was mental health care; and the second group, with six people, used the theme of art as care. In both moments only one of them was accompanying a researchâs participant. Content analysis was used as a method of data analysis in this study. The results pointed to a userâs perspective of valuation of a care practice that asked certain specific key to building relationships between professionals and patients which were reported as the exercise of freedom of expression, practice autonomy, exercise of valuing oneself and interacting with other individuals, with the consequent development of the participants as social subjects. The use of art in mental health care showed the significance of this fundamental part of mental health care. The characteristics of the context of working with art appeared as facilitators of healthy relationships between users and professionals.

Background: Primary care may be a key setting for suicide prevention as many patients visit their General Practitioner (GP) in the weeks leading up to their death. Comparatively little is known about GPs’ perspectives on risk assessment, treatment adherence, management of and interactions with suicidal patients prior to the patient’s suicide and the services available in primary care for suicide prevention. Aim: This study aimed to explore primary care data on a clinical sample of individuals who died by suicide and were in recent contact with mental health services in order to: investigate the frequency and nature of general practice consultations; examine risk assessment, treatment adherence and management in primary and secondary care; gain GPs’ views on patient non-adherence to treatment and service availability for the management of suicidal patients. Method: A mixed-methods study design including data from the National Confidential Inquiry on 336 patients who died by suicide, data from 286 patient coroner files, primary care medical notes on 291 patients and 198 semi-structured face–to-face interviews with GPs across the North West of England. We collected data on GPs' views on the treatment and management of patients in the year prior to suicide, suicide prevention generally and local mental health service provision. Quantitative data were analysed using SPSS. Interviews were transcribed verbatim and analysed using a thematic approach. Results: Overall, 91% of individuals consulted their GP on at least one occasion in the year before suicide. GPs reported concerns about their patient’s safety in 27% of cases, but only 16% of them thought that the suicide could have been prevented. The overall agreement in the rating of risk between primary and specialist care was poor (overall kappa = 0.127; p = 0.10). Non-adherence was reported for 43% of patients. The main reasons for non-adherence were lack of insight, reported side effects and multiple psychiatric diagnoses. We obtained qualitative data from GPs on their interpretations of suicide attempts or self-harm, professional isolation and GP responsibilities when managing suicidal patients. Limitations: Our findings may not be generalisable to people who died by suicide and were not under the care of specialist services. GPs recruited for the study may have had different views from GPs who have never experienced a patient suicide. Our findings may not be representative of the rest of the UK although many of the issues identified are likely to apply across services. Conclusion: Suicide prevention in primary care is challenging. Possible strategies for future suicide prevention in general practice include: increasing GP awareness of suicide-related issues and improving training and risk assessment skills; increasing awareness in primary care about why patients may not want treatments offered by focusing on each individual’s situational context; removing barriers to accessing therapies and treatments; and, better liaison and collaboration between services to improve patient outcomes.

This thesis examines the implications of the changes introduced by the NHS and Community Care Act 1990 for mental health services. It focuses on two main issues. Firstly, the impact on mental health services of the 'market' system of purchasers and providers introduced by the 1990 Act. Second.ly, the extent to which the 1990 changes had led to any increase in user participation and involvement in the planning and delivery of psychiatric services. Analysis of the existing theoretical literature found that there had been little research which focused on the specific implications of health care 'markets' for mental health services. In addition, much of the work on the development of psychiatry had not focused on the role of the local context in influencing the nature of mental health service provision. In this thesis these issues are explored through a case study of the mental health services of one English county. Semistructured, qualitative interviews were und.ertaken with managers, professionals and individuals in purchaser, provider and voluntary sector organisations. People using community mental health services in the county were also interviewed. This contrasts with many previous studies which have tended to concentrate exclusively on users of in-patient services. The study found that local circumstances played a significant role in the relationships between those purchasing, providing and participating in mental health services. The imminent closure of a large Victorian psychiatric hospital and the uncertainty about which services would replace it had been a source of tension between the newly formed purchaser and provider organisations in the county under study. The lack of any strong existing groups in the local area representing users of mental health services was also significant. It meant that increased user participation in the county after the 1990 Act was reliant on initiatives by managers and professionals rather than organised pressure from user groups and users themselves. The variety of different local mental health agencies purchasing and providing mental health services in the county called for a degree of cooperation between organisations which conflicted with the competition encouraged by the 'market' system introduced by the 1990 Act. The focus, first, on psychiatric services in the examination of 'markets' and, second, the importance of the local context in mental health service development provides the basis for the study's contribution to theoretical and policy debates both about the 1990 Act and psychiatric services in general.

<p>Istraživanje prikazano ovim radom imalo je za cilj da opi&scaron;e mentalno zdravlje<br />dece na hraniteljstvu ranog &scaron;kolskog uzrasta i da sagleda kakvu ulogu u aktuelnom<br />stepenu njihovog psihosocijalnog funkcionisanja ima kvalitet brige koji im je pružen u<br />hraniteljskoj porodici. Kvaliteta staranja o detetu je konceptualizovan iz okvira teorije<br />afektivne vezanosti kao posvećenost hranitelja detetu na sme&scaron;taju i podrazumeva nivo<br />emocionalne investiranosti i motivisanosti hranitelja da sa detetom uspostavi emotivno<br />blizak, stabilan i trajan odnos.<br />U uzorak istraživanja je uključeno 82 dece na sme&scaron;taju u hraniteljskim<br />porodicama, uzrasta od 5 do 11 godina, koji su &scaron;tićenici Centra za socijalni rad Grada<br />Novog Sada i vi&scaron;e op&scaron;tinskih centara na teritoriji Vojvodine (Novi Bečej, Bačka<br />Topola, Mali Iđo&scaron; i Vrbas), bez ozbiljnijih smetnji u psihomotornom razvoju i koja u<br />aktuelnoj hraniteljskoj porodici borave najmanje dva meseca. U uzorku je podjednak<br />broj dečaka i devojčica, pri čemu dominiraju deca koja su na sme&scaron;taju u standardnim<br />(nesrodničkim) hraniteljskim porodicama (90.2 %), u odnosu na srodničke.<br />Podaci o mentalnom zdravlju dece su prikupljani uz pomoć dve skale za procenu<br />dečije psihopatologije koje su popunjavale hraniteljice: Liste provere dečijeg pona&scaron;anja<br />za decu od 6-18 godina (Child Behavior Checklist for ages 6-18, CBCL/6-18,<br />Achenbah &amp; Reskorla, 2001) i Liste za procenu dece u socijalnoj za&scaron;titi uzrasta od 4-11<br />godina (Assessment Checklist for Children for ages 4-11, ACC, Tarren-Sweeney,<br />2007). Podaci o mentalnom zdravlju su prikupljani i za kontrolni uzorak dece koja<br />odrastaju u biolo&scaron;kim porodicama, ujednačenom po broju, polnoj i uzrasnoj strukturi sa<br />uzorkom dece na hraniteljstvu, kao i u odnosu na pol roditelja koji pruža podatke<br />(majke). Za operacionalizovanje i procenjivanje kvaliteta staranja o detetu od strane<br />hranitelja je kori&scaron;ćen polustrukturirani intervju &ldquo;To je moje čedo&rdquo; (&ldquo;This Is My Baby&rdquo;<br />interview&rdquo;, TIMB, Bates &amp; Dozier, 1998) koji se sastoji od standardizovanih pitanja u<br />vezi hraniteljicinih osećanja prema detetu i njihovog međusobnog odnosa i daje uvid u<br />tri dimenzije: prihvatanja deteta na sme&scaron;taju kao svog (eng. acceptance), posvećenosti u<br />podsticanju njegovog rasta i razvoja bez emotivne &ldquo;zadr&scaron;ke&rdquo; (eng. commitment) i<br />svesnosti o uticaju uspostavljenog odnosa sa detetom na detetov emocionalni i socijalni<br />razvoj, aktuelno i u budućnosti (eng. awareness of influence).<br />Rezultati istraživanja ukazuju da deca na hraniteljstvu u poređenju sa svojim<br />vr&scaron;njacima koji odrastaju u biolo&scaron;kim porodicama, ispoljavaju značajno vi&scaron;e problema<br />mentalnog zdravlja, pri čemu prednjače problemi sa pažnjom, smetnje afektivne<br />vezanosti u vidu nediskriminativnog, pseudozrelog i nesigurnog pona&scaron;anja u<br />5<br />interpersonalnim relacijama, eksternalizujući problemi (agresivno pona&scaron;anje, kr&scaron;enje<br />pravila), abnormalni obrasci ishrane (čuvanje, skladi&scaron;tenje i krađa hrane) i<br />samopovređivanje. Mentalno zdravlje dece je determinisano nepovoljnim razvojnim<br />okolnostima koje prethode sme&scaron;taju ali i kvalitetom brige koja im je pružena u<br />hraniteljskoj porodici, pa se kod dece o kojima brinu hraniteljice visokog nivoa<br />prihvatanja i posvećenosti beleži manje emocionalnih problema, problema u pona&scaron;anju i<br />odnosu sa drugima. Rezultati ukazuju i na moderirajuće efekte kvaliteta staranja, u<br />smislu da je stepen prihvatanja i posvećenosti od strane hraniteljica posebno značajan za<br />decu koja su pre sme&scaron;taja u hraniteljsku porodicu imala visoko rizično iskustvo, čineći<br />ih znatno vulnerabilnijim u okolnostima niskog kvaliteta brige, kao &scaron;to i okolnosti<br />visokog kvaliteta staranja u ovoj grupi dece ostvaruju najintenzivniji protektivni i<br />kompenzatorni efekat.<br />Rezultati su diskutovani u svetlu teorije afektivne vezanosti, u smislu potvrde<br />kvaliteta staranja kao protektivnog činioca koji podstiče rezilijentnost dece i implikacija<br />relevantnih za praksu socijalnog rada u oblasti hraniteljstva.</p> / <p>The purpose of the research presented in this paper is to describe the mental<br />health of children in foster care at early school-age and to analyse the role that the<br />quality of care they receive in foster family plays in the current level of their<br />psychosocial functioning. The quality of child care has been conceptualized from the<br />framework of the attachment theory as the commitment of foster carers to the foster<br />children and it implies a level of emotional investment and motivation of the foster<br />carers to establish an emotionally close, stable and permanent relationship with the<br />child.<br />The research sample involved 82 foster children, aged 5 to 11, who are in the<br />care of the Centre for Social Work of the City of Novi Sad and several municipal<br />centres in the territory of Vojvodina (Novi Bečej, Bačka Topola, Mali Iđo&scaron; and Vrbas),<br />who are without serious difficulties in psychomotor development and who have been<br />with the current foster family for at least two months. The sample included the same<br />number of boys and girls, and the majority were children in standard (non-kinship)<br />foster families (90.2 %), as opposed to kinship foster families.<br />Information about the mental health of the children was collected using two<br />scales for the assessment of psychopathology in children, which were filled out by<br />foster mothers: Child Behaviour Checklist for ages 6-18 (CBCL/6-18, Achenbah &amp;<br />Reskorla, 2001) and Assessment Checklist for Children for ages 4-11 (ACC, Tarren-<br />Sweeney, 2007). Information about the mental health was also collected for the control<br />sample of children who live with biological families, identical in number, gender and<br />age structure with the sample of children in foster care, as well as in relation to the<br />gender of the parent providing the information (mother). In order to operationalize and<br />assess the quality of child care, the research used the semi structured interview &ldquo;This Is<br />My Baby&rdquo; (TIMB, Bates &amp; Dozier, 1998) which contains standardized questions in<br />relation to the foster mother&rsquo;s feelings towards the child and their mutual relationship<br />and it also provides insight into three dimensions: acceptance of foster child as her own,<br />commitment in encouraging their growth and development without emotional<br />&ldquo;reservations&rdquo; and the awareness of influence of the established relationship with the<br />child on the child&#39;s emotional and social development, now and in the future.<br />The results of the research indicate that the children in foster care, as compared<br />to their peers growing up with biological families, display significantly more mental<br />health problems, and the most frequent ones are attention problems, attachment related<br />difficulties in the form of indiscriminate, pseudo mature and insecure interpersonal<br />8<br />behaviours, externalising problems, aggressive and rule-breaking behaviour, eating<br />problems, food maintenance behaviour and self-injury. The mental health of the<br />children is determined by the unfavourable development circumstances prior to<br />placement in foster care, but also by the quality of care that they receive in foster<br />family, and so the children in the care of foster mothers with a high level of acceptance<br />and commitment display fewer emotional, behavioural and interpersonal problems. The<br />results also indicate the moderation effects of the quality of care, in the sense that the<br />level of acceptance and commitment by the foster mothers is of particular significance<br />for the children who had high-risk experience before they were placed in foster family,<br />which made them significantly more vulnerable in the circumstances of low-quality<br />care, just like the circumstances of high-quality care with this group of children<br />produced a more intensive protective and compensatory effect.<br />Results are discussed in the light of the attachment theory, in terms of<br />confirmation of the quality of care as a protective factor which encourages the resilience<br />of children, as well as the implications relevant to the social work practice in the field of<br />foster care.</p>

Based on a Ph. D Thesis--Glasgow University, 1999. / Includes bibliographical references and index.

Based on a Ph. D Thesis--Glasgow University, 1999. / Includes bibliographical references and index.

Thesis (M.S.)--University of Michigan, 1995.

Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1999. / Source: Masters Abstracts International, Volume: 45-06, page: 2928. Typescript. Abstract precedes thesis as preliminary leaves iii-iv. Includes bibliographical references 122-127.

Based on a Ph. D Thesis--Glasgow University, 1999. / Includes bibliographical references and index.

Thesis (M.S.)--University of Michigan, 1995.