Mental health policy in the context of psychiatric hospitals: Challenges and perspectives

Pessoa Júnior, João Mário; Santos, Raionara Cristina de Araújo; Clementino, Francisco de Sales; Oliveira, Kalyane Kelly Duarte de; Miranda, Francisco Arnoldo Nunes de

doi:10.5935/1414-8145.20160012

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RESEARCH • Esc. Anna Nery 20 (1) • Jan-Mar 2016 • https://doi.org/10.5935/1414-8145.20160012 copy

Mental health policy in the context of psychiatric hospitals: Challenges and perspectives^* * This study was originated from the doctoral thesis “Perfis e práticas de profissionais de saúde mentais em hospitais psiquiátricos,” submitted to the doctoral program in nursing at the Federal University of Rio Grande do Norte (PPGEnf-UFRN) in 2014.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the study participants' opinions on mental health policy, in the context of psychiatric hospitals.

Methods:

This was a qualitative study with 60 healthcare professionals, all of whom had higher education degrees, undertaken in two large psychiatric hospitals from June to October 2014. Data were collected by means of a questionnaire, transcribed and processed with Alceste software, and interpreted using Bardin's thematic content analysis.

Results:

In public mental health care policies on psychiatric hospitals, there is a confluence of critical and complex scenarios that directly reflect on the work of mental health care professionals, ranging from institutional macro-political to actual care, developed in the daily life of this service.

Conclusion:

The results of this study reinforce the need for humanized mental health care, and intersectoral dialogue on the actions developed in this field.

Keywords:
Mental health services; Health policy; Human resources; Mental health

Variables	N
Professional category
Nurse	22
Physician	03
Psychologist	15
Occupational therapist	09
Social worker	09
Physical educator	02
Sex
Female	54
Male	6
Age group (years)
30 to 39	16
40 to 49	12
50 to 59	25
More than 60	6
Year of graduation
2000-2014	26
1975-1999	34
Post-graduate education
Specialization in mental health	12
Update/training in other areas	30
Master/PhD	3
No	15
Started work in mental health (year)
2000-2014	25
1975-1999	35

Thematic axis A - Aspects of mental health policy in the psychiatric hospital
Theme A.1 - institutional policy management	Theme A.2 - political barriers for the team
The state does not provide conditions necessary for the work of professionals (P6).	The psychiatric reform has not occurred in the institution (P41).
There is a lack of physical and outpatient infrastructure, and materials and medicines; the unit is overcrowded (P2).	Collaborate so that psychiatric reform guidelines are implemented in the institution (P18).
The lack of human resources hinders implementation of the policy (P12).	No, the internal political questions of the institution impede the interdisciplinary process from occurring, and also make it so that the psychiatric reform doesn't flow (P52).
As there is no therapeutic design of the institution, which adheres to the National Policy, it is often clumsy, and for this reason does not continue (P22).	We have isolated practices that contribute to strengthen the Brazilian psychiatric reform (P1) I think the relationships between professionals are still lacking (P26).
There is no assisted discharge, and no guarantee of continued care (referral), which causes the revolving door phenomenon. Effectively, network care does not exist (P31).	There are difficulties with integration, specification of roles and functions, in addition to work in multidisciplinary teams (P28).

Thematic axis B - Aspects of mental health policy in professional care
Theme B.1 - Embracing users and their families	Theme B.2 - Difficulties for professional work in the public mental health care network
Promote greater interaction between patient and family members/community (P16).	There is still a need for greater interaction with the primary care network, as well as intensification of actions to demystify mental illness in society (P24).
Make the link among patient, family and institution in terms of access to services and guaranteed patient rights (P10).	Disarticulation of the services and precariousness of the extra hospital network (P2).
Specialized listening, welcoming subjectivity, family orientation, responsible referrals aimed at improved adherence to treatment (P3).	There could be a better connection with the substitute services (care network), which would reduce the need for hospitalizing patients (P4).
Meet the demands of patients and their families (P9).	There is an overload of patients in search of vacancies (P43).
Work with the patient and family for the patient's resocialization and continuity of treatment after discharge (P6).	Despite being a psychiatric hospital, there is a movement of networking (P1).
The work is developed by professionals individually, where actions are fragmented, and most professionals don't have an overall vision (P14).	The substitute services don't receive the demand as it should, in addition to the stigma that is exposed to the patient, family and the professionals (P8).
A best practice of humanization would also be necessary, since many professionals are "stuck" in older systems (Q6).	The referral does not work for substitute services (P7).

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[1] Corresponding author: João Mário Pessoa Júnior. E-mail: joaomariopessoa@gmail.com