Made available in DSpace on 2016-12-23T13:46:56Z (GMT). No. of bitstreams: 1 DISSERTACAO CLAUDIA ROSSONI.pdf: 504158 bytes, checksum: d1a95f90f56dd1b602a4de770efcbdca (MD5) Previous issue date: 2006-11-20 / This research studies the directed conditions of the modeling used in the organization of the Mental Health Service on Serra District that has in the Mental Health Team of the Regional Health Unities, an extra-hospital service for the reorientation of the attendance model. Qualitative research consummated through a case study that has with data collection method, the Focal Group. Five Focal Groups are realized with the mental health team professionals, in October to December months of 2005 and the data had been analyzed in its content, on the basis of Bardin. It classifies the directed conditions that shape the mental health service in two modalities: constituted and constituent. The constituted ones, of the municipal politics of mental health, are the ones that point the line of direction technician-administrative politics, and the constituent, the ones that are related to the social practices developed in the daily of the health institution for the mental health professionals, from the processes lived deeply for these actors in the relation with the territory and the demand in health. It concludes that the implanted service has potentialities and contributions for the reorientation of the attendance model. It detaches that the consisting conditions had been important for the creation and consolidation of the mental health service, but is centered in the constituent conditions the modeling of this service, therefore it is in the daily relation between its actors who if become possible to introduce new forms to deal with the psychic suffering and to construct a new culture in mental health. For in such a way, the magnifying of a net of mental health and one politics of permanent education of its professionals for the appropriation of the territory is necessary and attendance of the demands in health. To catch these phenomena was important to recognize the potentialities of the service in the consummation of the politics of mental health of the city and to apprehend its limits and perspectives. / Esta pesquisa estuda as condições norteadoras da modelagem utilizada na organização do serviço de saúde mental do município de Serra, que tem nas Equipes de Saúde Mental das Unidades Regionais de Saúde um serviço extrahospitalar para a reorientação do modelo assistencial. Pesquisa qualitativa realizada através do estudo de um caso que teve como método de coleta de dados o Grupo Focal. Foram realizados 05 (cinco) Grupos Focais com os profissionais das equipes de saúde mental, nos meses de outubro a dezembro de 2005 e os dados foram analisados em seu conteúdo, com base em Bardin. Classifica as condições norteadoras que modelam o serviço de saúde mental em duas modalidades: constituídas e constituintes. As constituídas pela política municipal de saúde mental são as que apontam a diretriz política e técnicoadministrativa e as constituintes as que se referem às práticas sociais desenvolvidas no cotidiano da instituição de saúde pelos profissionais de saúde mental, a partir dos processos vivenciados por esses atores na relação com o território e a demanda em saúde. Conclui que o serviço implantado tem potencialidades e contribuições para a reorientação do modelo assistencial. Destaca que as condições constituídas foram importantes para a criação e consolidação do serviço de saúde mental, mas está centrada nas condições constituintes a modelagem deste serviço, pois é na relação cotidiana entre seus atores que se torna possível introduzir novas formas de lidar com o sofrimento psíquico e construir uma nova cultura em saúde mental. Para tanto, é necessária a ampliação de uma rede de saúde mental e uma política de educação permanente de seus profissionais para a apropriação do território e atendimento das demandas em saúde. Captar esses fenômenos foi importante para reconhecer as potencialidades do serviço na efetivação da política de saúde mental do município e apreender seus limites e perspectivas.

O objetivo deste estudo foi compreender os conceitos e estratégias que norteiam a assistência dos profissionais que atuam em um Centro de Atenção Psicossocial para atendimento de pacientes com transtornos, decorrentes do uso e dependência de substâncias psicoativas, na tentativa de subsidiar as ações dos demais serviços de saúde que atendem tais pacientes. Optou-se pela pesquisa qualitativa, seguindo a metodologia de estudo de caso; assim, nove profissionais foram entrevistados e o eixo norteador das questões foi referente à concepção de serviço e as ações assistenciais ali desenvolvidas. Os dados foram analisados à luz do conceito da representação social. Valendo-se dos temas emergentes foram elaboradas duas representações centrais da pesquisa: Concepção sobre o serviço de atenção psicossocial. Ações assistenciais aos pacientes com transtornos decorrentes de uso prejudicial e ou dependência de álcool e outras drogas. A análise final orienta-se para a compreensão de que o uso prejudicial do álcool e outras drogas decorrem de fatores multifacetados, propondo nessa linha de raciocínio a assistência psicossocial / The purpose of this study is to understand concepts and strategies that orient the assistance to professionals working in a Center of Psychosocial Attention to assist patients with disorders due to use and addiction of psychoactive substances, in the attempt to support actions of other health services which assist these patients. A qualitative research was our choice following the methodology of a case study. Nine professionals were interviewed and the interviews were based on questions aiming service and the assistance actions developed in the same institutions. Data were analyzed under the point of view of the social representation. Considering the emergent issue, two central representations of the research were elaborated: conception on the service of psychosocial attention. Assistance actions to patients with disorders due to the harmful use and/or addiction to alcohol and other drugs. The final analysis is oriented towards the comprehension that the harmful use of alcohol and other drugs are caused by varied factors, proposing a psychosocial assistance

An examination of developments between 1970-1990 demonstrate a substantial restructuring of relations between the state and nonprofit societies within Vancouver's mental health system. While helping to establish and support the growth of nonprofit societies, the state, during the 1970's, maintained a "hands off" relationship with the nonprofit sector. Throughout the 1980's and early 1990's, state intervention into the affairs and aspirations of nonprofit societies dramatically increased, primarily through the establishment of corporatist arrangements. Such arrangements necessitated the establishment of non-aligned intermediary organizations to regulate and monitor activities within the nonprofit sector. The establishment and development of nonprofit societies and the subsequent restructuring of relations between the state and nonprofit societies is explored through an examination of corporatism. This examination includes a detailed case study of two nonprofit societies operating in the city of Vancouver between 1972 to the present, the Coast Foundation Society and The Greater Vancouver Mental Health Services Society. The methodology utilized includes analysis of secondary data, archival and documentary materials, and personal interviews with a number of key informants previously or currently employed within the mental health system. Analytic themes from the literature on pluralism and corporatism, along with Claus Offe's theoretical examination of state-interest group relations, are used to explain the construction of corporatism during this period. While the inquiry provides a detailed account of developments within Vancouver's mental health system through a case study approach, broader issues are also explored. The impact of macro economic changes, especially the effect of the recessionary period during the 1970's, is crucial in understanding changing state priorities and the subsequent construction of corporatism. An understanding, therefore, of the way in which corporatism relates to the broader reconstruction of consensus within late capitalist societies is an important focus of this study. / Arts, Faculty of / Sociology, Department of / Graduate

The current study investigated maternal determinants of mental health service use, namely, individual child therapy, among preadolescent children diagnosed with ADHD. The Behavioral Model of Health Care Utilization (Andersen, 2008) was used as a theoretical framework for the study. Data from the last three rounds of ECLS-K dataset were employed to test a longitudinal model using Bayesian analysis. Socio-demographic variables and maternal mental health were tested as exogenous variables and mother-child relationship variables, discipline variables, and perceived maternal concern about child’s overall behavior and child’s emotional symptoms were tested as intervening variables. Results showed that only maternal mental health remained in the model as an exogenous variable. The effect of mental health on child therapy was mediated by maternal aggravation and maternal concern about overall behavior in one path and by maternal concern about emotional symptoms in another path, suggesting that maternal mental health needs to be considered when attempting to understand help-seeking determinants. Both concern variables were found to have large direct effects on child therapy. The results of the current study showed the importance of maternal mental health and the importance of determinants related to mother-child relationship in a mother’s decision to seek therapy for a child.

Climate-anxiety is a growing mental health issue among the public and particularly among students in sustainability-related studies in Higher Education Institutions (HEI). As education on climate change in HEI overly relies on cognitive learning, students are not able to address their emotions and potential worries about climate change adequately. The research field of climate-anxiety has emerged after 2007 and relates to other mental health responses to environmental destruction such as eco-anxiety. This study examines whether climate-anxiety affects students within HEI and what coping strategies are used by them. The aim is to suggest approaches for HEI and educational tourism providers to better address climate-anxiety. Specifically, it investigates whether non-formal actors like ecovillages can help students to cope with climate-anxiety. Ecovillages are increasingly recognising their role in Education for Sustainable Development (ESD) and helping students with climate-anxiety could balance the shortcomings of HEI. Five case studies of ecovillages were included to determine the potential of educational tourism in reducing climate-anxiety. Even though the study found that short-term study visits were not helpful for students climate-anxiety, it can be assumed that students could gain hands-on coping techniques from more extended stays at ecovillages. Particularly the ecovillages learning environment and pedagogy are beneficial for coping with climate-anxiety. It is suggested that HEI should initiate cooperations with local ecovillages to improve climate-anxiety among students, as it was found that lecturers and Student Mental Health Services (SMHS) in HEI in Sweden do not sufficiently address climate-anxiety.

Apesar de terem surgido há mais de um século na Europa, o crescimento do número de unidades de saúde mental em hospitais gerais no Brasil veio de encontro às diretrizes das reformas sanitária e psiquiátrica propaladas partir da década de setenta. Desde então, essas unidades não foram submetidas a uma avaliação sistemática. O presente trabalho teve por objetivo conhecer os modos de funcionamento, a inserção na rede de assistência à saúde mental e o compromisso populacional de algumas dessas unidades na Região Metropolitana da Grande São Paulo. Para isso buscou-se obter, segundo a lógica de um processo avaliatório, as premissas que norteariam o uso de informações por gestores situados em diversos níveis em relação às unidades estudadas. Os resultados evidenciaram falta de clareza quanto ao papel desse tipo de equipamento dentro da rede assistencial, o que parece ser fruto da ausência de uma política de saúde mental na região. As dificuldades mais freqüentemente relatadas, como a impossibilidade de garantir a vinculação de pacientes em serviços extra-hospitalares especializados após a internação e a grande proporção de pacientes que chegam aos pronto-atendimentos sem necessitarem de um cuidado de urgência, não foram tidas como passíveis de algum tipo de resposta por parte dos hospitais gerais. Nas unidades, onde se privilegiam informações sobre a produção dos serviços em detrimento da avaliação do acesso e do impacto no estado de saúde da população que reside na área de abrangência do hospital, há um funcionamento independente do restante da rede, o que contribui para a fragmentação e iniqüidade da assistência à saúde mental. Um dos principais exemplos é a exclusão de pacientes das enfermarias psiquiátricas dos hospitais gerais, particularmente os cronificados, cuja patologia impossibilita a efetividade da terapêutica médica dentro do prazo estipulado para a internação. Em contrapartida, foram identificadas iniciativas que pretendem resgatar a integralidade da atenção, prioritariamente aos pacientes que merecem intervenções de maior complexidade e de longo prazo. Quanto ao cuidado aos pacientes portadores de transtornos mentais mais prevalentes, uma alternativa seria utilizar mecanismos de pressão – entre os quais informações sobre a utilização dos pronto-atendimentos psiquiátricos – para que os gestores municipais passem a investir nesse sentido. / Although having appeared more than a century ago in Europe, the increase in the number of mental health units in general hospitals in Brazil met the guidelines of the public health and psychiatric reforms propagated since the early seventies. Since then, these units haven't been submitted to a systematic assessment. The objective of present work was to be acquainted with the functioning modes of some of these units in São Paulo metropolitan area, their insertion in the mental health assistance system and their commitment to the population. In order to do so, there was an attempt to obtain, according to an assessment logic, the premisses guiding the use of information by the managers situated in different levels in relation to the studied units. The findings showed little clarity concerning the uses of such instruments inside the assistance system, which seems to be connected to the lack of a mental health policy for the studied region. The most frequently mentioned difficulties, like the impossibility to guarantee the patient the continuity of the treatment in the extra hospital services, after he has left the hospital, and the great proportion of patients that arrive at urgency services without having the need to receive urgent care, were not seen as something that general hospitals themselves could contribute to. The units, where the information about the services' production were privileged to the prejudice of the assesment of the services' access and the impact of the unit on the healthconditions of the population living under its referal areas, function independently of the rest of the mental health services, which contributes to the mental health care fragmentation and iniquity. One of the principal examples is the exclusion of patients from the the general hospitals' psychiatric inpatient services, especially the chronically mentally ill, whose pathologies make an effective treatment impossible, considering the period of time set for hospitalization. On the other hand, there has been identified initiatives that wish to redeem the integrate care, especially for the patients that require a more complex and long run treatment. An alternative for the care of the patients that have the most prevalent disabilities would be the use of pressure mechanisms – like information concerning the uses of psychiatric urgency services – to estimulate local managers investments.

Apesar de terem surgido há mais de um século na Europa, o crescimento do número de unidades de saúde mental em hospitais gerais no Brasil veio de encontro às diretrizes das reformas sanitária e psiquiátrica propaladas partir da década de setenta. Desde então, essas unidades não foram submetidas a uma avaliação sistemática. O presente trabalho teve por objetivo conhecer os modos de funcionamento, a inserção na rede de assistência à saúde mental e o compromisso populacional de algumas dessas unidades na Região Metropolitana da Grande São Paulo. Para isso buscou-se obter, segundo a lógica de um processo avaliatório, as premissas que norteariam o uso de informações por gestores situados em diversos níveis em relação às unidades estudadas. Os resultados evidenciaram falta de clareza quanto ao papel desse tipo de equipamento dentro da rede assistencial, o que parece ser fruto da ausência de uma política de saúde mental na região. As dificuldades mais freqüentemente relatadas, como a impossibilidade de garantir a vinculação de pacientes em serviços extra-hospitalares especializados após a internação e a grande proporção de pacientes que chegam aos pronto-atendimentos sem necessitarem de um cuidado de urgência, não foram tidas como passíveis de algum tipo de resposta por parte dos hospitais gerais. Nas unidades, onde se privilegiam informações sobre a produção dos serviços em detrimento da avaliação do acesso e do impacto no estado de saúde da população que reside na área de abrangência do hospital, há um funcionamento independente do restante da rede, o que contribui para a fragmentação e iniqüidade da assistência à saúde mental. Um dos principais exemplos é a exclusão de pacientes das enfermarias psiquiátricas dos hospitais gerais, particularmente os cronificados, cuja patologia impossibilita a efetividade da terapêutica médica dentro do prazo estipulado para a internação. Em contrapartida, foram identificadas iniciativas que pretendem resgatar a integralidade da atenção, prioritariamente aos pacientes que merecem intervenções de maior complexidade e de longo prazo. Quanto ao cuidado aos pacientes portadores de transtornos mentais mais prevalentes, uma alternativa seria utilizar mecanismos de pressão – entre os quais informações sobre a utilização dos pronto-atendimentos psiquiátricos – para que os gestores municipais passem a investir nesse sentido. / Although having appeared more than a century ago in Europe, the increase in the number of mental health units in general hospitals in Brazil met the guidelines of the public health and psychiatric reforms propagated since the early seventies. Since then, these units haven't been submitted to a systematic assessment. The objective of present work was to be acquainted with the functioning modes of some of these units in São Paulo metropolitan area, their insertion in the mental health assistance system and their commitment to the population. In order to do so, there was an attempt to obtain, according to an assessment logic, the premisses guiding the use of information by the managers situated in different levels in relation to the studied units. The findings showed little clarity concerning the uses of such instruments inside the assistance system, which seems to be connected to the lack of a mental health policy for the studied region. The most frequently mentioned difficulties, like the impossibility to guarantee the patient the continuity of the treatment in the extra hospital services, after he has left the hospital, and the great proportion of patients that arrive at urgency services without having the need to receive urgent care, were not seen as something that general hospitals themselves could contribute to. The units, where the information about the services' production were privileged to the prejudice of the assesment of the services' access and the impact of the unit on the healthconditions of the population living under its referal areas, function independently of the rest of the mental health services, which contributes to the mental health care fragmentation and iniquity. One of the principal examples is the exclusion of patients from the the general hospitals' psychiatric inpatient services, especially the chronically mentally ill, whose pathologies make an effective treatment impossible, considering the period of time set for hospitalization. On the other hand, there has been identified initiatives that wish to redeem the integrate care, especially for the patients that require a more complex and long run treatment. An alternative for the care of the patients that have the most prevalent disabilities would be the use of pressure mechanisms – like information concerning the uses of psychiatric urgency services – to estimulate local managers investments.

Mental health services in South Africa and the field of psychology are not keeping up with the changed landscape of child sexual abuse that includes women who perpetrate these violations. New laws have not made a massive impact on out of control behaviours, while the paucity of mental health services for women who sexually violate children is a significant failing in mental health service provision. Exploratory, descriptive research approached the topic from the perspective of the psychology of healing rather than the psychology of wrongdoing. Individual semi-structured interviews were conducted with 38 professionals in relevant fields, purposefully selected in four provinces in South Africa that revealed a lack of knowledge, resources, and funding, as well as gaps in curricula. Some practitioners were willing to work with women who sexually violate children, while others were either unwilling or reluctant to do so for various reasons. Women who sexually violate children are typically not mentally ill but could have mental disorders and lives dominated by dysfunction and trauma. Data were analysed utilising Attride- Stirling’s (2001) thematic networks, while Gannon, Rose, and Ward’s (2008) descriptive model of female sexual offending (DMFSO) provided the theoretical framework. Recommendations include establishing online services to aid perpetrator disclosure and therapeutic interventions, providing individual psychotherapeutic interventions to uncover more than recent trauma, directing donor funding to sex offender programmes, networking among service providers including government agencies, and training those within the mental health services environment and the criminal justice system. Furthermore, mental health and relevant medical practitioners need to ensure comfort with their sexuality and to resolve their psychological blind spots before offering psychotherapeutic interventions to women who sexually violate children. / Psychology / Ph. D. (Psychology)