Les cancers primitifs du péritoine ont une incidence qui varie de 1 à 2 cas/an/1 000 000 d'habitants selon les types. Leur diagnostic et leur prise en charge sont complexes et exigent des spécificités de moyens et de compétences. Dans le cadre du plan cancer, le réseau national de prise en charge des tumeurs rares du péritoine (RENAPE) s'est structuré autour de centres experts et de missions transversales pour garantir à chaque patient, l'accès à l'expertise médicale et diagnostique. Après une revue de la littérature sur l'épidémiologie de ces cancers et leurs caractéristiques de prise en charge, l'objectif de ce travail est d'évaluer l'impact de l'organisation du réseau RENAPE, et de ses actions mises en œuvre, pour améliorer le parcours de soins des patients et favoriser l'évolution des pratiques dans la prise en charge de ces cancers. Une première étude, menée sur une cohorte de mésothéliomes péritonéaux, démontre l'apport de l'organisation RENAPE sur la diminution des délais de prise en charge thérapeutique. Une seconde étude rapporte les actions mises en œuvre par le réseau pour standardiser et homogénéiser les procédures chirurgicales et approches thérapeutiques. Une troisième étude présente les caractéristiques épidémiologiques de la population issue de l'observatoire mis en place au sein du réseau. Enfin, une quatrième étude analyse la distribution spatiale des patients pris en charge au sein du réseau et évalue l'impact de facteurs socio-économiques sur l'incidence des mésothéliomes péritonéaux. En s'appuyant sur une dynamique de réseau, l'organisation RENAPE a permis de structurer une filière de référence qui intègre une approche multidisciplinaire / Rare peritoneal malignancies (RPM) are extremely rare with annual incidence of 1 to 2 case/1,000,000 of the population per year depending types. Diagnostic and therapeutic management are complex and need specialized clinical skills associated to specific technical platforms. As part of the French cancer plan the national network for the treatment of rare peritoneal malignancies (RENAPE) has been organized including expert centres and cross-disciplinary healthcare issues to allow the patients to access to clinical expertise. After literature review of epidemiological data, the aim of this work is to evaluate the impact of the RENAPE healthcare organization on the clinical pathways of patients and to support the development of clinical practices in the management of RPM. A first study demonstrated the benefit of the RENAPE network to reduce the therapeutic management delays in cohort of peritoneal mesothelioma (PM). Then a second work reports the RENAPE initiative to standardize and homogenize the surgical procedures and therapeutic approach. A next study describes the epidemiological characteristic of the population from the RENAPE registry. Finally a fourth study analyzes the geographical distribution of RENAPE cohort and to evaluate the impact of the socioeconomic factors on the PM incidence. Based on the network approach, the RENAPE organization succeeded to structure a healthcare system with multidisciplinary integrated approach

[pt] A pesquisa tem como objetivo analisar a Rede de Atenção Psicossocial (RAPS) para o atendimento às mulheres usuárias de drogas da maternidade de um hospital universitário na cidade do Rio de Janeiro. Como pontos específicos do estudo, discutiu-se a política de drogas vigente no município, além do mapeamento dos equipamentos disponíveis, no âmbito da saúde, na rede no território do hospital buscando contribuir para subsidiar políticas e serviços voltados para esse grupo na perspectiva da convivência familiar. Realizou-se uma pesquisa exploratória sobre esse tema bastante atual, porém, ainda pouco estudado. Como recursos metodológicos, foi realizada uma análise crítica da literatura acadêmica, das legislações e das políticas a respeito do assunto, além da participação em oficinas de debates e seminários, o que muito contribuiu para as reflexões. O estudo permitiu constatar que a rede ainda não possui serviços específicos voltados para o atendimento às puérperas usuárias de drogas, os dispositivos atuam de forma isolada e incipiente com equipamentos precarizados e contam com a presença de um número reduzido de profissionais. / [en] The research aims to Analyze the Psychosocial Care Network that serve pregnant women who are drug users at a university hospital in the city of Rio de Janeiro. Some specific issues were discussed, such as: the current drug policy in the city and the mapping of services available within the health care network in the hospital territory aiming at contributing to support policies and services for this group in view of family life. An exploratory study was carried out focusing on this very current topic, though still under explored. As methodological resources, a critical analysis of academic literature, legislation and policy on the matter was carried out, as well as participation of the researcher in workshops debates and seminars, which greatly contributed to the current analysis. Results pointed out that the network does not have any specific service for mothers who are drug users, services operate in isolated and precarious ways and rely on a small number of professionals.

Patient-centredness and patient empowerment have been gaining importance in health policy and society already since the 1990s (Fumagalli et al. (2015), Castro et al. (2016)). For example, increasing patient empowerment has been one of the declared national health objectives in Germany since 2003 because patient orientation and participation provide important impulses for a demand-oriented and efficient design of healthcare systems and services (Bundesministerium für Gesundheit (2018)). A transition is taking place from an institution-based view of care provision to a more patient-based view that considers patients as co-managers of their individual care process and well-being (Kayser et al. (2019)). This transition also encompasses the developments towards integrated care1, i. e. a closer coordination between inpatient, outpatient and home care services, broadening the traditional focus from acute care to better integrate healthpromoting, preventive and post-treatment or palliative services as part of the whole continuum of care across sector boundaries (Minkman (2012), World Health Organization (2016), Expert Group on Health Systems Performance Assessment (2017)). These developments are particularly relevant for patients with long-term, chronic diseases or multimorbidities as their needs are often more complex and not exclusively medically determined (Smith and O’Dowd (2007), Hujala et al. (2016)).

Made available in DSpace on 2014-12-17T15:39:01Z (GMT). No. of bitstreams: 1 LaisBB_DISSERT.pdf: 4153066 bytes, checksum: b629cf83014e7a5061ed66d61adbd8b6 (MD5) Previous issue date: 2013-04-12 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The present study aims to meet the attention given to women with mental health needs in specialized services for the fight against violence against women, as well as psychosocial care network in the municipality of NatalRN. It is a qualitative research characterized as research-intervention that took place in the year 2011. The study started in the Centre of Reference in which individual semi-structured interviews were carried out directed to the coaching staff and manager, in order to know the care offered in relation to the aforementioned clientele. From the Reference Centre were identified through analysis of registration records, the routes traversed by users through the network of psychosocial care and hospital network. After the identification of the same were visited two day-care Centers, two psychiatric hospitals, a basic health Unit and the local shelter. In these organizations was investigated the reception and procedures offered to users in situations of violence, the knowledge of policies for women and the coordination with the attention to women, through interviews with semi-structured individual scripts directed to professionals. The interviews were analyzed taking as starting point the theoretical framework of French Institutional Analysis, which includes the assumption of events analysers for the critical reading of dimensions introduced in the practices of care of the teams that took part in the study. The survey results revealed difficulties on the part of the same host of users with this profile, both in the face of violence as services in mental health services. This fact led to the lack of support under the guarantee of their rights, ceasing the possibilities of confronting the situations of violence, as well as in the context of mental health care / O presente estudo tem como finalidade conhecer o acolhimento e aten??o dispensados ?s mulheres com demandas em sa?de mental nos servi?os especializados para o enfrentamento da viol?ncia, bem como pela rede de aten??o psicossocial no munic?pio de Natal/RN. Trata-se de uma pesquisa qualitativa caracterizada como pesquisainterven??o realizada no ano de 2011. O estudo se iniciou no Centro de Refer?ncia no qual foram realizadas entrevistas semiestruturadas individuais direcionadas ? equipe t?cnica e gestora, objetivando-se conhecer os cuidados ofertados em rela??o ? clientela supracitada. A partir do Centro de Refer?ncia foram identificados, por meio da an?lise de fichas de cadastro, os itiner?rios percorridos pelas usu?rias atrav?s da rede de aten??o psicossocial e rede hospitalar. Ap?s a identifica??o dos mesmos foram visitados dois Centros de Aten??o Psicossocial, dois Hospitais Psiqui?tricos, uma Unidade B?sica de Sa?de e a Casa Abrigo local. Nestes equipamentos investigou-se o acolhimento e procedimentos oferecidos ?s usu?rias em situa??o de viol?ncia, o conhecimento das pol?ticas para mulheres e a articula??o com a rede de aten??o ?s mulheres, por meio de entrevistas com roteiros semi-estruturados individuais direcionadas aos profissionais de refer?ncia. As entrevistas foram analisadas tendo como ponto de partida o referencial te?rico da An?lise Institucional francesa, o qual prev? a elei??o de analisadores para a leitura cr?tica das dimens?es institu?das nas pr?ticas de cuidados das equipes que fizeram parte do estudo. Os resultados da pesquisa revelaram dificuldades por parte das mesmas no acolhimento das usu?rias com este perfil, tanto nos servi?os de enfrentamento ? viol?ncia quanto nos servi?os de sa?de mental. Tal fato ocasionava a desassist?ncia no ?mbito da garantia dos seus direitos, cessando as possibilidades de enfrentamento das situa??es de viol?ncia, bem como de cuidados no ?mbito da sa?de mental

No description available.

L'engorgement des services des urgences est une question d'actualité. L'augmentation de la fréquentation de ces services par des cas non urgents surcharge ces centres de soins. Par conséquence, la qualité du service délivré aux patients se dégrade et les coûts des soins augmentent. Afin de résoudre ce problème, cette étude porte un intérêt particulier au réseau amont de prise en charge des urgences (pompiers, ambulances privées,médecin libéral, SAMU…). Il s'agit de savoir comment le dispositif actuel doit s'adapter afin de mieux répondre aux besoins des patients. Pour ce faire, le champ de l'étude s'est réparti en deux parties.Une première analyse s'est focalisée notamment sur la régulation médicale au SAMU/Centre15, pivot du réseau amont de prise en charge des urgences et ciment des relations entres les différents acteurs des urgences hospitalières.Une deuxième partie, à vision se situant à un niveau plus global cette fois, prend en compte la phase amont de la prise en charge des urgences dans sa totalité. Elle analyse la complexité du réseau et se centre sur deux éléments d'amélioration possibles, celui de l'introduction des Maisons Médicales de Garde et celui du renforcement de SOS Médecins. / Emergency Department (ED) overcrowding is a topical issue. The increasing attendance at such service by patients with non urgent problems resulted in surcharging the ED. Consequently, the quality of the delivered service is degraded and the care costs are on the increase. In order to solve this problem, a particular interest is taken in the pre-hospital emergency care network (firemen, private ambulances, General Practitioner, SAMU…). Our main purpose is to determine how the current system must adapt to better respond to patients health care needs. This study is divided into two parts: A first analysis focuses on the processing of emergency calls into the SAMU/Centre 15 as itplays an important role in the management of patients flew through this network and guarantees better relations between different actors of this system.A second one deals with the entire pre-hospital emergency care network. The complexity ofthis net is analysed and some alternatives are studied in order to improve the management ofEmergency Department's patients: the establishment of « Maisons Médicales de Garde » and the strengthening of existing medical centres such as « SOS Médecins ».

Submitted by Cláudia Bueno (claudiamoura18@gmail.com) on 2016-09-12T13:17:35Z No. of bitstreams: 2 Dissertação - Loreta Marinho Queiroz Costa - 2016.pdf: 2479228 bytes, checksum: 01217c18f2c2afc5fc3a415e2b74f9c6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Cláudia Bueno (claudiamoura18@gmail.com) on 2016-09-12T13:18:43Z (GMT) No. of bitstreams: 2 Dissertação - Loreta Marinho Queiroz Costa - 2016.pdf: 2479228 bytes, checksum: 01217c18f2c2afc5fc3a415e2b74f9c6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-09-12T13:18:43Z (GMT). No. of bitstreams: 2 Dissertação - Loreta Marinho Queiroz Costa - 2016.pdf: 2479228 bytes, checksum: 01217c18f2c2afc5fc3a415e2b74f9c6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-01-21 / Considering the magnitude and incidence of chronic diseases in the current Brazilian epidemiological profile and the need to establish the Care Networks Health - RAS in the SUS as a response to chronic conditions, but that meet at the same time to acute conditions and acute exacerbation of chronic conditions this work is an intervention proposal within the service organization, which aims to develop Logic Model of Patient care Network with Chronic Kidney disease - DRC, seeking to ensure continuity and comprehensiveness of care.Logical Model is a methodological resource to explain program structure results-oriented, is Basically a systematic and visual way to present and share the understanding of the relationship between the resources available to the programmed actions and changes for results expected to achieve. Used - in the structure of the Logical Model guidelines and criteria defined in ministerial orders on the topic and the principles of Care Model to Chronic Conditions - MACC, designed to be applied in the SUS. The results presented contextualize the situation of Chronic Terminal Renal Disease (ESRD) in Goiás from December 2009 to 2013; describe the Nephrology Assistance Network of High Complexity available in Goiás / 2015 and bring the logical model of the Individual Care Network with Chronic Kidney Disease, CKD, to be operationalized in care line of logic, in order to maintain renal function, and when the inexorable progression is the slowness in speed loss of renal function. His final presentation consists of two parts: the first, the logical model of care to the population, and the second, the logical model of the operational structure of the RAS that despite being separated, constitute a single instrument in the network forming process. It is hoped that this work contribute to the process of planning and implementation of the Care Network Patient with Chronic Kidney Disease - DRC, the health system response to a chronic condition. / Considerando a magnitude e a relevância das doenças crônicas no atual perfil epidemiológico brasileiro e a necessidade de se estabelecer as Redes de Atenção à Saúde - RAS no SUS como resposta às condições crônicas, mas que atendam ao mesmo tempo às condições agudas e agudização das condições crônicas, este trabalho trata de uma proposta de intervenção no âmbito da organização dos serviços, que objetiva desenvolver Modelo Lógico da Rede de Atenção ao Paciente com Doença Renal Crônica - DRC, buscando a garantia da continuidade e integralidade da atenção. Modelo Lógico é um recurso metodológico para explicitar estrutura de programa orientado para resultados, basicamente é uma maneira sistemática e visual de apresentar e compartilhar a compreensão das relações entre os recursos disponíveis para as ações programadas e as mudanças por resultados que se espera alcançar.Utilizou-se, na estruturação do Modelo Lógico, as diretrizes e critérios definidos em portarias ministeriais referentes ao tema e os princípios do Modelo de Atenção às Condições Crônicas - MACC, idealizado para ser aplicado no SUS. Os resultados apresentados contextualizam a situação da Doença Renal Crônica Terminal (DRCT) em Goiás nos meses de dezembro de 2009 a 2013; descrevem a Rede de Assistência em Nefrologia de Alta Complexidade disponível em Goiás/2015 e trazem o Modelo Lógico da Rede de Atenção da Pessoa com Doença Renal Crônica - DRC, a ser operacionalizada na lógica da linha de cuidado, visando a manutenção da função renal, e quando a progressão é inexorável, a lentificação na velocidade de perda da função renal. Sua apresentação final é formada por duas partes: a primeira, o modelo lógico de atenção à população, e a segunda, o modelo lógico da estrutura operacional da RAS que, apesar de estarem separados, constituem-se num instrumento único no processo de conformação de rede. Espera-se com este trabalho contribuir no processo de planejamento e implantação da Rede de Atenção ao Paciente com Doença Renal Crônica - DRC, resposta do sistema de saúde a uma condição crônica.

No description available.

Au sein de la périnatalité organisée en réseau(x), entre les objectifs préventifs et thérapeutiques attendus pour les bébés et leurs parents et les vécus concrets, des écarts sont à constater. Nous avons dans cette recherche souhaité proposer quelques pistes de réflexion concernant ces constats : notre démarche en psychopathologie et psychologie clinique s’associe à un positionnement ethnopsychologique, psychanalytique et systémique, pour aborder la complexité de cette problématique.Notre hypothèse est que la compréhension du travail psychique des réseau(x) de soins, ici situés autour de la Naissance, passerait par :1) la prise en compte de l’existence d’un « réseau dans la tête » de chaque protagoniste de l’enfantement, professionnel et parent, en tant que formation psychique spécifique des groupalités intra, inter et trans-subjective de la réticularité2) le fait d’envisager les résistances et ressources propres aux exigences de ce travail psychique en réseau, qui entravent et/ou étayent les qualités dynamiques des processus perceptifs, relationnels et communicationnels3) le principe selon lequel ces processus perceptifs fragilisent et/ou soutiennent les qualités potentiellement préventives et thérapeutiques de cette organisation de soins spécifiques à la mise et à la venue au monde des enfants.4) l’idée que cette organisation des soins se modélise en réticularité pour permettre une adaptabilité des processus psychiques défensifs, groupaux et singuliers plus ou moins conscientisés, face aux émergences et réminiscences mobilisées par le phénomène de la Naissance.Le recueil des perceptions attenantes au réseau périnatal et à la place de chacun au sein de cette organisation, a été effectué selon la méthode ethnobiographique auprès des protagonistes de l’enfantement (familles et professionnels) en Languedoc-Roussillon, de 2005 à 2009, au sein de services d’obstétrique, de pédiatrie et de pédopsychiatrie périnatale. A partir de l’analyse de ces données et de trois vignettes cliniques, sont questionnés ici les élaborations et les processus psychiques participant et procédant des liens institués autour de la Naissance. L’analyse, étayée de certains apports des théoriciens du chaos, aboutit à établir peu à peu un modèle de compréhension du travail psychique propre aux réseaux de soins, dont notamment la périnatalité. Ce modèle propose de procéder par :- l’analyse psychologique simultanée des situations cliniques en cinq focales ; niveau singulier conscient, niveau singulier inconscient, niveau groupal conscient, niveau groupal inconscient et selon les différentes strates du réseau (réseau-dispositif ; réseau local-informel ; réseau de proximité formalisé ; réseau-famille ; réseau-professionnel ; réseau dans la tête).- le repérage et l’instrumentalisation des protagonistes-clés de cette méthodologie ; le référent, le répondant et le préoccupé.Face aux mobilisations convoquées par l’enfantement, chacun et tous, familles et professionnels, mettent en place des processus et des élaborations psychiques propres au domaine de la périnatalité réticulaire, à travers des dynamiques psychiques complexes, où le sujet apparaît de, dans, entre et à travers le(s) groupe(s), afin de permettre une adaptabilité défensive adéquate face aux éprouvés participant et procédant de la mise et de la venue au monde des enfants. Entre exigences et possibilités de chacun et de tous, il s’agit d’un tissage dynamique, entre accordages et désaccordages intra, inter et trans-subjectifs : groupalités psychiques réticulaires, réseau(x) dans la tête, dont les qualités en termes de flexibilité et/ou de rigidification, vont permettre, ou peu, ou pas, les potentialités créatrices de la Naissance, dans des contextes préventifs et thérapeutiques / In the context of perinatal nexus, there are differences between the preventive and therapeutic purposes set for the baby and her/his parents on one hand and actual experiences on the other hand. In this research, we wish to develop some reflections about these differences, by mainly resorting to clinical psychology and psychopathology approaches, with ethno-psychological, psychoanalytic and systemic views to grasp the complexity of this theme. Our hypothesis is that a better understanding of the mental shaping of network around the birth could proceed from : - acknowledging this mental shaping in network for each and all partners, professional and parent, as specific mind shaping of network in intra, inter and trans-subjective groups. - taking into account the resistances and resources fitted to mental shaping of network, that hinder and/or support the dynamic qualities of perceptive processes that partake and originate in this care organisation and which weaken and/or prop up its preventive and therapeutic potentialities.Using an ethno-biographical method, a data collection of the birth protagonists’ (the families and medical-nursing staff) perceptions of perinatal nexus and the part played by each one of them in it, made in obstetric, paediatric and child psychiatric units, in Languedoc-Roussillon, from 2005 to 2009. From the data analysis and from three clinical examples, were particularly examined psychological elaborations and processes that originate and partake in the established birth nexus. This analysis, made complete with some contributions of chaos theoreticians, leads to a pattern of understanding of the mind shaping in this specific perinatal network. This model suggests to proceed from : - simultaneous psychological analysis of clinical situation in five levels ; conscious individual level, unconscious individual level, conscious group level, unconscious group level and various network levels (system-network, locally and informally network, formal closeness network, family-network, professional-network, mental shaping in network). - the key-protagonists’ identification and instrumentalization of this method; “the” referent, “the” guarantor and “the” involved.Facing thoughts about child birth, everyone (the families and medical-nursing staff) sets up psychological elaborations and processes that originate and partake in specific perinatal nexus, through psychological and complexe dynamics, which emerges the subject “from”, “in”, “between” and “through” human group(s), in order to permit adequate defensive adaptability when facing feelings partaking and originating in coming and bringing into the world. In between the demands and possibilities of each protagonist, a dynamic weaving of thoughts is ranging from being tune to being out of tune : there lies a mind shaping of network whose flexibility and/or rigidity can or cannot much entice, creative potentialities on human birth, in preventive and therapeutic context

O início do século XXI é marcado por diversas questões que correlacionam os problemas da privação da liberdade e sua interface com a Saúde Pública, como nas discussões sobre o uso problemático de álcool e outras drogas e o aumento do encarceramento desses indivíduos, assim como na temática do denominado \"louco infrator\", que, apesar da Reforma Psiquiátrica, continua sem acesso aos seus direitos fundamentais. O presente trabalho tem como problemática central investigar, à luz dos princípios da Reforma Psiquiátrica, como se processa a dinâmica das transferências de pessoas internadas nos Hospitais de Custódia e Tratamento Psiquiátrico do Estado de São Paulo para os Hospitais Psiquiátricos Comuns, Centros de Atenção Psicossocial e Residências Terapêuticas, sob ordem judicial. Tem como objetivos identificar os motivos que determinam transferências, sua legalidade, assim como os discursos das áreas jurídicas, psiquiátricas e de saúde mental que se constituem em torno da pessoa com transtorno mental em conflito com a lei e caracterizar como se apresenta a relação Justiça e Saúde na dinâmica dessas transferências como mecanismo jurídico-sanitário, identificando implicações, alcances e limitações e o lugar da transinstitucionalização nesse processo. Do ponto de vista metodológico, trata-se de pesquisa de natureza documental e qualitativa. Como documentos foram identificados acórdãos, processos de execução criminal de medida de segurança e processos de internação compulsória, entre outros de natureza cível, relacionados a pessoas com transtorno mental em conflito com a lei, que tramitam ou tramitavam no Tribunal de Justiça do Estado de São Paulo. Articula-se a questões emergentes da pesquisa documental, a realização de entrevistas, em profundidade, via Roteiro Temático, com dois grupos de sujeitos de pesquisa, profissionais da área jurídica, assim como, profissionais da área da saúde, com experiência de trabalho relacionada à temática. A discussão e interpretação de dados e narrativas revelam que a noção da periculosidade se apresentou como eixo central para a determinação das transferências. A prática da Internação Compulsória com Interdição, após a extinção da medida de segurança, apresenta-se como forma de continuidade do cumprimento da medida de segurança. A desinternação condicional, como medida exclusivamente jurídica, onde os cuidados em saúde ocupam aspecto secundário, fazendo com que a área da Saúde atue sob a égide da Justiça, representa um aspecto limitador para o processo de transinstitucionalização, com vistas a desinstitucionalização. A desinternação e a imposição de suas condições meramente punitivas representa um grande desafio para o cenário das execuções da medida de segurança com o aumento do número de reinternações, caracterizando o fenômeno do \"revolving door\" ou \"porta giratória\", como forma de gestão em \"circuitos\", que geram \"novos crônicos\". Diante de tal prática, a atuação autônoma dos Centros de Atenção Psicossocial, a expansão das Residências Terapêuticas, assim como o investimento em políticas públicas de inclusão social apresentam-se como condições necessárias para a desinstitucionalização das pessoas com transtorno mental em conflito com a lei. / The beginning of the 21st century is marked by several issues that correlate the problems of deprivation of liberty and its interface with Public Health, such as discussions about the problematic use of alcohol and other drugs and the increasing incarceration of these individuals, as well as the theme. the so-called \"insane offender\" who, despite the Psychiatric Reform, still has no access to his fundamental rights. The present work has as its central problem to investigate, in the light of the principles of Psychiatric Reform, how the dynamics of the transference of hospitalized people in the Custody and Psychiatric Treatment Hospitals of the State of São Paulo to the Common Psychiatric Hospitals, Psychosocial Care Centers and Therapeutic Residences, under court order. It aims to identify the motives that determine transfers, their legality, as well as the discourses of the legal, psychiatric and mental health areas that constitute around the person with mental disorder in conflict with the law and to characterize how the relationship between Justice and Health in the dynamics of these transfers as a legal-health mechanism, identifying implications, scope and limitations and the place of transinstitutionalization in this process. From the methodological point of view, this is a documentary and qualitative research. As documents were identified judgments, proceedings for criminal enforcement of security measure and cases of compulsory detention, among others of a civil nature, related to people with mental disorder in conflict with the law, who are processing or proceeding in the Court of Justice of the State of São Paulo. It is linked to emerging issues of documentary research, conducting in-depth interviews via Thematic Roadmap, with two groups of research subjects, legal professionals, as well as health professionals, with work experience related to thematic. The discussion and interpretation of data and narratives reveal that the notion of dangerousness was presented as the central axis for the determination of transfers. The practice of Compulsory Detention with Interdiction, after the safety measure has been extinguished, is presented as a way of continuing compliance with the safety measure. Conditional withdrawal, as an exclusively legal measure, where health care occupies a secondary aspect, making the Health area act under the aegis of Justice, represents a limiting aspect for the transinstitutionalization process, with a view to deinstitutionalization. The disinternation and imposition of its merely punitive conditions represents a major challenge for the scenario of executions of the security measure with the increase in the number of readmissions, characterizing the phenomenon of revolving door as a form of management in \"Circuits\" that generate \"new chronicles\". Given this practice, the autonomous performance of the Psychosocial Care Centers, the expansion of Therapeutic Residences, as well as the investment in public policies for social inclusion are necessary conditions for the deinstitutionalization of people with mental disorders in conflict with the law.