[Integrated management of patients with schizophrenia: beyond psychotropic drugs]

Mental health services implementation in Colombia-A systematic review

Colombia's mental health services have a complex history shaped by 60 years of armed conflict, a predominantly clinical approach to mental health, and social factors such as inequities and stigma. The 1990 Caracas declaration proposed a shift towards decentralised community mental health services and interventions based on the recovery approach and emphasis on social determinants of mental health in the Americas. Colombia has adopted these approaches in its legal and practical framework in recent years, but implementation has been uneven. This systematic review aims to contribute to mental health services understanding in Colombia by examining the barriers and facilitators to the implementation of mental health services in Colombia. A search was conducted to explore available peer-reviewed studies on Colombian mental health services across five databases (Medline, PubMed, Scopus, Scielo and BVS) on quantitative and qualitative research papers published in the last ten years and without language restrictions. The Consolidated Framework for Implementation Research (CFIR) was used to structure the analysis and identify barriers and facilitators during the implementation of mental health services. We adapted the CFIR to attend to gender, race and age informed by the Socio-Political Economy of Global Mental Health framework, given the importance of these factors to the Colombian health landscape. Finally, narrative synthesis was used to summarise the data. 1 530 records were identified, and 12 articles met all inclusion criteria and were included in the analysis. 8 papers described substance use disorders services, 11 involved multidisciplinary healthcare professionals, and 7 were implemented at a local scale. The primary barriers to implementation were the lack of coordination, high workloads, and low funding. Facilitators included the use of protocols, and the involvement of communities, stakeholders, users, and external champions. Findings suggest the continued importance of community and recovery approaches and efforts to improve coordination between multi-sector actors involved in the mental health spaces (e.g., public, and private organisations, users and their families).

Autonomy of people with psychological suffering from the perspective of work: Perceptions of users and their families

OBJECTIVE

To present the results of a study with a psychosocial approach that aimed to examine the autonomy of people with mental suffering cared for at psychosocial care centres from the perspective of work, based on the perceptions of the users and their families, and using the psychosocial rehabilitation framework and Agnes Heller's theory of everyday life.

METHODS

Four psychosocial care centres were selected, and 40 people collaborated with the research through semi-structured interviews analysed with the Collective Subject Discourse technique.

RESULTS

Although the users wanted to have a job, they showed no initiative, as there are impediments to carrying out work activities due to the side effects of the medication and the obstacles posed by third parties concerned about the loss of social benefits. Prejudice was seen as a mechanism that negatively interferes with social relations and empowerment for autonomy. Expectations of resuming studies and participation in voluntary activities, especially religious ones, were frequent in the users' discourse.

CONCLUSIONS

There is an urgent need to expand territorial spaces so that the users of mental health services can be protagonists of their own autonomy and carry out their occupations in the area of productivity with greater ownership.

Autonomy of People with Psychological Suffering from the Perspective of Work: Perceptions of Users and their Families

OBJECTIVE

To present the results of a study with a psychosocial approach that aimed to examine the autonomy of people with mental suffering cared for at psychosocial care centres from the perspective of work, based on the perceptions of the users and their families, and using the psychosocial rehabilitation framework and Agnes Heller's theory of everyday life.

METHODS

Four psychosocial care centres were selected, and 40 people collaborated with the research through semi-structured interviews analysed with the Collective Subject Discourse technique.

RESULTS

Although the users wanted to have a job, they showed no initiative, as there are impediments to carrying out work activities due to the side effects of the medication and the obstacles posed by third parties concerned about the loss of social benefits. Prejudice was seen as a mechanism that negatively interferes with social relations and empowerment for autonomy. Expectations of resuming studies and participation in voluntary activities, especially religious ones, were frequent in the users' discourse.

CONCLUSIONS

There is an urgent need to expand territorial spaces so that the users of mental health services can be protagonists of their own autonomy and carry out their occupations in the area of productivity with greater ownership.

Mentalmente Sanos: Una experiencia con enfoque comunitario

Debido a la necesidad de reformar la asistencia psiquiátrica y trascender de un modelo centrado en la asistencia clínica a un modelo más comunitario, surge Mentalmente Sanos como una iniciativa desde la academia bajo el convenio de docencia servicio entre la Universidad del Valle y la Red de Salud ESE Ladera. Este grupo de apoyo, conformado desde el 2009 por personas con discapacidad mental que participan de manera libre y voluntaria, funciona con el fin de promover procesos de inclusión social y habilidades sociales en vida cotidiana. Cuenta con la participación de estudiantes y docentes de terapia ocupacional, medicina y psiquiatría.Metodológicamente, es un espacio de construcción conjunta, se trabaja desde dos enfoques, el de las capacidades y el comunitario. Las actividades se planean y desarrollan semanalmente garantizando la participación de todos, teniendo en cuenta los intereses, inquietudes y capacidades.Mentalmente Sanos, además de posibilitar procesos de inclusión social y la puesta en marcha de un abordaje con la comunidad, se convierte en una oportunidad para reflexionar en torno a la construcción del sujeto desde un modelo social de la discapacidad y la importancia de la vinculación de los actores institucionales para garantizar la implementación de estrategias de atención comunitaria.