Ce mémoire de maîtrise vise à comprendre comment la question de l'accessibilité aux soins de santé mentale se pose dans l'univers des jeunes adultes en difficulté. Plus précisément, le but de l'étude est de documenter les barrières à l'accès aux soins de santé mentale, d'analyser les logiques sous-jacentes à ces barrières et finalement d'évaluer l'impact de l'expérience d'être jeune adulte en difficulté sur celles-ci. L'approche de l'anthropologie médicale et le concept de souffrance sociale, sensibles aux facteurs culturels, socio-économiques et politiques, servent de contexte d'analyse aux 12 entretiens semi-dirigés réalisés auprès de jeunes adultes fréquentant des Auberges du cœur à Montréal. L'identification de barrières à l'accès a, dans un premier temps, permis d'observer que les obstacles dans l'expérience de recours aux soins de santé mentale peuvent provenir autant des institutions que des jeunes adultes eux-mêmes. Dans un deuxième temps, l'analyse qualitative a servi à dégager trois principales logiques qui sous-tendent ces barrières : le parti pris positiviste, la logique marchande, et la tendance à la psychologisation. Les données récoltées tendent à montrer que des influences politiques et économiques sont déterminantes dans le maintien de différents types de barrières à l'accès et qu'une pleine reconnaissance de ces enjeux profonds est essentielle pour agir positivement sur l'accessibilité aux soins de santé mentale de la population en général, et plus particulièrement des jeunes adultes en difficulté dont les besoins se font criants. / This Master's thesis aims to understand how the issue of access to mental health care arises in the world of young adults in difficulty. More precisely, the research's objectives are to document the barriers to access to mental health care, to analyze tendencies underlying these barriers and to evaluate the impact of being young adult in trouble on them. The approach of medical anthropology and the concept of social suffering, sensitive to cultural, socio-economic and political factors framed the analysis to the 12 semi-directed interviews conducted with young adults using services from Auberges du coeur to Montreal. First, the identification of barriers to access allowed to observe the obstacles in the experience of use of mental health care may come as institutions that young adults themselves. Secondly, the qualitative data analysis was used to identify three main logic underlying these barriers: the positivist bias, market logic, and the trend of psychologizing. The data collected suggest that political and economic influences are critical in maintaining different barriers to access, and full recognition of these deep issues is essential to act positively on access to mental health care of the general population, especially young adults in difficulty whose needs are urgent.

Made available in DSpace on 2016-04-29T13:31:32Z (GMT). No. of bitstreams: 1 Juliana A Oliveira.pdf: 795655 bytes, checksum: cd71278ab84392899b8db3021d0e1f1b (MD5) Previous issue date: 2007-05-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The Reform of Psychiatric services in Brazil is in process of consolidation and the transition from treatment at psychiatric hospitals to rehabilitation and shelter services is still under way. As such, due to a variety of reasons, some clients of these services prefer to remain at psychiatric hospitals instead of returning to their homes. Research was carried out at a psychiatric hospital attached to SUS (Sistema Único de Saúde) and located in the city of São Paulo, in order to better understand the reasons for the resistance to disinterment. Information was gathered with clients and professionals using a diversity of research strategies (observations, conversations, interviews and participation in routine activities) during the visits made to the institution between August 2005 and March 2006. Interviews were carried out with patients that, according to the various health professionals working at this institution, externalized the "desire to remain in the internment" and with a Charity Sister that assumed the role of "spokesman" for the professional team. The analysis was base on Discursive Social Psychology in dialogue with a constructionist perspective. The desire to remain at the hospital was based on multiple factors, including lack of financial conditions, of housing, family, work and social relationships, as well as the progressive weakening of these social bonds due to frequent psychiatric internments. Moreover, the psychiatric hospital seems to function as a protective shell from a society that is intolerant with regards to mental illness. However, the desire to remain in hospital seems to be more related to lack of alternatives than to internment itself as the people that were interviewed often were sad and their speech presented many lapses and contradictions indicating paradoxical positions regarding staying in and leaving. We conclude that it is urgent to implement the proposals of the Psychiatric Reform, specially concerning strategies for strengthening social bonds in order that the desire to return to social life can truly blossom / Partindo do pressuposto que a Reforma Psiquiátrica está em pleno processo de construção e que em decorrência de seus pontos falhos, alguns usuários podem querer continuar vivendo em hospitais psiquiátricos, o presente estudo investiga, por meio das práticas discursivas de usuários e trabalhadores de um serviço de Saúde Mental da cidade de São Paulo, os sentidos que sustentam o suposto desejo de permanecer internado . Para coleta de informações elegimos um hospital psiquiátrico da cidade de São Paulo, predominantemente vinculado ao SUS, onde fizemos visitas durante o período de agosto de 2005 a março de 2006, distribuídas entre observação das rotinas, participação nas variadas atividades, entrevistas com usuárias que verbalizaram o desejo de permanecer no internamento e uma Irmã de Caridade, porta-voz da equipe profissional. A análise das informações coletadas foi sustentada a partir da perspectiva do construcionismo social. De modo geral, as entrevistas contribuíram para melhor entender o suposto desejo de permanecer no hospital psiquiátrico . A falta de condições financeiras, habitação, trabalho, relacionamentos sociais, além de internações psiquiátricas recorrentes, pareceram dificultar a reinserção social, bem como diminuir a proximidade com a família. Além disso, o hospital psiquiátrico pareceu tornar-se uma proteção do usuário em uma sociedade intolerante perante a loucura. É válido destacar as falas das usuárias sobre o hospital e a experiência de internação psiquiátrica foram acompanhadas de lapsos de linguagem e feições entristecidas, retratando o sofrimento da internação e a contradição presente em optar pela vida intra-muros. A partir dessas reflexões indaga-se sobre a urgência do fortalecimento efetivo da rede social extra-muros, a partir da estruturação da Reforma Psiquiátrica, de modo a possibilitar o desejo de retorno ao convívio social

This paper analyses mental patient’s rights. Mental patient has all political, economic, social and cultural rights. Mental patient with a mental illness has a right to appropriate, accessible and suitable medical aid provided free of charge at state health-care institutions. The paper further discusses such patients’ rights as the right to confidentiality with regard to information concerning their health. Involuntary hospitalization is studied in consideration of the constitutional right to liberty of an individual. Paper analyses criteria for involuntary hospitalization. The institute of guardianship is also discussed.

This project addressess the importance of early childhood intervention for California's infants and toddlers and how the managed care trends are affecting families' ability to obtain help for their children.

Vården av psykisk ohälsa får i regel mindre resurser än den somatiska vården världen över, och den globala covid-19-pandemin har lett till både störningar av psykiatrisk vård och ökad psykisk ohälsa i befolkningen. Denna studie undersöker vilka effekter coronapandemin haft på vården av psykiskt sjuka i fyra länder. Genom kvalitativ tematisk analys av en enkätundersökning på personer som arbetar med vård av psykisk ohälsa (n=41) i Bolivia, Colombia, Etiopien och Japan fann denna studie att pandemins påverkan på den psykiska vården varit omfattande, med ökade symtom hos befintliga patienter och fler med psykiska problem, men att vårdepersonal varit flexibel och gjort vad de kunnat för att möta befolkningens ökade behov av psykisk vård med adekvata insatser trots nya begränsningar i vårdarbetet och minskade resurser. Undersökningen fann också att vårdpersonalen själva fått anpassa sitt privatliv i den pandemiska situationen. / Throughout the world the mental health care is given fewer resources than somatic care, and the global covid-19 pandemic has resulted in both disturbances of psychiatric care and increased mental problems in the population. This survey investigated the impact of the pandemic on mental health care in four countries. Through qualitative thematic analysis of the statements from people working in mental health care (n=41) in Bolivia, Colombia, Ethiopia and Japan this study found the effects of the pandemic to be extensive, with increased symptoms of psychological suffering in existing patients and an increased flow of new patients. Its was also found that mental health staff have tried to handle the increasing need for care with flexibility and appropriate interventions, to make up for diminished resources and increased complications in their work. It was also found that the pandemic had demanded adaptations to the situation for mental health workers in their private lives.

Problems of mental health care in the Czech republic have been defined in the early nineties. Yet after nineteen years of progress in this area, these problems are still major topics in mental health care policy documents. Main purpose of diploma paper is therefore to analyse mental health care problems and at the same time also might-be solutions. Mental health care problems definitions as conceptualized in mental helth care policy documents are found to be plausible. Though the amount of supportive data is sufficent, there are differences in decisiveness of some arguments. Available solutions are brought up and described in various manners in order to show their own logic, rules and after all their usability. Final conclusions consider the roles and responsiblities of various policy actors.

MRDV / Institute for Rural Development / Traditional medicine still plays a bigger role in people dealing with health and disease. Research shows that in some Asian and African countries, traditional medicine forms the primary mode of health care for 80% of the population. This is actively promoted in South Africa and is used by at least 70% of the country’s population. This study investigated the contributory factors leading mental health care users to use a combination of traditional and modern medicine in rural areas. The study was conducted using qualitative research methods. The population of this study were MHCUs, Mental health practitioners and traditional healers. Purposive sampling was used to select participants. Data was analyzed through a computer programme called Atlas TI. The results revealed the following as contributory factors leading mental health care users to use modern and traditional medicine in rural areas : cultural factor , belief in witch craft , influence by significant others (family members and friends), poor PHC intervention and treatment method. Recommendations to the health care practitioners and policy makers around the use of traditional and modern medicine was made based on the findings.

Studien syftade till att öka kunskapen om äldres syn på psykisk ohälsa utifrån frågeställningen: Hur upplever äldre psykisk ohälsa? Åtta semistrukturerade intervjuer genomfördes (åldrar mellan 66–84, M=75,25) och analyserades utifrån tematisk analys. Fyra teman identifierades: Det är inte lätt att vara gammal, Ett harmoniskt åldrande, Det finns ju roligare saker att prata om och Man får nog bra vård om man väl kommer till. Resultaten visade att utanförskap till följd av ålder upplevdes påverka den psykiska hälsan negativt och att sociala sammanhang och en meningsfull tillvaro verkar hälsofrämjande. Vidare beskrevs en dubbelhet i attityder där en mer accepterande inställning till psykisk ohälsa utvecklats i samhället men att det fortfarande är skamfyllt för individen. Avslutningsvis beskrevs en kluvenhet till vård för psykisk ohälsa då den upplevs relevant men otillgänglig. Studien påvisar behovet av att tillgängliggöra resurser för äldres psykiska ohälsa samt att ta äldres föreställningar i beaktning i vårdprocessen. / The aim of the current study was to promote knowledge surrounding elders’ views on mental health, by employing the research question: How do elders perceive mental health? Eight semi-structured interviews were conducted (ages 66-84, M=75.25) and analyzed using thematic analysis. Four themes were identified: Hardships of being old, Harmonious aging, There are more amusing subjects and There’s good care once you get there. Results indicated an experience of age-related exclusion having negative effects on mental health, while social inclusion and a fulfilling everyday life promoted good health. Furthermore, split attitudes were expressed regarding mental health issues, where society has become increasingly accepting but the individual still may find it shameful. Finally, an ambivalence toward mental health care was discerned where it was perceived as necessary but inaccessible. The study highlights the need to allocate resources to mental health care for elders and to consider their perspectives in the caring process.

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...

Community mental health teams common in many countries with developed community mental health care have been slowly advancing in recent years. It is expected that this trend will continue to grow with the reform of psychiatric care. The diploma thesis focuses on community mental health teams for the target group of people with severe mental illness, which are one of the basic pillars of mental health care abroad. The theoretical part describes the activities of these teams in the context of community mental health care and also presents these teams mainly in terms of their composition and way of work. The research part analyzes the current situation of four specific teams in terms of multidisciplinary composition and team cooperation, describes and interprets some of the specific difficulties that these services face in the beginning of multidisciplinary teamwork and captures some specific moments of their functioning. Utilizing a qualitative approach through in-depth interviews with team leaders and their founding organizations has enabled them to convey the specific context of these teams and at least partially capture the dynamics of their current state and development. The practical part points to some factors that may complicate the teamwork, such as insufficient involvement of medical staff...