This thesis judges a state of fulfilling the lawful requirements in the area of occupational safety and health in real organisation. The goal of this thesis is to define deficiencies in keeping lawful requirements and to propose possible solutions of this deficiencies. The output of this thesis is a suggestion of the health and safety management system in this organisation should work to follow the valid law requirements.

The Abstract This thesis deals with the problematic of burn out syndrom. In the theoretical part it deals with the prevention from the side of the employer and the support of the Ministry of Health. It compares psychosocial support provided by the divisions of Integrated rescue system. In addition it describes the actual situation in providing of the long term intensive care with the focus on the roots of origins of the burn out syndrom in those departments. In the practical parts were describes 4 Prague hospitals (ÚVN, FN Motol, RK Malvazinky, ETOILE CZ, a. s.) and their areas of prevention, through the qualitative methodology of data collection. Through the analysis quantitative metodology, it was found out, that majority of the respondents would appreciate creation of anonymous phone line within the frame of psychosocial support. The respondents also claim that it would be good, if the employers would be given by the law the obligation to provide the psychosocial support. From the research it appears, that the employers, eventhough they are aware of the risk of the burn out syndrom appearance in the departments of intensive care, they do not measure the appearance of this phenomen with the tools meant for it. Based on comparison of both research methods was proven, that 63 % of the respondents are...

Contexto do Estudo: Limeira-SP é uma cidade que abriga um dos principais pólos de produção de joias e bijuterias, que tem como característica o uso da mão de obra informal nos domicílios, envolvendo crianças e adolescentes nas atividades de montagem, soldagem e cravação de peças. Pesquisa no município revelou que 27% dos alunos da rede estadual de ensino trabalham montando e soldando joias e bijuterias, uma população 8.340 indivíduos envolvidos em tarefas repetitivas e perigosas para a saúde. O diagnóstico desta situação motivou a mobilização de instituições públicas e da sociedade civil na criação de uma rede intersetorial articulada pela Comissão Municipal de Erradicação do Trabalho Infantil de Limeira COMETIL que opera desde 2007. O objetivo deste projeto é avaliar o alcance, limites e possibilidades das ações intersetoriais desenvolvidas pela COMETIL, no período de 2007 2010, de modo destacar as estratégias utilizadas e avaliar as mesmas. Foi empregada metodologia qualitativa do tipo estudo de caso baseadas em: a) participação de pesquisadores que são membros da COMETIL (nos moldes de pesquisa-ação); b) análise de documentos e; c) entrevistas semiestruturadas com 13 indivíduos representantes de alguns segmentos envolvidos na referida Comissão. Os resultados foram ordenados cronologicamente para destacar os principais eventos percebidos como determinantes na história das intervenções realizadas pela COMETIL. Foi possível constatar: a importância das pesquisas acadêmicas na identificação de problemas socias; o papel da mídia na divulgação dos dados; a relevância de ações pautadas na promoção da saúde que visam a sensibilização da população e o desenvolvimento de habilidades técnicas entre os servidores público; a proeminência da articulação intersetorial e, sobre tudo, o apoio de instituições como o Ministério Público do Trabalho e Ministério do Trabalho e emprego; a necessidade de avançar nas ações de vigilância em saúde; e, por fim, a potencialidade da estratégia de territorialização para o desenvolvimento de ações no campo da Saúde e do Desenvolvimento Social. A Análise dos resultados possibilitou perceber as estratégias exitosas adotadas pela Comissão, bem como constatar os limites da articulação em rede em curso e apontar novos rumos para a superação dos mesmos. Alguns setores primordiais para o êxito das ações ainda apresentam resistência para participar de forma efetiva das ações intersetoriais. Os empresários de joias e bijuterias precisam repensar seu fluxo produtivo, de modo a torná-lo sustentável tanto do ponto de vista ambiental quanto da saúde do trabalhador; a rede estadual de ensino também precisa se engajar nos espaços instituídos pela COMETIL, uma vez que esses são loci privilegiados para pautar estratégias de atuação. É notória a penetração social que as escolas têm na sociedade e, por esse motivo, é imprescindível a participação dos mesmos, além disso, as crianças e adolescentes que tem maior potencial para a exploração do trabalho estão inseridos nas escolas da rede estadual. Considerações Finais: a COMETIL instituiu uma rede intersetorial descentralizada que atua de forma territorializada sobre o problema do Trabalho Infantil e Trabalho Adolescente desprotegido, muito embora ainda não haja indicadores quantitativos para evidenciar a sua contribuição para a redução dos índices de Trabalho Infantil. Algumas das estratégias desenvolvidas podem servir de exemplo para outras iniciativas com esse intuito. Novas pesquisas são necessárias para promover mudanças no fluxo produtivo de modo a troná-lo sustentável e verificar a efetividade das ações de promoção da saúde / Study context: The city of Limeira-SP houses the largest centers of jewelry and costume jewelry production in Brazil, which is characterized by the use of informal and domestic labor, including teenage and child labor in tasks of assembling, welding, and setting pieces. A study has revealed that in the city 27 per cent of students from the public state schools were working in assembling and welding jewelry, what meant a total of 8,340 individuals conducting tasks that were repetitive and dangerous to their health. This diagnosis of the situation led to the mobilization of public institutions and civil society in creating an inter-sectoral network articulated by the Municipal Commission for the Eradication of Child Labour in Limeira COMETIL, which operates since 2007. The objective of this project is to evaluate the scope, limits and possibilities of the inter-sectoral actions taken by COMETIL in the period between 2007 and 2010, in order to highlight and to evaluate their strategies. The methodology used in the study was qualitative and structured like a case study, based on: a) the participation of researchers who were members of COMETIL (along the lines of action research), b) a document analysis and c) semi-structured interviews with 13 individuals representing some segments involved in the committee. The results were organized chronologically to highlight key events perceived as crucial in the history of the interventions conducted by COMETIL. They include: the importance of academic research in identifying social problems; the role of the media in the dissemination of the results; the significance of the actions based on health promotion aimed at raising public awareness and the development of technical skills among public servants; the prominence of inter-sectoral articulation and specially the support of institutions like the Ministry of Labour and the Ministry of Labor and Employment; the need to advance on actions of health surveillance; and finally the potential of the strategy of territorialization to the development of actions in the field of Health and Social Development. The analysis of the results allowed to understand the successful strategies adopted by the Commission, as well as to observe the limits of the articulations of the network and to point out new ways to overcome them. There is still resistance from some essential sectors to participate in an effective way on the inter-sectoral actions. The jewelry entrepreneurs need to rethink the production flow in order to make it sustainable regarding both the environment and the workers healt h; the state educat ion system also needs to be engaged in the spaces established by COMETIL since these loci are privileged space to formulate strategic actions. The schools have significant social penetration in society and therefore their participation is essential. Moreover, the children and adolescents with greater potential for labor exploitation are inserted in the public state schools. Final considerations: COMETIL instituted an inter-sectoral decentralized network that operates territorially on the issue of unprotected Child and Adolescent Labour. Even though there are no quantitative indicators to demonstrate its contribution in reducing the rates of Child Labour, some of the developed strategies can serve as an example for other initiatives to this end. Further research is needed to promote changes in the production flow to make it sustainable and to verify the effectiveness of undertaken actions of health promotion

Contexto do Estudo: Limeira-SP é uma cidade que abriga um dos principais pólos de produção de joias e bijuterias, que tem como característica o uso da mão de obra informal nos domicílios, envolvendo crianças e adolescentes nas atividades de montagem, soldagem e cravação de peças. Pesquisa no município revelou que 27% dos alunos da rede estadual de ensino trabalham montando e soldando joias e bijuterias, uma população 8.340 indivíduos envolvidos em tarefas repetitivas e perigosas para a saúde. O diagnóstico desta situação motivou a mobilização de instituições públicas e da sociedade civil na criação de uma rede intersetorial articulada pela Comissão Municipal de Erradicação do Trabalho Infantil de Limeira COMETIL que opera desde 2007. O objetivo deste projeto é avaliar o alcance, limites e possibilidades das ações intersetoriais desenvolvidas pela COMETIL, no período de 2007 2010, de modo destacar as estratégias utilizadas e avaliar as mesmas. Foi empregada metodologia qualitativa do tipo estudo de caso baseadas em: a) participação de pesquisadores que são membros da COMETIL (nos moldes de pesquisa-ação); b) análise de documentos e; c) entrevistas semiestruturadas com 13 indivíduos representantes de alguns segmentos envolvidos na referida Comissão. Os resultados foram ordenados cronologicamente para destacar os principais eventos percebidos como determinantes na história das intervenções realizadas pela COMETIL. Foi possível constatar: a importância das pesquisas acadêmicas na identificação de problemas socias; o papel da mídia na divulgação dos dados; a relevância de ações pautadas na promoção da saúde que visam a sensibilização da população e o desenvolvimento de habilidades técnicas entre os servidores público; a proeminência da articulação intersetorial e, sobre tudo, o apoio de instituições como o Ministério Público do Trabalho e Ministério do Trabalho e emprego; a necessidade de avançar nas ações de vigilância em saúde; e, por fim, a potencialidade da estratégia de territorialização para o desenvolvimento de ações no campo da Saúde e do Desenvolvimento Social. A Análise dos resultados possibilitou perceber as estratégias exitosas adotadas pela Comissão, bem como constatar os limites da articulação em rede em curso e apontar novos rumos para a superação dos mesmos. Alguns setores primordiais para o êxito das ações ainda apresentam resistência para participar de forma efetiva das ações intersetoriais. Os empresários de joias e bijuterias precisam repensar seu fluxo produtivo, de modo a torná-lo sustentável tanto do ponto de vista ambiental quanto da saúde do trabalhador; a rede estadual de ensino também precisa se engajar nos espaços instituídos pela COMETIL, uma vez que esses são loci privilegiados para pautar estratégias de atuação. É notória a penetração social que as escolas têm na sociedade e, por esse motivo, é imprescindível a participação dos mesmos, além disso, as crianças e adolescentes que tem maior potencial para a exploração do trabalho estão inseridos nas escolas da rede estadual. Considerações Finais: a COMETIL instituiu uma rede intersetorial descentralizada que atua de forma territorializada sobre o problema do Trabalho Infantil e Trabalho Adolescente desprotegido, muito embora ainda não haja indicadores quantitativos para evidenciar a sua contribuição para a redução dos índices de Trabalho Infantil. Algumas das estratégias desenvolvidas podem servir de exemplo para outras iniciativas com esse intuito. Novas pesquisas são necessárias para promover mudanças no fluxo produtivo de modo a troná-lo sustentável e verificar a efetividade das ações de promoção da saúde / Study context: The city of Limeira-SP houses the largest centers of jewelry and costume jewelry production in Brazil, which is characterized by the use of informal and domestic labor, including teenage and child labor in tasks of assembling, welding, and setting pieces. A study has revealed that in the city 27 per cent of students from the public state schools were working in assembling and welding jewelry, what meant a total of 8,340 individuals conducting tasks that were repetitive and dangerous to their health. This diagnosis of the situation led to the mobilization of public institutions and civil society in creating an inter-sectoral network articulated by the Municipal Commission for the Eradication of Child Labour in Limeira COMETIL, which operates since 2007. The objective of this project is to evaluate the scope, limits and possibilities of the inter-sectoral actions taken by COMETIL in the period between 2007 and 2010, in order to highlight and to evaluate their strategies. The methodology used in the study was qualitative and structured like a case study, based on: a) the participation of researchers who were members of COMETIL (along the lines of action research), b) a document analysis and c) semi-structured interviews with 13 individuals representing some segments involved in the committee. The results were organized chronologically to highlight key events perceived as crucial in the history of the interventions conducted by COMETIL. They include: the importance of academic research in identifying social problems; the role of the media in the dissemination of the results; the significance of the actions based on health promotion aimed at raising public awareness and the development of technical skills among public servants; the prominence of inter-sectoral articulation and specially the support of institutions like the Ministry of Labour and the Ministry of Labor and Employment; the need to advance on actions of health surveillance; and finally the potential of the strategy of territorialization to the development of actions in the field of Health and Social Development. The analysis of the results allowed to understand the successful strategies adopted by the Commission, as well as to observe the limits of the articulations of the network and to point out new ways to overcome them. There is still resistance from some essential sectors to participate in an effective way on the inter-sectoral actions. The jewelry entrepreneurs need to rethink the production flow in order to make it sustainable regarding both the environment and the workers healt h; the state educat ion system also needs to be engaged in the spaces established by COMETIL since these loci are privileged space to formulate strategic actions. The schools have significant social penetration in society and therefore their participation is essential. Moreover, the children and adolescents with greater potential for labor exploitation are inserted in the public state schools. Final considerations: COMETIL instituted an inter-sectoral decentralized network that operates territorially on the issue of unprotected Child and Adolescent Labour. Even though there are no quantitative indicators to demonstrate its contribution in reducing the rates of Child Labour, some of the developed strategies can serve as an example for other initiatives to this end. Further research is needed to promote changes in the production flow to make it sustainable and to verify the effectiveness of undertaken actions of health promotion

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / This exploratory study investigates Traumatic Brain Injury (TBI) rehabilitation processes and outcomes among culturally diverse outpatients in community-based rehabilitation who have sustained a Mild to Moderate TBI. The major aims of this study are twofold: firstly, to determine whether community-based rehabilitation outcomes following TBI differ across Mäori, Pacific and Pakeha cultures; and secondly, to determine and identify any service delivery needs for Mäori and Pacific people in TBI rehabilitation that may be distinct from Pakeha. A fixed comparative non-experimental design was utilised where participants were selected using direct control based on their self-identified ethnic group resulting in sub-samples of 11 Mäori, l1 Pacific and 11 Pakeha (n=33). A "Close Other" from their care-giving support network was selected by the participant to take part in the study (n=20). Each participant completed the Neurobehavioural Cognitive Status Examination (Cognistat), the Brain Injury Community Rehabilitation Outcome Scales (BICRO Scales), the Client Satisfaction Questionnaire (CSQ-31), the Beck Depression Inventory, 2nd Edition (BDI-II), the Impact of Events Scale Revised (IES-R) and a semi-structured qualitative interview, while a "Close Other" completed a BICRO "Carer" questionnaire. Results indicate that all participants were at a homogenous level of overall cognitive functioning but Pacific peoples scored significantly lower than both Mäori and Pakeha on two Language subtests and significantly lower than Pakeha on the Memory subtest. Statistical analysis suggests that both Years of Formal Education and English as a Second Language are important factors contributing to these differences. Individual handicap increased following TBI and decreased following rehabilitation, with no significant difference across cultures and suggesting efficacy of rehabilitation. Of the total sample, 42% scored in the clinically depressed range (half of whom were Pakeha) and 24% of the sample showed mild signs of post-traumatic stress (of whom almost 90% were Mäori or Pacific). Although 97% of participants were generally satisfied with their overall rehabilitation service, Mäori and Pacific people were significantly less satisfied with their Physical Surroundings and the Quantity of Services they received. In conclusion, there appears to be universalities in TBI experience and global rehabilitation outcomes that transcends individual cultures. However, there are micro-level cultural variations that have valuable implications when planning culturally appropriate rehabilitation services for the future. For Mäori and Pacific People, acculturation levels will determine the extent to which these implications apply.

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / This exploratory study investigates Traumatic Brain Injury (TBI) rehabilitation processes and outcomes among culturally diverse outpatients in community-based rehabilitation who have sustained a Mild to Moderate TBI. The major aims of this study are twofold: firstly, to determine whether community-based rehabilitation outcomes following TBI differ across Mäori, Pacific and Pakeha cultures; and secondly, to determine and identify any service delivery needs for Mäori and Pacific people in TBI rehabilitation that may be distinct from Pakeha. A fixed comparative non-experimental design was utilised where participants were selected using direct control based on their self-identified ethnic group resulting in sub-samples of 11 Mäori, l1 Pacific and 11 Pakeha (n=33). A "Close Other" from their care-giving support network was selected by the participant to take part in the study (n=20). Each participant completed the Neurobehavioural Cognitive Status Examination (Cognistat), the Brain Injury Community Rehabilitation Outcome Scales (BICRO Scales), the Client Satisfaction Questionnaire (CSQ-31), the Beck Depression Inventory, 2nd Edition (BDI-II), the Impact of Events Scale Revised (IES-R) and a semi-structured qualitative interview, while a "Close Other" completed a BICRO "Carer" questionnaire. Results indicate that all participants were at a homogenous level of overall cognitive functioning but Pacific peoples scored significantly lower than both Mäori and Pakeha on two Language subtests and significantly lower than Pakeha on the Memory subtest. Statistical analysis suggests that both Years of Formal Education and English as a Second Language are important factors contributing to these differences. Individual handicap increased following TBI and decreased following rehabilitation, with no significant difference across cultures and suggesting efficacy of rehabilitation. Of the total sample, 42% scored in the clinically depressed range (half of whom were Pakeha) and 24% of the sample showed mild signs of post-traumatic stress (of whom almost 90% were Mäori or Pacific). Although 97% of participants were generally satisfied with their overall rehabilitation service, Mäori and Pacific people were significantly less satisfied with their Physical Surroundings and the Quantity of Services they received. In conclusion, there appears to be universalities in TBI experience and global rehabilitation outcomes that transcends individual cultures. However, there are micro-level cultural variations that have valuable implications when planning culturally appropriate rehabilitation services for the future. For Mäori and Pacific People, acculturation levels will determine the extent to which these implications apply.

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / This exploratory study investigates Traumatic Brain Injury (TBI) rehabilitation processes and outcomes among culturally diverse outpatients in community-based rehabilitation who have sustained a Mild to Moderate TBI. The major aims of this study are twofold: firstly, to determine whether community-based rehabilitation outcomes following TBI differ across Mäori, Pacific and Pakeha cultures; and secondly, to determine and identify any service delivery needs for Mäori and Pacific people in TBI rehabilitation that may be distinct from Pakeha. A fixed comparative non-experimental design was utilised where participants were selected using direct control based on their self-identified ethnic group resulting in sub-samples of 11 Mäori, l1 Pacific and 11 Pakeha (n=33). A "Close Other" from their care-giving support network was selected by the participant to take part in the study (n=20). Each participant completed the Neurobehavioural Cognitive Status Examination (Cognistat), the Brain Injury Community Rehabilitation Outcome Scales (BICRO Scales), the Client Satisfaction Questionnaire (CSQ-31), the Beck Depression Inventory, 2nd Edition (BDI-II), the Impact of Events Scale Revised (IES-R) and a semi-structured qualitative interview, while a "Close Other" completed a BICRO "Carer" questionnaire. Results indicate that all participants were at a homogenous level of overall cognitive functioning but Pacific peoples scored significantly lower than both Mäori and Pakeha on two Language subtests and significantly lower than Pakeha on the Memory subtest. Statistical analysis suggests that both Years of Formal Education and English as a Second Language are important factors contributing to these differences. Individual handicap increased following TBI and decreased following rehabilitation, with no significant difference across cultures and suggesting efficacy of rehabilitation. Of the total sample, 42% scored in the clinically depressed range (half of whom were Pakeha) and 24% of the sample showed mild signs of post-traumatic stress (of whom almost 90% were Mäori or Pacific). Although 97% of participants were generally satisfied with their overall rehabilitation service, Mäori and Pacific people were significantly less satisfied with their Physical Surroundings and the Quantity of Services they received. In conclusion, there appears to be universalities in TBI experience and global rehabilitation outcomes that transcends individual cultures. However, there are micro-level cultural variations that have valuable implications when planning culturally appropriate rehabilitation services for the future. For Mäori and Pacific People, acculturation levels will determine the extent to which these implications apply.

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / This exploratory study investigates Traumatic Brain Injury (TBI) rehabilitation processes and outcomes among culturally diverse outpatients in community-based rehabilitation who have sustained a Mild to Moderate TBI. The major aims of this study are twofold: firstly, to determine whether community-based rehabilitation outcomes following TBI differ across Mäori, Pacific and Pakeha cultures; and secondly, to determine and identify any service delivery needs for Mäori and Pacific people in TBI rehabilitation that may be distinct from Pakeha. A fixed comparative non-experimental design was utilised where participants were selected using direct control based on their self-identified ethnic group resulting in sub-samples of 11 Mäori, l1 Pacific and 11 Pakeha (n=33). A "Close Other" from their care-giving support network was selected by the participant to take part in the study (n=20). Each participant completed the Neurobehavioural Cognitive Status Examination (Cognistat), the Brain Injury Community Rehabilitation Outcome Scales (BICRO Scales), the Client Satisfaction Questionnaire (CSQ-31), the Beck Depression Inventory, 2nd Edition (BDI-II), the Impact of Events Scale Revised (IES-R) and a semi-structured qualitative interview, while a "Close Other" completed a BICRO "Carer" questionnaire. Results indicate that all participants were at a homogenous level of overall cognitive functioning but Pacific peoples scored significantly lower than both Mäori and Pakeha on two Language subtests and significantly lower than Pakeha on the Memory subtest. Statistical analysis suggests that both Years of Formal Education and English as a Second Language are important factors contributing to these differences. Individual handicap increased following TBI and decreased following rehabilitation, with no significant difference across cultures and suggesting efficacy of rehabilitation. Of the total sample, 42% scored in the clinically depressed range (half of whom were Pakeha) and 24% of the sample showed mild signs of post-traumatic stress (of whom almost 90% were Mäori or Pacific). Although 97% of participants were generally satisfied with their overall rehabilitation service, Mäori and Pacific people were significantly less satisfied with their Physical Surroundings and the Quantity of Services they received. In conclusion, there appears to be universalities in TBI experience and global rehabilitation outcomes that transcends individual cultures. However, there are micro-level cultural variations that have valuable implications when planning culturally appropriate rehabilitation services for the future. For Mäori and Pacific People, acculturation levels will determine the extent to which these implications apply.

Rapportens syfte är att i en fallstudie undersöka vilka effekter personalen på ett vård och omsorgsboendeti Filipstads kommun upplever i sin vardag, efter att ett nytt IT-system implementerats, för att bedöma om upphandlingsprocessens genomförande ligger till grund för effekterna personalen upplever. Detta ämne är aktuellt, då digitalisering inom vården ingår allt mer i personalens vardag inom vård och omsorg. Effekter efter en implementering av ett IT-system uppstår alltid, men frågan är om effekterna påverkar vård och omsorgspersonalens vardagliga arbetssituation på ett positivt eller negativt sätt. Detta är en fallstudie med kvalitativ inriktning, där metodvalen är semistrukturerad intervju och deltagande känd observation. Utifrån den insamlade teorin utformades de intervjufrågor som användes vid intervju med säkerhetssamordnare (SS ) och upphandlingschef (UC) för Filipstads kommun som är IT-systemets beställare. Efter intervjun med SS och UC i sammanhållning med teori utformades de intervjufrågor som ställdes till gruppledaren för vård och omsorgsboendet samt fem stycken personal på vård och omsorgsboendet, varav fyrast jobbar dag och en jobbar natt. Resultatet av fallstudien visar att upphandlingsprocessen och implementeringen av IT-systemet utförts utan några större brister, men IT-systemet har en hög dysfunktionalitet. Respondenternas och gruppledarens syn är att kraven sett annorlunda ut om de fått medverka vid kravinsamlingen, denna syn stöds inte av det som framkommit under rapportens skrivande.Dock har personalens vardagliga arbetssituation försämrats efter det nya IT-systemet implementerats. Syftet med det nya IT-systemet var att personalen skulle känna sig tryggare och ha bättre koll över brukarna. Detta har inte uppnåtts då IT-systemet har en så hög dysfunktionalitet att en slutbesiktning varit omöjlig att genomföra.

Orientador: Sílvio Yasui / Banca: Abilio da Costa Rosa / Banca: Clara Virginia de Queiroz / Resumo: As críticas ao hospital psiquiátrico nasceram com o próprio hospital. Contudo, foi a partir da Segunda Guerra Mundial que tais críticas se reverteram em outros caminhos para a atenção aos portadores de transtornos psiquiátricos. No Brasil, sob influência de várias experiências ocorridas fora do país, surgem diversas propostas inovadoras no campo da atenção à saúde mental. A partir daí, multiplicam-se no país ambulatórios de psicologia e psiquiatria, hospitais-dia, residências terapêuticas e diversos núcleos/centros de Atenção Psicossocial (NAPS/CAPS). Transformados em política pública, os centros de Atenção Psicossocial se espalham pelo país, preconizando um atendimento ambulatorial, interdisciplinar e de orientação territorial, com ações tanto individuais como em grupo. Diante dessa realidade, o psiquiatra permanece frente a um grave impasse. Geralmente formado sob os auspícios de um grande hospital, o psiquiatra que se propõe a trabalhar a partir da ótica psicossocial e imerso em uma pequena cidade, vê-se exposto às diversas contradições e ilogicidades do discurso psiquiátrico tradicional. As variadas comunidades locais e seus saberes são uma freqüente ameaça ao saber psiquiátrico medicamente constituído. Respostas, antes fáceis no interior do hospital, têm variadas implicações na dinâmica do território e adquirem uma complexidade para a qual, em geral, o psiquiatra não se encontra preparado. Diante disso, o presente trabalho tenta discutir, a partir de diversas situações concretas - vividas no cotidiano da Atenção Psicossocial da pequena cidade de Porto Nacional, no Tocantins - a dissonância entre essas duas espécies de psiquiatria: a tradicional (afinada com a biologia... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The critics to the psychiatric hospital came from the own hospital itself. Although it was from the second war that such critics went to another ways to the attention to the carrier of psychiatric disorder. In Brazil under the influence of several experiences which ones happened out of the country, several innovative proposals appear relating to the mental health. From that point, there were many psychology and psychotherapy clinical settings, day hospital, therapeutic rooms and Centre of Psychosocial Attention. (NAPS/CAPS). These ones became Public Political ones around all the country starting an Interdisciplinary Territorial Medical Supporting Centre giving both individual and group supporting. From that reality, there is a difficult situation for the psychiatrist from which one is difficult or impossible to find a good solution. Usually these psychiatrists are trained under the responsibility of a big hospital and when he (the psychiatrist) starts working from this psychosocial point and immerses in a small city , the psychiatrist is among of varies contradictions and illogicalities from the traditional psychiatric language. The local and varieties communities and their own knowledge are a frequency threat in relation to the psychiatric knowledge that it has been formed. So answers which were easy to have inside the hospital, now these answers have varied implications in the dynamic of the territory and they obtain complexity which in general, the psychiatrist is not ready for. In this way, the current study tries to argue from several concrete situations which were happened day by day... (Complete abstract click electronic access below) / Mestre