A substantial gap exists between those who are considered experts on mental health (e.g., academics, mental health professionals) and those in charge of constructing mental health policies (e.g., legislators, Senators). This gap is in areas of both knowledge and professional relations. Mental health professionals are not adequately trained to engage in policy advocacy and reform efforts and have little to no policy advocacy training (Smith, Reynolds, & Rovnak, 2009). Policymakers lack necessary knowledge related to mental health for effective mental health policy construction (Corrigan, Druss, & Perlick, 2014; Lee, Smith, & Henry, 2013). As a result of this gap, mental health policies are ineffective, and many mental health professionals lack understanding and experience in the area of policy advocacy (Smith et al., 2009; Tanenbaum, 2005). This qualitative study aimed to contribute to filling this gap by exploring the perspectives of policymakers with the purpose of gaining a better understanding of the mental health policy construction and reform process. The purpose of this qualitative study was to explore the perspectives and lived experiences of state-level, practicing policymakers regarding their decision-making processes related to mental health policy construction in efforts to reveal a clearer understanding of how to participate in effective policy reform.A phenomenological qualitative research design and Interpretative Phenomenological Analysis (IPA) approach was used to explore the lived experiences and perspectives of a total of eight state-level practicing policymakers surrounding the mental health policy construction process. After securing IRB approval, all eight participants participated in face-to-face individual, semi-structured interviews. The interviews were audio recorded and ranged from 45 to 90 minutes. Data was then analyzed using IPA data analysis methods. The final data analysis product included three super ordinate themes and related themes and subthemes.

In 1963, President John F. Kennedy signed the Mental Retardation and Community Mental Health Centers Construction Act, establishing the beginnings of deinstitutionalization in the United States. By some counts, this Act was a stupendous policy success—by others, a dismal failure. 50 years later, no cohesive national mental health care policy has emerged to deal with increased rates of mental illness among the homeless and the incarcerated. However, California has made enormous strides to create a state policy which provides adequate services to the mildly, moderately, and severely mentally ill as well as adequate funding for those services through Proposition 63, the Mental Health Services Act, passed in 2004. This paper reviews mental health policy history from Colonial America to the present, paying special attention to JFK's deinstitutionalization in 1963 and the discontents that followed. It takes a special look at California's mental health care policy history and the strides the state has made to better serve the mentally ill.

Background. A number of commentators (Holloway 1996 Muijen 1996a; 1996b) have suggested that two events in the form of homicides carried out by mental health service users came to exert a disproportionate influence on English mental health policy over the period 1985-2000. In particular it has been suggested that the events formed the focus for a ‘moral panic’ caused by ‘irresponsible’ and ‘sensationalist’ reporting in UK newspapers (Neal 1998; Prins and Swan 1998). Aims. In the light of such claims this study critically explores the role played by the deaths of Jonathan Zito and Isabel Schwarz play in establishing violent assaults perpetrated by people experiencing mental illness as a ‘social problem’. It examines whether a shift in the discourse on mental illness took place in UK newspapers and explores how the deaths of Isabel Schwarz were and Jonathan Zito were framed in terms of causal responsibility. Finally it evaluates what influence, if any, the deaths in question had on the social policy agenda. Design. Case study / mixed design integrating quantitative and qualitative methods. Method. Content analysis consisting of a longitudinal analysis of the nature of the representation of mental illness changed over the period in two UK newspaper. Framing a sub-type of discourse analysis examined changes in the discourse of mental illness and the effects of the emergence of the community care tragedy as a ‘new’ narrative. It was also used to examine the potential influence on social policy on mental illness of changes in societal level frames particularly the emergence of the risk society. Results. The content analysis found that mental illness appeared increasingly in the context of a threat to public safety in newspapers over the period but that the overall representation was more balanced. The framing analysis identified and evidenced a competitive process in framing the issue of homicides committed by service users with mental health problems and demonstrated the potential influence of macro level social frames on the policy making proces

No abstract available.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-11-21T08:57:36Z No. of bitstreams: 1 Andrea Saraiva de Barros.pdf: 7442496 bytes, checksum: c3a461e8f2eb65725ec9c7083c3c92c9 (MD5) / Made available in DSpace on 2018-11-21T08:57:36Z (GMT). No. of bitstreams: 1 Andrea Saraiva de Barros.pdf: 7442496 bytes, checksum: c3a461e8f2eb65725ec9c7083c3c92c9 (MD5) Previous issue date: 2018-10-01 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Since the advent of the Law of Psychiatric Reform (Law nº 10.216 / 2001), people diagnosed with mental disorder have been considered subject of rights. Nonetheless, when faced with potential legal consequences there is a frequent scenario of violations. To these people the law attributes the statute of incomputability that removes them from the legal system and that comes with a presumed dangerousness. A safety measure is applied to them, which implicates compulsory determination of treatment that should occur in an outpatient basis or in an inpatient treatment in a Hospital of Custody and Psychiatric Treatment – HCTP. In the state of São Paulo there were hundreds of people waiting for placement in the HCTPs, distributed in regular prison units without assistance. To address that, an alliance between Psychiatry and Justice was created and a cooperation term was established that led to the creation, in 2014, of a psychiatric ward – still inside a regular penitentiary – that could concentrate these people in an irregular situation. The objectives of this research are to reconstruct this history of creation and to understand what today corresponds to the application and execution of safety measures as well as through which paths the reissue of the notion of dangerousness has been occurring. To do so: a) a literature review was carried out around the following axes: the security measures application’s logic in Brazil; the construction of the dangerous subject; the concept of deinstitutionalisation, which guided the Psychiatric Reform, and the disputes that were established in the scenario of security measures, starting from Law nº 10.216 / 2001, highlighting the events of the São Paulo context; b) interviews were made with subjects who participated actively or followed closely the process of creation of that ward; c) analysis of the verification reports of dangerousness’ termination of a 86 patients group who were awaiting for placement in an irregularly confined hospital at psychiatric wards of regular penitentiaries. The empirical study discussed through some analysts, the alliances and tensions in the configuration of the Ward, looking especially at the issue of the drug user subject, a growing phenomenon in all Penitentiary System. Based on the theoretical contributions of Michel Foucault and the authors of Institutional analysis, we were able to understand that judicial asylums and special wards are only some of the spaces of a management model in transinstitutional circuits that absorb the ungovernable subjects, marked by a new situational notion of dangerousness / Embora, no Brasil, as pessoas diagnosticadas com transtorno mental, desde o advento da Lei da Reforma Psiquiátrica (Lei nº10.216/2001), sejam consideradas sujeitos de direitos, quando entram em conflito com a lei observamos um cenário frequente de violações. A essas pessoas a lei atribui o estatuto da inimputabilidade que as retira do ordenamento jurídico e que vem acoplado a uma periculosidade presumida. A elas é aplicada uma medida de segurança que implica na determinação compulsória de tratamento que deverá acontecer em regime ambulatorial ou em regime de internação em Hospital de Custódia e Tratamento Psiquiátrico – HCTP. No Estado de São Paulo haviam centenas de pessoas aguardando por vagas nos HCTPs, pulverizadas por unidades prisionais comuns e completamente desassistidas. Para tanto, a partir de uma aliança entre Psiquiatria e Justiça, estabeleceu-se um termo de cooperação que ensejou na criação, em 2014, de uma ala psiquiátrica – ainda dentro de uma penitenciária comum – que pudesse concentrar essas pessoas em situação irregular. Os objetivos desta pesquisa consistem em reconstruir essa história de criação e compreender ao que responde hoje a aplicação e execução das medidas de segurança bem como por quais caminhos vem se dando a reedição da noção de periculosidade. Para tanto: a) realizamos revisão de literatura em torno dos seguintes eixos: a lógica de aplicação das medidas de segurança no Brasil; a construção do sujeito perigoso; o conceito de desinstitucionalização, norteador da Reforma Psiquiátrica, e o campo de lutas que se estabeleceu no cenário das medidas de segurança, a partir da Lei nº10.216/2001, ressaltando os acontecimentos do cenário paulista; b) entrevistas realizadas com sujeitos que participaram ativamente ou acompanharam de perto o processo de criação daquela Ala; c) análise dos laudos de verificação de cessação de periculosidade, de um grupo de 86 pacientes que estavam aguardando vagas para internação em hospital de custódia irregularmente confinados nas alas psiquiátricas de penitenciárias comuns. O estudo empírico discutiu por meio de alguns analisadores as alianças e tensões na configuração da Ala, olhando especialmente para a questão do sujeito usuário de drogas, perfil crescente em todo o Sistema Penitenciário. A partir dos aportes teóricos de Michel Foucault e dos autores da Análise Institucional, pudemos compreender que os manicômios judiciários e alas especiais consistem apenas em um dos espaços de um modelo de gestão em circuitos transinstitucionais que absorvem os sujeitos ingovernáveis, marcados por uma nova noção situacional de periculosidade

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este estudo tem como objetivo a análise dos centros de atenção psicossocial. Considera que a adoção do modelo psicossocial demanda a inserção e da responsabilização territorial. Investiga os efeitos da territorialização para a clínica e a organização dos serviços. Apresenta a reforma psiquiátrica brasileira como parte de um processo mais amplo de transformação da política pública de saúde. Situa a influência da crítica ao paradigma psiquiátrico e do Sistema Único de Saúde no desenvolvimento de experiências locais de reorientação da assistência psiquiátrica. Elege como campo de pesquisa a configuração dos centros de atenção psicossocial da Secretaria Municipal de Saúde do Rio de Janeiro, apontando seus avanços e impasses.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este estudo tem como objetivo a análise dos centros de atenção psicossocial. Considera que a adoção do modelo psicossocial demanda a inserção e da responsabilização territorial. Investiga os efeitos da territorialização para a clínica e a organização dos serviços. Apresenta a reforma psiquiátrica brasileira como parte de um processo mais amplo de transformação da política pública de saúde. Situa a influência da crítica ao paradigma psiquiátrico e do Sistema Único de Saúde no desenvolvimento de experiências locais de reorientação da assistência psiquiátrica. Elege como campo de pesquisa a configuração dos centros de atenção psicossocial da Secretaria Municipal de Saúde do Rio de Janeiro, apontando seus avanços e impasses.

Made available in DSpace on 2017-07-10T18:17:59Z (GMT). No. of bitstreams: 1 Ana Carolina B Nisiide.pdf: 3056855 bytes, checksum: f90e6fb08e7f0c2ef69c23a81bfdfab8 (MD5) Previous issue date: 2016-08-09 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The family as a privileged place of social protection becomes increasingly a "partner" of the state and focus of social policies. It is required that the family meets certain functions of breeding, individual formation, protection and socialization, but it will be a space of protection only if it is protected, need to have access their rights. In this sense, despite the family exert their protective function, it cannot be a substitute of the State and not eximi it of its responsibilities. It is urgent to discuss the significance of social protection, contrasting family responsibilities to the State, expanding the look over the place that the family occupies in various social policies, among them the Mental Health. After all, the family institution has historically been removed from the patient in psychological treatment, but over the Psychiatric Reform process this was taken as a fundamental factor for social rehabilitation of the patient. Faced with the constant threat of kicking and precariousness of Mental Health Policy in the neoliberal environment, added to redirect policy passing to favor territorial basic services and the various functions that the family takes on the care of the patient, the aim of this study is understand the configuration of the family role in a Psychosocial Attention Centre (CAPS) in the city of Toledo (Parana state - Brazil), as recommended by the Mental Health Policy in the Psychiatric Reform process. This is a quantitative and qualitative research. Using as data collection the document research methodology, semi-structured interview and directed observations, it was possible interpret the data collected through the content analysis technique. As some of the results for this problem, it was found that the role is experienced by these families, basically, as individual's care in psychic suffering. The way they exercise their role relates closely with the socioeconomic context in which they are, permeated by difficulties in access to employment and income, prejudice and social stigma and feelings of guilt and stress related to mental disorder. On the other hand, the CAPS objective conditions also put limits to offer greater space for the family support; moreover, the offered spaces are hardly occupied by families. Front this context, that families adopt a posture against reform, situation closely related to the lack of a more consistent support of the service network, or try to fight for their rights through the CAPS Patients, Family and officials Association; however, the lack of coordination, the lack of clarity in relation to the Mental Health Policy and the principles of psychiatric reform and the lack of political support, substantially limit advancement possibilities of this association. This situation has a direct impact on the social reintegration possibilities of individuals in psychological suffering and limits the political struggle of these families to advances in Mental Health Policy and the Psychiatric Reform Movement. / A família, como lugar privilegiado de proteção social, passa cada vez mais a ser tomada como parceira do Estado e foco das políticas sociais. Exige-se, então, que a família cumpra determinadas funções de reprodução, de formação do indivíduo, de proteção e de socialização, mas, para que ela possa ser espaço de proteção ela precisa ser protegida, precisa acessar aos seus direitos. Nesse sentido, apesar de a família exercer sua função protetiva, ela não pode ser um substituto do Estado e nem eximi-lo de suas responsabilidades. É premente discutir o significado da proteção social, contrapondo as responsabilidades familiares às do Estado, ampliando o olhar sobre o lugar que a família ocupa nas mais diversas políticas sociais, dentre elas a de Saúde Mental. Afinal, a instituição familiar foi historicamente afastada do sujeito em sofrimento psíquico, mas ao longo do processo da Reforma Psiquiátrica essa foi tomada como ator fundamental para reinserção social do paciente. Frente às constantes ameaças de retrocesso e a precarização da Política de Saúde Mental na conjuntura neoliberal, somadas ao redirecionamento da política que passa a privilegiar os serviços de base territorial e as várias funções que a família vai assumindo no cuidado com o paciente, objetiva-se, com esse estudo, compreender como se configura o protagonismo familiar em um CAPS do município de Toledo/PR, conforme o preconizado pela Política de Saúde Mental no processo de Reforma Psiquiátrica. Trata-se de uma pesquisa de cunho quantitativo e qualitativo. Utilizando-se como metodologia de coleta de dados a pesquisa documental, a entrevista semiestruturada e as observações dirigidas, foi possível interpretar os dados coletados por meio da técnica de análise de conteúdo. A partir da análise dos resultados, constatou-se que o protagonismo é vivenciado por essas famílias, basicamente, como cuidado do sujeito em sofrimento psíquico. A forma como elas exercem seu protagonismo relaciona-se, intimamente, com o contexto socioeconômico em que estão inseridas, permeado por dificuldades de acesso ao trabalho e à renda, pelo preconceito e pelo estigma social e por sentimentos de culpa e de estresse relacionados ao transtorno mental. Por outro lado, as condições objetivas do CAPS também colocam limites para a oferta de um espaço maior para o apoio familiar, além disso, os espaços ofertados são pouco ocupados pelas famílias. Frente esse contexto, ou as famílias adotam uma postura contrarreformista, situação intimamente relacionada à falta de um suporte mais consistente da rede de atendimento, ou tentam lutar pelos seus direitos por meio da Associação de Pacientes, de Familiares e de Funcionários do CAPS; todavia, a falta de articulação, a pouca clareza em relação à Política de Saúde Mental e aos princípios da Reforma Psiquiátrica e a escassez de apoio político limitam substancialmente as possibilidades de avanço dessa associação. Essa conjuntura, repercute diretamente nas possibilidades de reinserção social do sujeito em sofrimento psíquico e limita a luta política dessas famílias para avanços da Política de Saúde Mental e do Movimento de Reforma Psiquiátrica.

This thesis deals with the Czech and international ideas applied in the "Strategy of Reform of Psychiatric Care" issued in 2013 by the Ministry of Health of the Czech Republic. The main starting point of this work is the fact that the care of people with mental illness in Czech and international environment is oriented on the biological treatment of the patient with psycho- pharmaceuticals and that there is a deficit in the area of psychosocial treatment. International and Czech mental health policy seeks to promote a bio-psycho-social approach to patient's care. However, current psychiatry continues to be involved in conducting clinical research focused on the efficiency of psycho-pharmaceuticals. These studies are driven and sponsored mainly by the pharmaceutical industry. But international and Czech policies are still not able to adequately reflect this situation within the field of psychiatry. The Czech Republic has not so far paid attention to mental health issues and has lagged behind the other developed countries in this area. The empirical part of this work is divided into two parts. The first part of the research focuses on the Czech and international ideas applied in the "Strategy of Reform of Psychiatric Care" issued in 2013 by Ministry of Health. The methods used here are - content...

Epidemiological trends in mental disorders are shown against a background governed by medical aid health policy. The study quantitatively analyzed a dataset of mental disorders for South Africa’s leading medical aid scheme. South Africa’s leading medical aid scheme has been in operation for almost three decades. This degree of longevity allows for a reliable longitudinal analysis of diagnostic trends. Through consent of the Scheme, a database was provided, which lists mental disorder diagnoses over seven years from 2008 to mid-way through 2015. Data from this source were analyzed and interpreted. Data fields provided and made use of from the raw medical scheme database are: Date of admission (Year, Month); Patient gender; Database population per year; Patient diagnosis (DEG Description); Total per DEG Description. Each diagnosis (mental disorder) is presented in the following ways: 1. Bar charts showing the volume of specific mental illnesses each year. 2. Bar charts showing fluctuations of occurrence of a specific mental illness over time. 3. Frequency of specific mental illnesses over time, relative to the entire database population. 4. Male:Female ratio per mental disorder. 5. Female Outpatient vs. Inpatient volumes across each mental disorder and across all years (2008 – 2015).v 6. Male Outpatient vs. Inpatient volumes across each mental disorder and across all years (2008 – 2015). 7. Total number of patients per mental disorder across time (2008 – 2015). 8. Frequency polygons showing the fluctuation of a selected mental disorder over time as compared to other selected mental disorders. It is found that there are changes in prevalence rates of mental disorders over time and that these fluctuations are attributed to an economic factor within medical aid scheme cost-driven policy. The effect of cost-driven policy is that members diagnosed with a mental disorder may not be granted provision of adequate treatment because diagnosis is in part, determined by economic structures. Costs for mental illness treatment programmes are curtailed by keeping patient numbers significantly low, by radically over-diagnosing certain mental illnesses treated with comparably cheaper pharmaceuticals or by drastically curbing time spent in a mental health facility. Some members of the medical aid scheme have been deliberately misdiagnosed. Alternatively, those, correctly diagnosed, do not receive the treatment required of such an illness. The scenario then is of thousands of mentally ill people, who are not treated effectively. Members continue to pay fees, paying under the illusion that medical cover ensures effective treatment / Psychology / M.A. Psychology