Dissertations / Theses on the topic 'The history of the mental hospital'

The Kew Asylum has been a dominant feature of Melbourne’s built environment for over 100 years. In addition to the visual impact it has made on Melbourne’s skyline it has been very much a part of the psychological landscape of the collective imagination of the city’s inhabitants. Despite this, comparatively little has been written about its impact on society, and almost nothing has been recorded in any comprehensive sense, about its occupants or inmates. This dissertation aims to go some way towards redressing this, not with a broad sweep institutional biography, but with an intimate portrait of the asylum’s earliest days. Covering a time frame of less than 50 years, this thesis adopts a multi-theoretical approach in order to illuminate the different facets of asylum life with the maximum clarity. The thesis contains several themes, some of which overlap and interweave in order to examine the complexity of institutional life.

I examined the factors that led to the rise and fall of psychiatric hospitals and its impact on two select groups of individuals: adults and older adults with severe mental illness. To explore the reasons behind these fluctuations, the State of Texas was used as a case study. Additionally, the fluctuations occurred for different reasons in public vs. for-profit investor-owned psychiatric hospitals. Using an investor-owned psychiatric hospital organization as a case study, I investigated the differences in factors that influenced the growth and/or demise in public vs. investor-owned psychiatric hospitals. Evolution and devolution of psychiatric hospitals was assessed during select time periods: 1700 to1930, 1940 to1970, 1980 to 2000, and 2000 to present. Time period selections were relevant to the important drivers of the span of time that influenced the psychiatric hospitals. Historical review and trend analysis was used to identify the total number of psychiatric hospitals and/or total number of psychiatric hospital beds and psychiatric hospitals by type. Analysis showed there was a cyclical pattern of evolution and devolution of psychiatric hospitals and each cycle altered the form, function, and role of the psychiatric hospital along with altering the location of care for adults and older adults with severe mental illness. The research results suggest a long-stay residential facility, specializing in evidence-based treatment for adults and older adults with severe mental illness, to counter the dire shortage of psychiatric hospital beds.

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Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior
In Brazil, the mental health network proposed by the Psychiatric Reform inserts the intermediate and replacement services in the pursuit of alignment or resocialization of patients with mental and behavioral disorder in the community. Was adopted, among other services, the Center for Psychosocial Care, Home Therapy, Sheltered Home, Day Hospital and psychiatric beds in general hospital. In this context, the State of Rio Grande do Norte implanted the Day Hospital Dr. Elger Nunes (HDEN) in Natal / RN in 1996, linked to State Department of Public Health. At HDEN happened a multi and interdisciplinary therapeutic work, besides being the scene of disciplinary practices, and extension projects for graduate courses in Higher Education Institutions in the city. However, with the process of decentralization of local services, the hospital was terminated by an administrative state act in 2006, leaving damage to the activities provided to users, disciplinary practices and extension activities. From this breakdown, the objective was to narrate the trajectory of HDEN through a multidisciplinary team of professionals and teachers who used it as a field of disciplinary practices. It is characterized as a documental and qualitative, backed in the technique of thematic oral history, following the phases: authorization of the interviewee, interview recording, transcription, textualization and transcreation of the material obtained. We used documents, ordinances, general reports of activities, among others, plus interviews to fifteen employees who used this service, being thirteen part of the multidisciplinary team of professionals and two graduation professors of health care area, nursing and medicine. The stories collected were organized according to the technique chosen, respecting its steps. In preparing the body subjected to ALCESTE computer program, priority was given to the vital tone for the formation of categories and classes elected by the program, structured in three thematic areas. In the first axis, called Trajectory of HDEN, were recalled the beginning of its activities, the steps of that time, their activities, and its actors - users, families, professionals, and teaching practices. The second axis has dealt with the process of extinction of HDEN, rescuing the feelings of employees, the main reasons given at the time and immediate postextinction scenario. And the third axis revealed in an articulated form the situation of mental health in Natal / RN, listing to the challenges and prospects for the psychosocial care, starting from the trajectory of HDEN with emphasis on activities. Moreover, the trajectory of HDEN provides recognition of the historical basis outlined in the constitution of the network of substitute services present in the current scenario of psychosocial care in the city of Natal and in RN.
No Brasil, a rede de sa?de mental proposta pela Reforma Psiqui?trica insere os servi?os intermedi?rios e substitutivos, na busca pela aproxima??o ou ressocializa??o do portador de transtorno mental e comportamental junto ? comunidade. Adotou-se, entre outros servi?os, o Centro de Aten??o Psicossocial, Resid?ncia Terap?utica, Lar Abrigado, Hospital-dia, Leito Psiqui?trico em Hospital Geral. Nesse contexto, o Estado do Rio Grande do Norte, implantou o Hospital-Dia Dr. Elger Nunes (HDEN) em Natal/RN no ano de 1996 ligado ? Secretaria Estadual de Sa?de P?blica. No HDEN acontecia um trabalho terap?utico multi e interdisciplinar, al?m de ser palco de pr?ticas disciplinares e projetos de extens?o de cursos em gradua??o de Institui??es de Ensino Superior no munic?pio. Entretanto, com o processo de municipaliza??o dos servi?os locais, o Hospital foi extinto por ato administrativo estadual em 2006, deixando preju?zo para as atividades prestadas aos usu?rios, as pr?ticas disciplinares e as atividades extensionistas. Partindo dessa ruptura, objetivou-se narrar a trajet?ria do HDEN atrav?s dos profissionais da equipe multidisciplinar e dos professores que o utilizaram como campo de pr?ticas disciplinares. Caracteriza-se como estudo documental e qualitativo, respaldado na t?cnica da hist?ria oral tem?tica, seguindo as fases: autoriza??o do colaborador, grava??o da entrevista, transcri??o, a textualiza??o e a transcria??o do material obtido. Utilizaram-se documentos, portarias, relat?rios gerais de atividades, entre outros; somada a realiza??o de entrevistas a quinze colaboradores que utilizaram esse servi?o, sendo treze profissionais da equipe multidisciplinar e dois docentes da gradua??o da ?rea da sa?de, Enfermagem e Medicina. As hist?rias coletadas foram organizadas conforme a t?cnica escolhida, respeitando-se suas etapas. Na prepara??o do corpus submetido ao programa inform?tico ALCESTE, priorizou-se o tom vital para a forma??o das categorias e classes elegida por ele, estruturada sob tr?s eixos tem?ticos. No primeiro eixo denominado Trajet?ria do HDEN rememorou-se o in?cio de suas atividades, os percal?os nesse momento, as atividades desenvolvidas, al?m dos seus atores os usu?rios, familiares, profissionais, e as pr?ticas de ensino. O segundo eixo ocupou-se do Processo de extin??o do HDEN, resgatandose os sentimentos dos colaboradores, as principais justificativas dadas na ?poca e o cen?rio imediato p?s-extin??o. E, o terceiro eixo analisado revelou de forma articulada a situa??o da Sa?de mental em Natal/RN, elencando-se os desafios e perspectivas para a aten??o psicossocial, partindo-se da pr?pria trajet?ria do HDEN com ?nfase nas atividades desenvolvidas. Ademais, a trajet?ria do HDEN propicia o reconhecimento das bases hist?ricas tra?adas na constitui??o da rede de servi?os substitutivos presente no atual cen?rio de aten??o psicossocial do munic?pio de Natal e no RN.

Charting the trans-Atlantic movement of ‘dynamic’ psychiatry from The Henry Phipps Psychiatric Clinic, Baltimore, to Gartnavel Mental Hospital, Glasgow, this thesis throws light upon the resultant ‘dynamic’ case note records, produced in Gartnavel during the 1920s. By undertaking an in-depth, qualitative analysis of Gartnavel’s case note records and corresponding archival materials, I explore the polemical question, posed, amongst others, by Foucault, of how psychiatry achieves its distinct status as a science of the individual. Foucault, most notably in Discipline and Power, ascribes to the psychiatric profession the power to fashion individual patient histories into cases, cases which simultaneously emphasise the individuality of a patient, while condensing, i.e. ‘fixing’ their identities that they may be constituted ‘an object for a branch of knowledge and a hold for a branch of power’. This thesis, while recognising the validity of this argument, explores how the clinical practices and philosophical outlook of dynamic psychiatry in the early twentieth century enabled both patient and psychiatrist to negotiate the construction of the psychiatric case note record, and consequently of patients’ individual identities. D. K. Henderson, physician superintendent of Gartnavel between 1921 and 1932, was one of the first, if not the first psychiatrist fully to incorporate dynamic principles into the working practices of a British mental hospital. Initiating methods of case note taking and staff meeting consultation (now integral components of modern day psychiatric practice) he transported the teachings of his mentor, the Swiss émigré psychiatrist Adolf Meyer, to the everyday clinical practices of Gartnavel. The dissemination of dynamic psychiatry through Henderson’s published works and medical teachings is recognised as having integrally shaped the practices of Scottish psychiatry in the twentieth century. However, the significance of the unpublished case note records, produced under his superintendence of Gartnavel during the 1920s, as sources of historical enquiry has gone largely unrecognised. A near-unique archive of ‘dynamic’ case note records is used in this thesis to reveal, what Roy Porter termed, a ‘history from below’ of clinical practices and examinatory processes. For as Henderson employed stenographers and clinical clerks to record verbatim and semi verbatim the dialogues that passed between patients and psychiatrists within staff meetings and mental examinations, I, as Porter himself aspired to, take as the focus of my research a history of the ‘two-way encounters between doctors and patients’. By employing an interdisciplinary research method, one that incorporates Foucauldian, literary, critical medical humanities, as well as more traditional forms of medical history scholarship, I establish a history of dynamic psychiatry set within clinical encounters. Engaging with current debate, evolving primarily within the interdisciplinary sphere of the medical humanities, I argue these records reveal a history of medical humanism, one in which both patients and psychiatrists actively shaped the history of twentieth century Scottish psychiatry.

This study examines the most vital criteria for being discharged from forensic psychiatric care in 1915-1945. To do so a qualitative oriented comparative text analysis has been made on medical records from the forensic psychiatric departement at Sankt Sigfrids mental hospital in Växjö, Sweden. The result shows that the most vital criteria for the whole period is that a patient proves himself to be diligent, hard-working and that he can return to an environment where he can live and make a living for himself. Furthermore, from 1940 and forward the result shows that the discharge trial has been expanded, which results in that the criteria for being discharged should to a greater extent been showed in the free rather than in the institution. The conclusion of this is that the psychiatry during the later years of the study aimed to create a more socially adapted and producitve citizen out of the patient than it did in the earlier years.

This study analyses the fact that young adults under the age of 21 were sent to mental institutions in the early 20th century. To further examine this statement, three main questions provide insights about life inside of the mental hospital in Växjö, Sweden. What factors did overall result in psychiatric care for young adults in the early 20thcentury? By using microhistory as a historical method, what aspects can indicate patient's subordinate role at the hospital? How can the psychiatric institutions be viewed from a disciplinary standpoint while focusing on the power they possess over underage individuals? The chosen institution is called Sankt Sigfrid's hospital (alsoWexio hospital) and provides valuable records and journals between the years of 1907and 1921, on which the study is based on. The results show that a total of 38 patients were admitted to the hospital under this period. Generally, there were 5 different illnesses that resulted in psychiatric care and dementia primaria was the most common one. The ages ranged between 11 and 20, with 20 as the most common age when arriving at the hospital. According to the results, most patients came from a background of farming and landowning. Poor relief was the most common factor for young adults being admitted to the hospital, whereas the second most common factor was the father overseeing the decision. Furthermore, 4 patients were part of a microhistorical study which primarily concluded that they were being subjected to constraint by the hospital. Since the material is examined from a disciplinary standpoint where the hospital is viewed in a position of power, the result is an example of psychiatric expansion through the country. This maintains the belief that psychiatric care developed through different phases of the 19th and 20th century and thus were in constant reform, whereas this study is merely an example of this process of developing.

The state´s responsibility for the health and well-being of the population was part of the development towards the welfare state. Government agencies at various levels were helpful in surveys and were also the state´s tool for enforcing social policy goals. The main purpose of the essay is to investigate in what way mental health care 1935-1939 was a tool for the growth of the welfare state. The pronounced questions are about what mental health care looked like regarding patients’ activation, mental care in families’ homes, sterilization and forensic psychiatry, and in what way mental health care can be said to have been a state administrative unit. The investigated material is documents from the administration at St. Olof's Hospital in Visby and the source material is examined on the basis of Michel Foucault's theories on discipline, control, exclusion mechanisms and biopolitics. The result of the essay is that mental health care and St. Olof's Hospital can be seen as one of the tools for the growth of the welfare state both as part of the administration, as a prerequisite for biopolitics, and as an entertainer and messenger of norms and discipline.

Abstract Amidst the worst disaster to impact a major U.S. city in one hundred years, New Orleans’ main trauma and safety net medical center, the Reverend Avery C. Alexander Charity Hospital, was permanently closed. Charity’s administrative operator, Louisiana State University (LSU), ordered an end to its attempted reopening by its workers and U.S. military personnel in the weeks following the August 29, 2005 storm. Drawing upon rigorous review of literature and an exhaustive analysis of primary and secondary data, this case study found that Charity Hospital was closed as a result of disaster capitalism. LSU, backed by Louisiana state officials, took advantage of the mass internal displacement of New Orleans’ populace in the aftermath of Hurricane Katrina in an attempt to abandon Charity Hospital’s iconic but neglected facility and to supplant its original safety net mission serving the poor and uninsured for its neoliberal transformation to favor LSU’s academic medical enterprise.

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O objetivo central desta Tese doutoral consistiu em analisar como as professoras primárias internadas no Hospital Juliano Moreira no Pará foram subjetivadas como loucas a partir de relações de saber-poder instituídas naquele espaço institucionalizado para a loucura em nosso Estado. Especificamente almejou refletir sobre as perspectivas teórico-metodológicas que envolvem a produção da verdade sobre a temática da Loucura e sua constituição enquanto campo epistemológico da produção científica no Brasil; problematizar as relações de saber-poder que orientaram a produção da Loucura a partir da institucionalização do modelo hospitalar no HJM nos anos de 1964-1984; analisar como os discursos oficiais dos governos paraenses engendrados pelos mecanismos de poder da disciplina e da biopolítica constituíram as práticas de tratamento da loucura nessa unidade hospitalar; e analisar como as professoras primárias internadas nesse espaço psiquiátrico foram subjetivadas como loucas a partir das relações de saber-poder prescritas em seus prontuários médicos. Sob quais dispositivos, a temática relacionada à Loucura vem se constituindo enquanto campo epistemológico da produção científica no Brasil a partir das relações de saber-poder? Como as relações de saber-poder produziram os modos de subjetivação a partir dos discursos da Loucura no Hospital Juliano Moreira, no Pará, entre os anos de 1964-1984? Como os mecanismos de poder da disciplina e da biopolítica se constituíram nos discursos oficiais dos governos paraenses nesse período por meio da análise das práticas de tratamento da Loucura nessa instituição hospitalar? Como as professoras primárias internadas nesse espaço clínico foram subjetivadas enquanto loucas a partir das relações de saber-poder prescritas em seus prontuários médicos? Pesquisa histórico-educacional sob lastro teórico-metodológico da genealogia foucaultiana com aporte documental nos prontuários médicos do HJM, em Mensagens dos governadores paraenses, jornais, relatórios da SESPA, os Boletins do Centro de Estudos do Hospital Juliano Moreira que circularam entre os anos de 1967-1971 e da Revista Paraense de Psiquiatria editada em 1984. A tese considerou que no campo da educação, a loucura constitui temática de pouco interesse epistemológico, contudo, os estudos de Michel Foucault sobre as categorias analíticas saber, poder, disciplina, biopolítica, discurso e subjetivação são importantes instrumentos teóricos capazes de auxiliar na compreensão das biopolíticas de saúde mental engendradas pelo Estado do Pará por ocasião do funcionamento do Hospital Juliano Moreira, pois no interior dessa instituição havia confronto de paradigmas de tratamento dos sujeitos internados e seus discursos produzidos para o enquadramento das mulheres professoras primárias como loucas emergiram das relações de saber-poder advindas dos domínios da Medicina e seus correlatos, assim como da força operante da sociedade disciplinar atravessada pelas políticas oficiais governamentais, cuja capilaridade se estende de maneira prescritiva aos ciclos familiares que também contribuíram para a legitimação do processo de subjetivação dessas professoras como loucas. Concluiu-se que as professoras primárias internadas no Hospital Juliano Moreira tinham seus saberes também orientados por uma racionalidade técnico-cientifica, porém, plenamente preteridos ante as relações de saber-poder da psiquiatra, assim como as manifestações de resistências dessas mulheres-professoras quanto ao seu processo de subjetivação, despontavam como indícios de afirmação de sua loucura e não como estratégias de resistências ao controle de seus corpos, sem prescindir do atravessamento das questões de gênero e sexualidade, permeadas pelas normatividades e poder das famílias.
The main objective of this doctoral thesis was to analyze how the primary teachers hospitalized in the Juliano Moreira Hospital, in Pará, were conceptualized as insane from relations knowledge-power instituted in that space institutionalized for madness in our state. The specific purpose is directed to reflect on the theoretical and methodological perspectives that involve the production of truth about the theme of Madness and its constitution as epistemological area of scientific production in Brazil; to problematize relations of power-knowledge that guided the production of Madness from the institutionalization of HJM hospital model in the years 1964-1984;to analyze how the official discourse of Para governments engendered by the power mechanisms of discipline and biopolitics constituted the madness treatment practices in this hospital; and analyze how primary teachers hospitalized in this psychiatric space were conceptualized as insane based on the relations of power-knowledge prescribed in their medical records. What devices is under, the thematic related to madness has been constituted as epistemological area of scientific production in Brazil based on the relations of power-knowledge? How relations know-power produced the ways of subjectivity from the Madness of speeches in Juliano Moreira Hospital, in Pará, between the years 1964-1984?How the mechanisms of power of discipline and biopolitics was constituted in official speeches of Pará governments in this period for through the analysis of Madness treatment practices in this hospital? How the primary teachers hospitalized in this clinical space were conceptualized as insane based on the relations of power-knowledge prescribed in their medical records? It is a historical and educational research under theoretical and methodological ballast Foucault's genealogy with documentary contribution in the medical records of HJM in Pará governorsmessagesof the period in question, newspapers, SESPA reports and two important journals begotten by professionals of psychiatry from Paráthe Bulletins of the Juliano Moreira Hospital Research Centre that circulated between the years 1967-1971 and Psychiatry Para Magazine edited in 1984. The formulated thesis consists of the assertion according to which the field of education the madnessconstitutes themed of little epistemological interest, however, studies of Michel Foucault about the analytical categories knowledge, power, discipline, biopolitics, speech and subjectivity are important theoretical tools able to helpin the understanding of mental health biopolitics engendered by the Pará Stateduring the functioning of Juliano Moreira Hospital, because within this institution had confrontation treatment paradigms of hospitalized subjects andtheir speeches produced for framing women as primary teachers as insane emerged from relations know-power coming from the areas of medicine and its related, as well as the operating force of the disciplinary society traversed for government official politics, whose capillarity extends of prescriptive way to family cycles that also contributed to the legitimacy of the subjective process of these teachers like mad. Sustenance starting from Foucault analytical anchors, which these primary teachers resisted to subjective process they have suffered, and the various manifestations of these invisibilized teachers, including their knowledge, were characterized as transgression mechanisms against the abduction of their bodies. I reiterate also that the forms of resistance of these teachers have subverted the discursive rationality centered on freedom and humanization of relations in the HJM from 1964 and all its prescriptive apparatus. It was concluded that primary teachers hospitalized in the Hospital Juliano Moreira and their various formsof manifestations that produced them like insane, had their knowledge also guided by a technical-scientific rationality, however, fully deprecated versus relations know-power psychiatrist, as well as the manifestations of resistance of these women-teachers about their subjectivation process, emerged as claim evidence of their madness and not as resistance strategies to control their bodies, without giving the crossing of gender and sexuality issues, permeated by normativities and power of families.
L'objectif principal de cette thèse de doctorat était d'analyser comment les enseignants primaire admis à l'hôpital Juliano Moreira au Pará, elles étaient considerées comme folles, à partir des relations savoir-pouvoir institué dans cet espace institutionnalisé pour la folie dans notre État. Les revendications particulières sont dirigés à réfléchir sur les perspectives théoriques et méthodologiques relatives à la production de la vérité sur le sujet de la folie et de sa constitution en champ épistémologique de la production scientifique au Brésil; problématiser les relations de pouvoir-savoir qui a guidé la production de la folie, a partir de l'institutionnalisation du modèle d‟ hôpital HJM dans les années 1964-1984; analyser comment le discours officiel des gouvernements du Pará a ete engendrée par les mécanismes de pouvoir de la discipline et de la biopolitique constitué les pratiques de traitement de la folie dans cet hôpital; et d'analyser la façon dont les enseignants du primaire ont admis que l'espace mental étaient considerées comme folles dans les relations de pouvoir-savoir prescrites dans leurs dossiers médicaux. Dans quelles dispositifs, la question relative à la folie a constitué comme champ épistémologique de la production scientifique au Brésil à partir des relations de savoir-pouvoir? Comme les relations savoir-pouvoir ont produit les termes pour être consideré a partir de discours de la Folie à l'hôpital Juliano Moreira, à Para, entre les années 1964-1984? Comme les mécanismes du pouvoir de la discipline et de la biopolitique constitués dans les discours officiels des gouvernements de Pará dans cette période pour moyens d‟analyser les pratiques de traitement de la folie dans cet hôpital? Comme les enseignants du primaire ont été internés dans cette cliniques et ont été considerées comme folles a partir des relations de pouvoir-savoir prescrites dans leurs dossiers médicaux? Il est une recherche historique et éducatif sur l‟aspect théorique et méthodologique de la généalogie de Foucault avec le soutien documentaire sur aux dossiers médicaux de HJM, dans les messages des gouverneurs de Pará pendant la période en question, des journaux, des rapports de SESPA et deux revues importantes engendrées par des professionnels de psychiatrie de Pará, la bulletins de Centre de recherche Hôpital Juliano Moreira qui circulaient entre les années 1967-1971 et de Magazine de Pará en Psychiatrie, édité en 1984. La thèse formulée est l'affirmation selon laquelle le domaine de l'éducation est la folie thème peu d'intérêt épistémologique, cependant, des études de Michel Foucault sur l'analyse des catégories de savoir, la discipline, biopolitique, de le discours et de la subjectivité sont des outils théoriques importantes capable de aider à la compréhension de la biopolitique de santé mentale engendrés par l'État du Pará pour l‟ocasion de l'opération de l'Hôpital Juliano Moreira, alors au sein de cette institution a été paradigmes de traitement de confrontation de sujets hospitalisés et ses discours produites pour encadrer les femmes des enseignants du primaire comme folles, ont émergé a partir des relations savoir-pouvoir provenant des domaines de la médecine et de son ainsi que la force connexe, d'exploitation de la société disciplinaire traversé par des politiques officielles du gouvernement dont ce sujet étend de manière prescriptif aux cycles de la famille qui a également contribué à la légitimité du processus pour considerer les enseignants comme folles. Donc, il a été conclu que les enseignants du primaire admis à l'hôpital Juliano Moreira et ses diverses manifestations qui les ont produits comme des folles, a eté aussi guidé par une rationalité technico-scientifique, cependant, totalement obsolète devant les relations savoir-pouvoir du psychiatre, quand même les manifestations de résistance de ces femmes-enseignants au sujet et en relation à le processus de subjectivation, émergé comme la preuve de sa folie et de n‟ai pas eu les stratégies de résistance de leur corps, sans oublier et sans donner la traversée des questions de genre et de sexualité, imprégné par normativités et le pouvoir de leurs familles.

What values does a state notable building express when it not only represents prosperity values but also carries burdensome memories from people's lives? In what ways does the preservation of a former madhouse/mental hospital affect our understanding of the field of mental illness? This essay intends to research a former mental hospital, located in the city of Vadstena in Sweden, which today operates as a hospital museum. In this study the old mental hospital has been defined as a difficult cultural heritage. Through an architectural analysis of the building together with literature studies from previous work within cultural heritage the study aims to understand how the site today contributes and affects our understanding of mental illness and care. By examining our past from a distinctive perspective the study shows how Vadstena Hospital Museum today plays a significant role in how the psychiatric historical representation is treated and experienced today. Through difficult and complex cultural heritage humans' less desirable actions and events have the opportunity to be seen, heard, felt and discussed from a different perspective.

La psicología y la psiquiatría, ayudan a entender al ser humano en un aspecto tanto médico como social (por su comportamiento). Es por esto que es importante contar con establecimientos dedicados al cuidado, seguimiento y tratamiento de las distintas enfermedades de salud mental. La tesis de grado en cuestión busca explicar y desarrollar en distintos aspectos, cómo se investiga, diseña y construye un hospital de salud mental, desde las necesidades generales y específicas de la ciudad de lima, y por qué no, del Perú. En la investigación se han evaluado puntos cruciales como: la investigación teórica, la evolución histórica y arquitectónica los establecimientos de salud mental; proyectos referenciales internacionales y nacionales, para así entender el funcionamiento las proporciones; el programa arquitectónico, con el cual se logra determinar el alcance cuantitativo del proyecto; el lugar, que según las directrices de la investigación determinan la ubicación ideal del proyecto; el usuario, para entender y determinar cuántas personas y qué tipos de personas habrá que tomar en cuenta en la edificación; y finalmente, la investigación y criterios referentes al diseño, usados como punto de partida para desarrollar el proyecto en lo que a arquitectura se refiere.
Psychology and psychiatry, help understand the human being in a medical as well as a social aspect (due to it’s behavior). This is why it is important to have facilities dedicated to the care, monitoring and treatment of different mental health diseases. This degree thesis seeks to explain and develop in various aspects, how to research, design and build a mental health hospital, from the general and specific needs of the city of Lima, and why not, from Peru. The research has evaluated crucial points such as: theoretical research, historical and architectural evolution of mental health facilities; international and national referential projects, in order to understand the proportions; the architectural program, with which the quantitative scope of the project is determined; the place, which according to the research guidelines determine the ideal location of the project; the user, to understand and determine how many people and what types of people should be taken into account in the building; and finally, the research and criteria related to the design, used as a starting point to develop the project as far as architecture is concerned.
Tesis

The Mental Health Memories project is an online archive created in order to display and preserve the personal histories of those with mental health experiences. The project aims to fill a void in available material culture related to the history of mental health and its preservation. Participants’ contributions include: oral histories, personal items, documents, and audio. Bringing together multimedia sources, the MHMemories website allows for the preservation of these items and stories through the digitization of contributions. This method allows for participants’ items to stay in their possession while also becoming part of the archive. In order to recruit participants, the Mental Health Memories project teamed up with the Psychiatric Stories Archive, based at California State University San Bernardino, and the San Bernardino County Behavioral Health Clubhouse. Three collection days facilitated the gathering of materials. The final product is the MHMemories.org/.com website which showcases the contributions of participants. The Mental Health Memories project helps to illustrate the diversity of mental health experiences.

This thesis considers the response of one New Zealand institution, Tokanui Mental Hospital, to legislation and policies for 'mental deficiency' introduced during the first half of the twentieth century. Institutional reactions to these policies have been under examined in New Zealand. While psychiatric or mentally ill patients have been the subject of a number of New Zealand histories of the asylum, 'mental defectives' have often been overlooked. Yet during the early-twentieth century, 'mental defectives' were thought to be a source of a number of social problems, and the New Zealand government considered a range of measures aimed at limiting the spread and effect of mental deficiency in society. Policies for 'mental deficiency' were influenced by contemporary anxieties about crime, sexuality and hereditarism. As a policy of segregation was formally prescribed, more 'mental defectives' were committed to mental hospitals and other institutions than ever before. An understanding of the responses to this perceived problem also provides an insight into wider social policies in New Zealand in the first half of the twentieth century. This thesis argues that gender was a significant factor in the decision to commit mental defectives to Tokanui. Subsequent categorisation and treatment within Tokanui was also affected by gender. Official reports inform us about the policies that were in place, and historical materials from Tokanui show how these worked in practice. Most of the archives of Tokanui Mental Hospital have been unexamined by historians before now, and close analysis of patient cases also reveals more about institutional practices. The connection between Tokanui and neighbouring Waikeria Prison is also explored, in the context of contemporary fears surrounding mental deficiency and crime.

The Mental Health Act 1983 was amended in 2007 and introduced the new role of the multidisciplinary Approved Mental Health Professional (AMHP) , who may be a nurse, psychologist, occupational therapist or social worker. The AMHP replaced the Approved Social Worker. Using a social constructionist perspective, this study has explored the decision-making of ten social work and ten nursing AMHPs in England. The purpose was to see if the decision making relating to management and assessment of risk varies according to the professional background of the AMHP. The study used an experimental vignette with each participant of audio-visual material containing mock health and social care records undertaken within a semi-structured interview. This study found that there was no difference in detention rates across the two groups studied in this research and found variance across the whole sample relating to the risks that were identified in the vignette. The findings suggest that there are differences in the way individual AMHPs reach decisions and in the factors that contribute towards that decision. Assumptions about discipline-related differences in social work and nurse decision-making have been challenged in this study. There is evidence to suggest that experience working in mental health was what AMHPs felt was the most significant factor contributing to their perception of risk. Overall, AMHPs expressed a good level of confidence in their practice as AMHPs. This study also highlighted that the majority of participants have felt afraid during a Mental Health Act assessment, and it illuminated how intuition and feelings have a role in how detention decisions are reached. The conclusion of this study gives rise to the need for further investigative research.

Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1993.
Source: Masters Abstracts International, Volume: 45-06, page: 2951. Abstract precedes thesis as 4 preliminary leaves. Typescript. Includes bibliographical references (leaf 75).

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Ministério da Saúde
Considerando que, além do sofrimento psíquico, as pessoas portadoras de transtorno mental também podem padecer de doenças físicas, e, portanto, podem ser atendidas em serviços não específicos, como o hospital geral, este trabalho teve como objetivo Identificar as percepções dos enfermeiros de um hospital geral acerca dos transtornos mentais ao lidarem com os pacientes psiquiátricos em seu cotidiano de trabalho. Trata-se de uma pesquisa com abordagem qualitativa, as narrativas foram analisadas embasadas na análise temática e o referencial teórico de Benedetto Saraceno e Emerson Elias Merhy, autores que abordam a reabilitação psicossocial e o processo de cuidar, respectivamente. Foram entrevistados dez enfermeiros e da análise dos discursos produzidos emergiram três temas: o preconceito, a carência de conhecimento na área de saúde mental e a deficiência no cuidado. A discussão dos temas demonstrou que o preconceito sobre os portadores de transtorno mentais ainda é presente na percepção dos enfermeiros, aparecendo de diversas maneiras, como mecanismos de defesa, formas de poder e atitudes de exclusão e discriminação. A carência de conhecimento foi evidenciada, tendo como fatores importantes a formação acadêmica e as condições pessoais internas dos sujeitos. Já a deficiência no cuidado apontou a prevalência do modelo biologicista, pautado na medicalização, que tem como consequência a dicotomia no cuidado. A partir destas reflexões, vê-se a importância de haver uma cultura institucional de valorização do cuidado e das pessoas, evidencia-se a necessidade de modificar conceitos antigos, como também, torna-se necessário a articulação da rede de atenção à saúde mental, da qual faz parte o hospital geral, como ferramenta fundamental para uma assistência completa à pessoa portadora de transtorno mental
Considering that besides the psychological distress, people with mental disorders may also suffer from physical illnesses, and therefore, they can be treated in not specific services, such as the general hospital. This study aimed to identify the perceptions of nurses in a general hospital about mental disorders when dealing with psychiatric patients in their daily work. It is a qualitative approach and the narratives were analyzed based on thematic analysis and theoretical of Benedetto Saraceno and Emerson Elias Merhy, authors who address the psychosocial rehabilitation and care process, respectively. Ten nurses were interviewed and the analysis of their speeches came across three themes: prejudice, lack of knowledge on mental health and deficiencies in care. The discussion of the issues showed that prejudice on people with mental disorder is still present in the perception of nurses, appearing in several ways, such as mechanisms of defense, forms of power and attitudes of exclusion and discrimination. The lack of knowledge was evident having as important factors the academic and personal internal conditions of the participants of this study. The deficiency in care, however, showed the prevalence of biological model, ruled by medicalization, which causes the dichotomy in the care. From these reflections, we see the importance of having an institutional culture of appreciation of care and people, showing the need to change old concepts. The articulation of the network of mental health care, witch the general hospital is part of it, is also important, and works as a fundamental tool for expanded and complete assistance to people with mental disorders as well

El proyecto de título se convierte en un desafío, tomando una problemática social que cada día genera más demanda, no sólo por el aumento progresivo que han sufrido las enfermedades mentales, sino también por la incipiente implementación del nuevo Plan de Salud Mental que apunta a la sustitución progresiva de los hospitales psiquiátricos y po rende requiere de una serie de nuevos programas que apunten a una atención ambulatoria, a la rehabilitación y alñ contacto con la comunidad. En base a lo anterior el proyecto se basa en la premisa de reincorporar y redignificar la imagen del enfermo mental como parte de nuestra sociedad, designándoles un lugar apropiado tanto espacial como sensorial que promueva y potencie un progresivo reencuentro entre el enfermo y su entorno físico, social y emocional. Bajo estas ideas nace el proyecto de título, un Hospital Día Psiquiátrico, específicamente respondiendo a la necesidad de una nueva infraestructura por parte del actual Hospital Día Raúl Silva Henríquez ubicado dentro del complejo hospitalario Sotero del Río. El proyecto busca demostrar la estrecha relación que existe la Arquitectura y óptimo desarrollo de la vida del hombre, como la tipología del espacio influye y determina comportamientos y sensaciones tanto a nivel físico, psíquico como social.

The incidence of smoking among mentally ill people is very high. Smokers have a 50%, rate of mental illness diagnosis compared with 23% rate for general population. To address this problem, the purpose of this project was to plan a smoking cessation program for patients in a mental health facility. The theoretical foundation for this project was based on the theory of planned behavior, which identifies the predictive nature of smoking and the benefits that can be derived from implementing a systematic approach for change. The project question examined the effectiveness of smoking cessation program using educational support, pharmacological strategies, and bi-weekly meetings to help patients in a mental health hospital to decrease smoking behavior. The project design was based on use of smoking questionnaires, the Hooked on Nicotine Checklist (HONC), effective pharmacological strategies, educational support, and counseling treatments to evaluate symptoms of dependency. The key results of this project included the creation of a plan that could foster reduction in illness, improved quality of life, and reduced costs related to the onset of major illness in this vulnerable population. This data collection process focused on a qualitative design in which selected professionals were asked to review the materials and answer questions. This project could increase awareness of the issue of smoking; in addition, this project could equip nurses with the tools to deliver evidence based interventions for tobacco dependence that may significantly reduce tobacco use. This project has the implications for positive social change through its potential to improve the health of people with mental illnesses. It also creates a safe and healthy environment in mental health facilities for patients who do not smoke.

People who are mentally unwell and have committed a criminal offence are cared for by forensic mental health services. Their treatment is provided in secure hospitals so that any risks to the public are minimised. The complex nature of the mental health difficulties experienced by this clinical population means that they are typically treated in secure hospitals for several years, incurring high economic and personal costs. The need for meaningful approaches to treatment and management of these individuals is therefore paramount. The first paper systematically reviewed eighteen qualitative research papers that explored stakeholder perspectives on the personal recovery approach to care in forensic contexts. Principles of personal recovery were perceived to be meaningful and applicable in forensic contexts if adaptations were made to overcome inherent barriers such as restrictions due to risk management. Methodological quality of the reviewed studies was limited by shortcomings in the transparency of study procedures. The second paper explored the experiences of a significant subpopulation of forensic service users who were discharged to the community subject to conditions including ongoing monitoring, then recalled back to a secure hospital due to a relapse in their mental state or other indicators of increased risk. Using grounded theory, a theoretical model was developed of how these individuals make sense of being recalled. This was found to be a recursive process influenced by their perceptions of events before their recall, during the recall itself, and their subsequent experiences.

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciencias da Saude
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Análise do Modelo Tecnológico Psiquiátrico de Cuiabá no contexto das políticas de saúde mental brasileiras, a partir de sua identificação na história da assistência psiquiátrica de um doente mental / louco. Complementarmente, analisa a sobrevivência deste louco e do saber sobre a loucura, a psiquiatria. Utiliza o estudo de caso como opção metodológica e discute os dados numa perspectiva dialética. Constata que há divergências cronológicas e não conceituais entre o modelo de Cuiabá e as tendências nacionais e que estas divergências são coerentes com a história do desenvolvimento político e econômico do Estado de Mato Grosso.

RESUMO: Este estudo foi realizado com o objectivo de conhecer os efeitos da desinstitucionalização dos doentes psiquiátricos crónicos durante o processo de encerramento do Hospital Miguel Bombarda (2007-2011). Este processo incluiu a fusão, em 2008, dos dois principais hospitais psiquiátricos de Lisboa- Hospital Miguel Bombarda (HMB) e Hospital Júlio de Matos (HJM), no Centro Psiquiátrico Hospitalar de Lisboa (CHPL). Foi criado um grupo controlo de pacientes ainda hospitalizados no CHPL (n=166) para comparação com o grupo de casos desinstitucionalizados (n=146). Desta amostra inicial (n=312) apenas 142 (76 casos e 66 controlos) foram incluídos, sendo as principais causas de exclusão: diagnóstico (patologia orgânica, demência ou debilidade mental, como diagnóstico primário) e transferência entre hospitais. A desinstitucionalização foi principalmente avaliada em termos de psicopatologia, utilização de serviços, satisfação, crime, condição de “sem abrigo” ou morte. Os resultados mostraram que a maioria dos doentes crónicos pode sair do hospital psiquiátrico para a comunidade sem agravamento da psicopatologia, aumento do crime ou da condição de “sem abrigo”. A satisfação parece estar aumentada na população desinstitucionalizada. A mortalidade, por outro lado, revelou-se uma questão problemática: apesar de não ter sido possível estabelecer uma comparação entre casos e controlos, a Taxa de Mortalidade Standard encontrada neste estudo foi muito superior ao esperado, de acordo com os resultados encontrados na literatura. Um estudo longitudinal da mesma população poderá ser objecto de futura investigação, possivelmente comparada com outra população similar de um programa de desinstitucionalização noutro país.--------- RÉSUMÉ: Cette étude a été menée afin de déterminer les effets de la désinstitutionnalisation des patients chroniques lors de la fermeture de l'hôpital Miguel Bombarda (2007-2011). Ce processus comprenait la fusion en 2008 de deux grands hôpitaux psychiatriques de Lisbonne: À savoir, Hôpital Miguel Bombarda (HMB) et Hôpital Julio de Matos (HJM), maintenant Centre de l'Hôpital Psychiatrique de Lisbonne (CHPL). Il a été créé un groupe contrôle des patients toujours hospitalisés à CHPL (n = 166) pour comparer avec les cas désinstitutionnalisés (n = 146). De cet échantillon initial (n= 312) à peine 142 (76 cas et 66 contrôles) ont été inclus, les principales raisons d'exclusion: diagnostique (maladie organique, démence ou d'arriération mentale comme diagnostic primaire) et les transferts entre hôpitaux. La désinstitutionnalisation a été principalement évaluée en termes de psychopathologie, de l'utilisation des services, la satisfaction, la criminalité, les “sans abri” et de la mort. Les résultats ont montré que la majorité des malades chroniques peuvent quitter l'hôpital psychiatrique et s´intégrer dans la communauté sans aggravation de la psychopathologie, augmentation de la criminalité ou du nombre de “sans-abri”. La satisfaction semble être en hausse dans la population désinstitutionnalisée. Toutefois, la mortalité s'est avéré être une question problématique, même si il n´a pas été possible d'établir une comparaison entre les cas et les contrôles, le Taux de Mortalité Standard estimé dans cette étude fut beaucoup plus élevé que prévu, en tenant compte des résultats établis dans la littérature. Une étude longitudinale de la même population pourra faire l'objet de futures recherches, peut-être comparé à une population similaire d'un programme de désinstitutionnalisation dans un autre pays. ----------- ABSTRACT:This study was conducted to assess the effects of deinstitutionalization of “long-stay” patients during the process of closing Hospital Miguel Bombarda (2007-2011). This process included the fusion, in 2008, of the two main psychiatric hospitals in Lisbon- Hospital Miguel Bombarda (HMB) and Hospital Júlio de Matos (HJM), into Centro Psiquiátrico Hospitalar de Lisboa (CHPL). A control group of still institutionalized patients in CHPL (n=166) was used as a comparison with the deinstitutionalized population (n=146). Of this 312 initial sample only 142 (76 cases and 66 controls) were included, the main causes of exclusion being diagnoses (organic disease, dementia and mental retardation- as first diagnoses) and transference between hospitals. Deinstitutionalization is mainly evaluated in terms of psychopathology, use of services, satisfaction, crime, vagrancy and deaths. The results show that most long-stay patients can successfully leave psychiatric hospitals and be relocated in the community without an increase in psychopathology, crime or vagrancy. Satisfaction seems to be improved in those patients. On the other hand, mortality remains an issue of concern: Although there was no possibility of comparing it between cases and controls, the Standard Mortality Rate (SMR) in our study was found to be much higher than expected judging by other studies results. A longitudinal further study of this same population will be the matter for a future investigation, possibily compared with another similar population from a desinstitutionalization programme in another country.

Volume I consists of three chapters. The first chapter is a systematic review exploring the factors associated with coercion in those who are involuntarily admitted to hospital. Those with psychosis, aggression and poor global functioning were some of the factors associated with a higher likelihood of experiencing coercion. The second chapter outlines an empirical research study exploring the experience of being detained under Section 136 of the Mental Health Act (1983, 2007) using Critical Incident Technique (Flanagan 1954, Butterfield, Borgen Maglio & Edmunson, 2009). The importance of meaningful human relationships was found to underpin many of the critical incidents. The third and final chapter is a public domain briefing document which provides a concise and accessible summary of both the systematic review and the empirical research study. Volume II consists of five chapters, each containing a Clinical Practice Report (CPR). The first report outlines the details of a 14 year old girl with anxiety formulated using cognitive-behavioural and systemic models. The second report presents a service evaluation of a dialectical behaviour therapy group provided by a CAMHS service. The third report outlines the case study of a 72 year old woman with a fear of falling, formulated using a cognitive-behavioural approach. The fourth report documents a single case experimental design, evaluating the efficacy of a cognitive-behavioural therapy for psychosis. The fifth chapter is the abstract of an oral presentation made outlining the use of cognitive analytic therapy with a 32 year old male.

El proyecto propone el diseño de un Hospital especializado en Salud Mental enfocado en el Modelo Comunitario de Atención Integral de Salud Mental y que, además, incorpora el concepto de La Arquitectura como Medio Terapéutico. Es así que mediante la fusión de ambas variables se logra un nuevo concepto de espacio bajo una perspectiva que prioriza la rehabilitación dentro de un núcleo comunitario en un entorno cuyos elementos arquitectónicos se basan en el estudio del comportamiento de los pacientes, de modo que sean considerados como un participante directo dentro de la terapia.
Tesis

Racial discrimination in mental health treatment in South Africa was well established by the 1890's. This study shows this discrimination was perpetuated through to the 1930's and 1940's. By means of a thorough review of racial and psychiatric literature pertaining to the period, this dissertation provides a rich context in to which to place the psychiatric practice of Valkenberg Mental Hospital for the period 1933-1943. Archival research was used to investigate official hospital records of, and case records for, Valkenberg for the years 1933; 1936; 1939; 1942 and 1943. Content analysis was used to analyse the case records and identify any discrimination across diagnosis, treatment, prognosis, criminal activity of patients, deaths in patients, and readmittance. Invidual case histories were also analyzed to ascertain psychiatric practice at a more individual level. Results showed that racial discrimination was still prevalent in the psychiatric practice of Valkenberg for the period. In Valkenberg 'non-European' patients received poorer care, were given inferior therapeutic treatment and often denied access to various effective treatments. European patients on the other hand superior care and had access to all the new and effective physical methods of treatment. Non-European patients were also subject to the racist attitudes of doctors and nurses, which in turn affected the level of care they received. The records also reveal the psychiatrists of the period not only purported the racist doctrines, they were involved in theories and studies that helped justify and confirm them. (154-163 pages missing).

Introdução. A reforma da assistência psiquiátrica no Brasil vem diminuindo progressivamente o número de leitos nos hospitais psiquiátricos convencionais. Ao mesmo tempo vem sendo estruturada uma rede substitutiva de serviços extra-hospitalares, entre os quais se encontra o Hospital Dia do HCFMRP-USP (HD) da DRS-XIII, com sede em Ribeirão Preto SP. Esse serviço, fonte dos dados do presente trabalho, é menos restritivo que hospitalização integral e mais protetor que tratamentos ambulatoriais. Esse processo, no entanto, apresentou como efeito colateral indesejável o fenômeno denominado porta giratória, representado pelo aumento importante da taxa de readmissões, que em alguns hospitais passa de 50% dos pacientes admitidos. Objetivos. Procura-se no presente trabalho: caracterizar o perfil sócio-demográfico e clínico da clientela atendida no HD, entre janeiro de 1996 e dezembro de 2005; identificar e descrever características dos pacientes que tiveram internações integrais psiquiátricas anteriores e readmissões ao HD; investigar se ocorre associação entre o tempo de permanência dos pacientes no HD e as variáveis sócio-demográficas e clínicas. Metodologia. Os dados foram coletados no prontuário de cada paciente, por meio de protocolo elaborado especificamente para esta finalidade. Os sujeitos foram 689 pacientes que fizeram 914 internações no HD. As variáveis foram analisadas através do programa SPSS versão 13.0. Resultados. Predominaram pacientes do sexo feminino (58,4%) com idade entre 20 a 39 anos (53,5%), brancos (84,2%), sem vínculo conjugal (59,7%), morando com familiares ou amigos (57,9%), procedentes de Ribeirão Preto e Região (90,2%), escolaridade até primeiro grau (53,6%), inativos profissionalmente (90,5%) e sem renda individual (51,2%). A maioria teve alta por ordem médica (73,3%), encaminhamento na alta para Ambulatórios (86,2%), uma única admissão no HD (77,8%), e tempo médio de permanência de 49 dias. Os diagnósticos mais prevalentes na alta foram: Esquizofrenia (32,8%), Episódio Depressivo (27,0%), Episódio Maníaco/ Transtorno Afetivo (15,1%), Transtorno de Personalidade (14,7%) e Outros/ Transtorno Neurótico (10,4%). Pacientes com internação integral anterior foram responsáveis por 47,0% das admissões. Discussão. Os resultados mostram que o HD trata adultos jovens, atingidos pela doença na plenitude da fase produtiva da vida e com quadros psiquiátricos com predomínio de Esquizofrenia. Existe uma dependência emocional e econômico-financeira com familiares e com o sistema público regional de dispensa de medicamentos e de transporte. A gravidade dos quadros psiquiátricos, conciliada com a complexidade social da doença mental, repercute negativamente no desenvolvimento do grau de instrução. O tempo médio de permanência está dentro do recomendado pelas normas da Portaria 224. Essa permanência permite uma terapia breve focal na maioria dos pacientes e uma intermediação positiva, retirando pacientes das internações e dirigindo-os para tratamentos ambulatoriais. Conclusão. O HD demonstrou atender pacientes com transtornos mentais graves e persistentes, estar inserido na rede de assistência da DRS-XIII e ser um serviço que desempenha função de ressocialização e reintegração de pacientes psiquiátricos graves na comunidade. O HD trata pacientes oriundos da DRS-XIII com história prévia de internação integral anterior, no entanto, não repete com esses pacientes o fenômeno porta giratória.
Introduction. The reform of psychiatric assistance in Brazil has progressively decreased the number of beds in conventional psychiatric hospitals. Concomitantly, a substitute network of extra-hospital services has developed, among which is the Day Hospital (HD) of the HCFMRP-USP of the DRS-XIII, based in Ribeirão Preto, SP. This service, source of the data presented here, is less strict than full-time hospitalization and more protective than outpatient clinics. This process, however, presented as an undesired effect the phenomenon termed revolving door, represented by the significant increase in the rate of readmissions, which in some hospitals responds for over 50% of all admissions. Objectives. To characterize the clinical and socio-demographic profile of the clientele attended at the HD between January 1996 and December 2005; to identify and describe the characteristics of patients who had previous full-time hospitalizations and were readmitted at the HD; to investigate whether there is any association between the time spent at the HD and clinical and socio-demographic variables. Methodology. Data were collected from the patients medical records by means of a protocol elaborated for this purpose. Participants were 689 patients who had 914 admissions at the HD. Variables were analyzed with the software SPSS, version 13.0. Results. Patients were predominantly females (58,4%), aged between 20 and 39 years (53,5%), white (84,2%), not married (59,7%), living with family or friends (57,9%), original from Ribeirão Preto and neighboring cities (90,2%), with elementary education (53,6%), unemployed (90,5%), and with no individual income (51,2%). Most patients were discharged by medical orders (73,3%), were referred to outpatient clinics after discharge (86,2%), had a single admission at the HD (77,8%), and mean hospitalization of 49 days. The most prevalent diagnoses at discharge were: Schizophrenia (32,8%), Depressive Episode (27,0%), Manic Episode/ Affective Disorder (15,1%), Personality Disorder (14,7%), and Others/ Neurotic Episode (10,4%). Patients with previous full-time hospitalizations accounted for 47,0% of admissions. Discussion. The results show that the HD treats young adults whose disease onset occurs at the peak of their productive age, with a predominance of Schizophrenia. The patients are economically and emotionally dependent on the family and on the regional public system of medication dispense and transportation. The severity of their psychiatric conditions together with the social complexity of mental disorders has a negative impact on the patients educational status. The mean hospitalization time is in accordance with the reccomendations of Regulation 224. This permanence enables brief focal therapy for most patients and a positive intervention, keeping patients away from hospitalizations and guiding them toward outpatient follow-up. Conclusion. The HD proved able to treat patients with severe and persistent mental disorders, to be inserted in the assistance network of the DRS-XIII, and to be a service that performs functions of resocialization and reintegration of severely ill patients in the community. The HD treats patients of the DRS-XIII with a previous history of full-time hospitalization, however, it does not repeat the revolving door phenomenon with these patients.

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No campo do cuidado em psiquiatria, a prática manicomial predominou como única possibilidade de tratamento, por quase duzentos anos. A Reforma Psiquiátrica no Brasil surgiu nos anos 70, em favor da mudança dos modelos de atenção e gestão nas práticas de saúde. As propostas vindas da reforma psiquiátrica, além de possibilitar a inclusão da pessoa acometida pelo transtorno mental na sociedade, também inserem a família como elemento importante no cenário da assistência. Sendo a família chamada a participar do processo de recuperação de seu membro que vivência a situação de doença, o serviço de saúde mental o qual presta assistência, também é componente importante da dinâmica do atendimento. Portanto, este estudo tem por objetivo compreender como os familiares veem a assistência recebida no Hospital Dia. A pesquisa é de natureza qualitativa exploratória, o cenário do estudo é o Hospital Dia de Saúde Mental da UNESP de Botucatu. Na coleta de dados foram ouvidos oito familiares que convivem com a pessoa portadora de transtorno mental, a partir de entrevistas semi-estruturadas e nessas foi utilizado o procedimento apresentativo-expressivo. Para a análise dos dados foi utilizada a análise temática. Como referencial teórico, recorremos à obra de Benedetto Saraceno, autor que deu subsídio à fase de análise dos resultados. Foram apreendidos os temas: Hospital Dia como espaço de acolhimento, de refúgio; Hospital Dia como propulsor de esperança; Dificuldades sentidas pela família e Proposta de mudança, de melhoria do serviço. A análise evidência que os familiares enfrentam dificuldades econômicas, afetivas e relacionais no convívio com a situação advinda da proximidade com o transtorno mental. O serviço de saúde pesquisado tem significativa importância no processo de busca da melhora. O preconceito e a segregação aparecem nos conteúdos obtidos, somando-se às dificuldades a serem transpostas. Também foi possível constatar que a desinformação sobre a situação vivida, ou seja, sobre o transtorno mental, é frequente nos relatos. Os participantes já recorreram a outros serviços de saúde mental e revelam esperar que o local pesquisado, de fato, venha trazer novas possibilidades para seu familiar, assim como, facilitar o convívio no núcleo da família e propiciar melhor entendimento desses acerca dos transtornos mentais.
In the field of psychiatric care, the manicomial practice predominated for almost two hundred years as the only possibility of treatment. The Psychiatric Reform in Brazil emerged in the 1970s, in favor of changing care and management models in health practices. The psychiatric reform proposals, besides making possible the inclusion of the person affected by the mental disorder in the society, also insert the family as an important element in the assistance scenario. Being the family called to participate in the process of recovery of their member who experiences the illness situation, the mental health service which provides assistance is also an important component of the dynamics of care. Therefore, this study aims to understand how family members see the care received at “Day Hospital”. The research is of a qualitative exploratory nature, the scenario of the study is the Mental Health Day Hospital of UNESP in Botucatu. In the collection of data, eight family members who lived with the person with mental disorder were heard, based on semi-structured interviews and in those cases, the presentation-expressive procedure was used. Thematic analysis was used to analyze the data. As a theoretical reference, we resorted to the work of Benedetto Saraceno, author who gave subsidy to the analysis phase of the results. The following themes were apprehended: Day Hospital as a place of welcome, refuge; Day Hospital as a propellant of hope; difficulties felt by the family and proposal of change, improvement of service. The analysis evidence that family members face economic, affective, and relational difficulties, in conviviality with the situation arising from the proximity to the mental disorder. And for this confrontation, the health service researched has significant importance in the search process for improvement. Prejudice and segregation appear in the contents obtained, adding to the difficulties to be transposed. It was also possible to verify that the disinformation about the situation lived, that is, about the mental disorder, is frequent in the reports. Participants have already turned to other mental health services and they hope that the researched place will, in fact, bring new possibilities for their family member, as well as facilitate family life and provide a better understanding of mental disorders.

Orientador: Maria Alice Ornellas Pereira
Resumo: No campo do cuidado em psiquiatria, a prática manicomial predominou como única possibilidade de tratamento, por quase duzentos anos. A Reforma Psiquiátrica no Brasil surgiu nos anos 70, em favor da mudança dos modelos de atenção e gestão nas práticas de saúde. As propostas vindas da reforma psiquiátrica, além de possibilitar a inclusão da pessoa acometida pelo transtorno mental na sociedade, também inserem a família como elemento importante no cenário da assistência. Sendo a família chamada a participar do processo de recuperação de seu membro que vivência a situação de doença, o serviço de saúde mental o qual presta assistência, também é componente importante da dinâmica do atendimento. Portanto, este estudo tem por objetivo compreender como os familiares veem a assistência recebida no Hospital Dia. A pesquisa é de natureza qualitativa exploratória, o cenário do estudo é o Hospital Dia de Saúde Mental da UNESP de Botucatu. Na coleta de dados foram ouvidos oito familiares que convivem com a pessoa portadora de transtorno mental, a partir de entrevistas semi-estruturadas e nessas foi utilizado o procedimento apresentativo-expressivo. Para a análise dos dados foi utilizada a análise temática. Como referencial teórico, recorremos à obra de Benedetto Saraceno, autor que deu subsídio à fase de análise dos resultados. Foram apreendidos os temas: Hospital Dia como espaço de acolhimento, de refúgio; Hospital Dia como propulsor de esperança; Dificuldades sentidas pela família e Propos... (Resumo completo, clicar acesso eletrônico abaixo)
Mestre

A conduta terapêutica em relação ao paciente psiquiátrico que prescrevia o asilamento sofreu alterações ao longo do tempo. Após a Segunda Guerra Mundial, em conseqüência de uma série de fatores sociais e econômicos, a desospitalização aparece como elemento da assistência psiquiátrica, desencadeando um processo de construção de uma nova política de saúde mental. Apesar de nacionalmente haver uma proposta de desospitalização, observa-se atualmente um número significativo de pessoas que permanecem internadas em hospitais psiquiátricos por tempo indeterminado. Na região de Ribeirão Preto, no Hospital Santa Tereza, nota-se uma situação particular: alguns pacientes internados recusam-se a desospitalização. O presente trabalho objetivou estudar os fatores envolvidos na recusa da desospitalização a partir do relato de pacientes internos em um hospital psiquiátrico com o diagnóstico de esquizofrenia e capacidade verbal preservada, investigando como os mesmos se posicionam em relação a sua hospitalização e desospitalização. Estudou-se aqueles que realmente confirmavam a recusa à desospitalização e, dentre esses, segundo escolha aleatória, foi aplicada uma entrevista semi-estruturada. Foi desenvolvida uma análise qualitativa, tendo como referência a análise de conteúdo temática. Após leitura exaustiva das entrevistas, chegou-se a oito unidades temáticas e os respectivos achados: O porquê da internação, os pacientes relataram ter “adoecido”, descrevendo vozes e profunda tristeza; Causalidade, houve associação entre perda de pessoas queridas e bens materiais, assim como evento espiritual e o advento dos sintomas psiquiátricos; Atribuição do destino ao outro, o outro como responsável pelo seu enlouquecimento e pela sua internação, selando, assim, seu destino; As mazelas sociais, características pessoais que não correspondem aos padrões sociais, como rompimento com família, trabalho e razão; Família, ausência da instituição familiar ou de vínculos familiares; Proteção hospitalar, proporcionando a sensação de segurança material como abrigo e assistência médica e a garantia de não contato com o outro, ameaçador e diferente; Identidade, possibilidade de exercer um trabalho limitado às suas capacidade físicas, estar cumprindo pena e estar se submetendo a um tratamento de saúde física; Motivo alegado como recusa, surgindo variados relatos que se estendem desde a sensação de liberdade ainda que internado até os longos anos de internação, fazendo com que o modo de vida asilar fosse incorporado fortemente pelos pacientes. A partir da análise dos dados se conclui que aspectos subjetivos dos pacientes, como o alheamento e o ‘sujeitamento’, são reforçados pelo funcionamento institucional, combinando-se de forma a perpetuar o isolamento na vida desses pacientes. Esses achados mostram-se importantes na medida em que podem contribuir com futuras elaborações de políticas públicas em saúde mental, além de trazer aspectos da dinâmica subjetiva que devem ser considerados no planejamento de tratamentos mais adequados à especificidade da população.
The therapeutic conduct which used to prescribe the isolation to the psychiatric pacient, has undergone some alterations along the time. After the Second World War, in consequence of a series of social e economic factors, the dehospitalization appears as na element of the psychiatric assistence, unleashing a process of construction of a new policy of mental health. In spite of a national proposal of dehospitalization, we currently observe a meaningful number of people who remain confined in psychiatric hospitals for indeterminate time. In the region of Ribeirão Preto city, in the Santa Tereza Hospital, we can see a peculiar situation: some confined pacients who refuse the dehospitalization. The present research aims at studying the factors involved in the refusal of dehospitalization, departing from the report of pacients with diagnosis of schizophrenia and preserved verbal hability, interned in a psychiatric hospital, to investigate how they behave concerning their hospitalization and dehospitalization. We have studied those who really confirmed the refusal to dehospitalization and, among these, by random choice, a semi- structured interview was applied. A qualitative analysis was developed, having the analysis of thematic content as reference. After exaustive reading of the interviews, we got to eight thematic units, and the respective results: The reason for the internation, the pacients reported having gotten “sick”, describing voices and deep sadness; Origin, there was association with the loss of dear people and possessions, as well as spiritual event and the beginning of the psychiatric symptoms; Attribution of the destiny to the other one, the other as responsible for the madness and for the internation, sealing the patient´s fate; The social illnesses, personal characteristics that do not correspond to the social patterns, as family breakdowns, work and reasoning disruption; Family, the lack of the family institution, or of family ties; Hospital protection, providing the feeling of material security as shelter and medical assistance, the warranty of no contact with the other, which is threatening and different; Identity, possibility to carry out a work limited to his/her own physical capacity, be under punishment, and undergoing a physical health treatment; The reason alledged as refuse, arising several reports which go since the feeling of liberty, even confined, to the long years of confinement, that make the life pattern of the asylum to be strongly assimilated by the pacients. From the data analysis, it was concluded that the subjective aspects of the pacients, like the alienation and the ‘submition’, are reinforced by the institutional functioning, which combined, perpetuate the isolation in the life of these people. These findings show important as they can corroborate with future elaborations of public policies in Mental Health, besides bringing aspects of the subjective dynamics that should be considered for the planning of more adequate treatments to the specificity of the population.

Orientador: Maria Alice Ornellas Pereira
Banca: Magda Cristina Queiroz Dell'Acqua
Banca: Ana Lúcia Machado
Resumo: Considerando que, além do sofrimento psíquico, as pessoas portadoras de transtorno mental também podem padecer de doenças físicas, e, portanto, podem ser atendidas em serviços não específicos, como o hospital geral, este trabalho teve como objetivo Identificar as percepções dos enfermeiros de um hospital geral acerca dos transtornos mentais ao lidarem com os pacientes psiquiátricos em seu cotidiano de trabalho. Trata-se de uma pesquisa com abordagem qualitativa, as narrativas foram analisadas embasadas na análise temática e o referencial teórico de Benedetto Saraceno e Emerson Elias Merhy, autores que abordam a reabilitação psicossocial e o processo de cuidar, respectivamente. Foram entrevistados dez enfermeiros e da análise dos discursos produzidos emergiram três temas: o preconceito, a carência de conhecimento na área de saúde mental e a deficiência no cuidado. A discussão dos temas demonstrou que o preconceito sobre os portadores de transtorno mentais ainda é presente na percepção dos enfermeiros, aparecendo de diversas maneiras, como mecanismos de defesa, formas de poder e atitudes de exclusão e discriminação. A carência de conhecimento foi evidenciada, tendo como fatores importantes a formação acadêmica e as condições pessoais internas dos sujeitos. Já a deficiência no cuidado apontou a prevalência do modelo biologicista, pautado na medicalização, que tem como consequência a dicotomia no cuidado. A partir destas reflexões, vê-se a importância de haver uma cultura institucional de valorização do cuidado e das pessoas, evidencia-se a necessidade de modificar conceitos antigos, como também, torna-se necessário a articulação da rede de atenção à saúde mental, da qual faz parte o hospital geral, como ferramenta fundamental para uma assistência completa à pessoa portadora de transtorno mental
Abstract: Considering that besides the psychological distress, people with mental disorders may also suffer from physical illnesses, and therefore, they can be treated in not specific services, such as the general hospital. This study aimed to identify the perceptions of nurses in a general hospital about mental disorders when dealing with psychiatric patients in their daily work. It is a qualitative approach and the narratives were analyzed based on thematic analysis and theoretical of Benedetto Saraceno and Emerson Elias Merhy, authors who address the psychosocial rehabilitation and care process, respectively. Ten nurses were interviewed and the analysis of their speeches came across three themes: prejudice, lack of knowledge on mental health and deficiencies in care. The discussion of the issues showed that prejudice on people with mental disorder is still present in the perception of nurses, appearing in several ways, such as mechanisms of defense, forms of power and attitudes of exclusion and discrimination. The lack of knowledge was evident having as important factors the academic and personal internal conditions of the participants of this study. The deficiency in care, however, showed the prevalence of biological model, ruled by medicalization, which causes the dichotomy in the care. From these reflections, we see the importance of having an institutional culture of appreciation of care and people, showing the need to change old concepts. The articulation of the network of mental health care, witch the general hospital is part of it, is also important, and works as a fundamental tool for expanded and complete assistance to people with mental disorders as well
Mestre

Thesis (M.A. (Clinical Psychology) -- University of Limpopo, 2012
The aim of this study was to profile the characteristics of children with mental retardation presenting at the Clinical Psychology Unit of Polokwane/Mankweng Hospital Complex over a period of five years. A descriptive methodological approach was chosen as a study design for the purpose of data collection and subsequent data analysis. Using the archival data method, the clinical files of all children presenting with mental retardation at this facility were retrieved and studied. A total of 326 (male = 169; female = 157) files covering the period under review were retrieved. The Statistical Package for Social Sciences (SPSS) was used to analyse the data. Categorical data were analysed by using frequency tables, descriptive statistics and crosstabulations. The study showed that 314 cases (96.3%) were reflected as Black, whilst the remaining 12 cases (3.7%) were reflected as White (2.15%); Indian (1.23%); and Other (0.30%). Several clinical methods that included clinical interviews, psychometric tests, clinical observations and collateral information sources were used by the psychologists for the purpose of making a diagnosis. The study further revealed that a huge number of cases (35.6%) were diagnosed with mental retardation. It was also found that 45.4% of the cases were diagnosed to have comorbid clinical conditions such as epilepsy, Down’s syndrome, visual problems etc. The majority of the persons were referred to the Clinical Psychology Unit to be assessed for school placement (50%) and disability grant (38.7%).With regard to interventions, psychologists who saw these persons tended to frequently refer them to special schools and other health professionals. Psychotherapy was the least utilised intervention method used by the psychologists. The findings of the present study reinforce the importance of and value of high quality management and treatment of mental retardation and related comorbid conditions. Based on these findings, it is recommended that more efforts be made to strengthen the working relationship between Polokwane/Mankweng Hospital Complex and the respective special schools where these persons that are diagnosed with mental retardation are referred to. It is further recommended that consideration be given to strengthening the relationship between Polokwane/Mankweng Hospital Complex and the social security agency so as to obviate any potential problems that could be associated with the allocation of the disability grants to persons with mental retardation.

This thesis takes issue with a polemical historiography of Bethlem which has tended to 'view the hospital as a nadir in the history of psychiatry, and to accept, too uncritically, the distorted metaphor of 'Bedlam' for the reality. It argues that there was not the radical equivalency that some historians have posited between animalistic conceptions of the insane and the actual practices and policies pursued at early modern Bethiem. Nor was this paradigm of madness the only oae prevailing in the classical period, Bethlem patients also being regarded (e.g.) as 'objects of charity', requiring both mental and bodily relief. Rather than 'brutalized', it is sustained, the inmates of Bethiem were being managed and maintained, although inadequately and inefficiently. What modern commentators have disparaged as maltreatment and squalor at Bethlem, was not merely the result of an attitude to the mad as brutes, but was also the result of a lack of resources and a failure to measure up to the ideals of provision. Furthermore, it is demonstrated that the squalor and brutality of Bethiem was neither as extreme, nor as undifferentiated, as has been alleged. The hospital is located comprehensively within the context of contemporary provision for the sick and insane poor, Bethiem having too often been portrayed as if a separate island of sequestered madness. Rather than describing an immutable monolith of tradition and apathy, significant areas of evolution and innovation in the care and treatment of the insane at the hospital are delineated. Uniquely exposed to public scrutiny, the environment of Bethiem was subject, more than that of any other contemporary hospital, to powerful external forces of arbitratioia. A particular focus of the analysis entails the complex interactions between the hospital's administrators and inhabitants, and the public at large. Inter-relations between Bethlem's visitors, staff and patients, and between the insane and those who supported and committed them, have especially suffered from simplistic interpretations, and from a general ignorance with the hospital's own records and with the records of other administrative and juridical bodies dealing with the poor insane. A major preoccupation of this survey has been to contribute greater nuance and balance to standard readings of responses to the insane, both within and without the hospital.

Magister Curationis - MCur
Professional nurses, with additional training in mental health, report attitudes and perceptions of mental health nursing that are more positive, whilst those with less training report more negative attitudes and perceptions to mental health nursing. The primary aim of this research study was to describe the attitudes and perceptions of professional nurses towards the mentally ill in a psychiatric hospital in the Cape Metropole. The objectives of the study were: to explore the attitudes and perceptions of professional nurses towards the mentally ill; to identify common factors that influence the professional nurses’ attitudes and perceptions towards the mentally ill; to compare the attitudes and perceptions of professional nurses who have completed the Regulation 425, Regulation 808 and Regulation 212 training in mental health nursing towards the mentally ill. A quantitative, exploratory, descriptive design was employed and cross-sectional survey was carried out. Participants comprised all permanent professional nurses (n=60) at a governmental Associated Psychiatric Hospital in the Cape Metropole. Participants completed a demographic questionnaire and two self-report questionnaires, measuring attitudes to and perceptions of mental health problems. Nurses with a diploma report significantly higher role competency than those nurses with a degree. The ethnicity of nurses played a role in the stereotyping of the mentally ill. No significant differences were evident between those professional nurses who had completed the advanced mental health course and those whom had not. However, the combined effects of learning the appropriate course and experience in the practical field of the mentally ill are necessary for the task of impacting positively on the attitudes of the nurses towards the mentally ill.

Relatório de Trabalho de Projeto realizado no âmbito do I Curso de Mestrado em Enfermagem de Saúde Mental e Psiquiatria
No âmbito do 1º Curso de Mestrado em Enfermagem de Saúde Mental e Psiquiatria elaborou-se um projeto de intervenção em serviço (PIS) e um projeto de aprendizagem clínica (PAC) visando a aquisição das Competências Comuns do Enfermeiro Especialista (CCEE), das Competências Específicas do Enfermeiro Especialista em Enfermagem de Saúde Mental (CEEEESM) e das Competências do Mestre em Enfermagem de Saúde Mental e Psiquiatria (CMESMP). O PIS baseou-se na Metodologia de Projeto e suas etapas. Na Etapa Diagnóstica identificaram-se as necessidades dos utentes de um hospital de dia de psiquiatria da região de Lisboa, sensíveis aos cuidados especializados de enfermagem de saúde mental. Identificaram-se como focos de enfermagem a Ingestão Nutricional, o Fazer Exercício e a Adesão ao Regime Medicamentoso. Na Etapa de Planeamento delinearam-se, suportadas na evidência, as intervenções que decorreram no contexto de uma consulta individual de enfermagem, criada por nós no serviço para dar resposta aos focos identificados. Na Etapa de Execução descreveram-se as intervenções efetuadas. Na Etapa de Avaliação avaliaram-se o processo e o produto final da consulta em matéria de ganhos em saúde. Para a Etapa de Divulgação elaborou-se um artigo relativo PIS implementado. As intervenções realizadas sustentaram-se na Teoria das Relações Interpessoais, no Processo de Aconselhamento e no Modelo Transteórico. A consulta sistematizou-se com base no processo de enfermagem: os diagnósticos, resultados esperados e intervenções de enfermagem definiram-se a partir da CIPE® Versão 2 e os indicadores de avaliação basearam-se na Classificação dos Resultados de Enfermagem. Os resultados esperados foram maioritariamente atingidos e o processo de implementação da consulta bem sucedido. A aquisição das CCEE explicitou-se em ligação ao PIS. O PAC desenvolveu-se em ligação às CEEEESM e a aquisição das CMESMP foi aí explicitada em sinergia ao realizado no PIS. A concretização do PIS e do PAC permitiu atingir o objetivo proposto.
Abstract:Within the 1st Masters course in Psychiatry and Mental Health Nursing, an intervention project in service (IPS) and a draft clinical learning (DCL) were elaborated for the acquisition of Common Competencies of Specialist Nurse (CCSN), Specific Competencies of Specialist Nurse in Mental Health (SCSNMH) and Master’s Competencies in Psychiatry and Mental Health Nursing (MCPMHN). The IPS was based on Project Methodology and its stages. In Step Diagnostic Survey, the needs of inpatients of a psychiatric day hospital in the Lisbon region, sensitive to specialized care of mental health nursing, were identified. The nursing foci identified were Nutritional Intake, Doing Exercise and the Adherence to Medication Regimen. In Step Planning were outlined, based on evidence, the interventions that took place in an individual nursing consultation, created by us in the service to respond to identified foci. In Step Execution were described interventions in nursing consultation. In Step Assessment was evaluated the process and the end product of consultation in terms of health gains. An article related to the IPS implemented was elaborated for Step Divulgation. The consultation held up on the Theory of Interpersonal Relations, on Counseling Process and on Transtheoretical Model. The consultation was systematized from nursing process: diagnosis, expected outcomes and nursing interventions were defined from the ICNP ® Version 2 and the evaluation indicators were based on the Nursing Outcomes Classification. The expected results were mostly achieved and implementation process of consultation was successful. The acquisition of CCSN was explained in connection to the IPS. The DCL was developed in connection to the SCSNMH and the acquisition of the MCPMHN was explicited in synergy with the accomplished stages in the IPS. It has been found that the embodiment of the IPS and the DCL allowed it to reach the proposed aim.

O atendimento de saúde mental em hospitais gerais no Brasil vem crescendo em especial na última década, como resultado de políticas sociais específicas para ampliação da rede de atenção psicossocial, constituindo mais um recurso para mudança de paradigmas na produção do cuidado. Assim, um dos maiores desafios para reforma psiquiátrica brasileira tem sido a coexistência de modelos de atenção, que seguem lógicas distintas na relação estabelecida entre os modos de gestão de políticas, oferta e organização dos serviços, e na relação entre os profissionais e os usuários. O Rio Grande do Sul, em especial a política estadual, vem utilizando recursos públicos para incentivo ao atendimento de saúde mental em hospitais gerais, nos últimos três governos, com as devidas diferenças de contextos e políticas propostas, configurando, assim, um cenário de concentração de leitos em relação aos demais estados do país. Uma tese sobre as políticas sociais, que utilizam recursos públicos para complementação do Sistema Único de Saúde, no atendimento de saúde mental, utilizando leitos de saúde mental em hospitais gerais foi um desafio colocado a partir de vários outros questionamentos que envolvem esta temática; possibilitando, assim, discutir os contextos desta modalidade de atenção e em especial os modelos de atenção presentes nos processos de trabalho das equipes. Para a construção desta tese foi utilizada uma pesquisa quantiqualitativa, com o objetivo de compreender quais modelos de atenção em saúde mental se expressam na organização e gestão da atenção, a partir da ampliação de leitos de saúde mental em hospitais gerais no Rio Grande do Sul. Para tanto foram utilizados como fontes legislações, dados do Datasus, relatórios e projetos terapêuticos de hospitais gerais, além da realização de entrevistas e grupos nominais. O cuidado na crise ainda tem no hospital uma referência muito forte; é possível encontrar nas diferentes instituições um modelo híbrido, que contempla diferentes experiências e formações, com potencial de movimento e que pode desacomodar práticas mais rígidas, promover cuidado com acolhimento e singularidade – desafios que se colocam para o trabalho em rede. Estes e outros resultados estão presentes nesta tese que reúne o trabalho de pesquisa conectado com o da experiência profissional da pesquisadora.
The mental health care in general hospitals in Brazil has been growing especially in the last decade as a result of specific social policies to expand the network of psychosocial care and is another resource for paradigm shift in care production. So, one of the biggest challenges for the Brazilian Psychiatric Reform has been the coexistence of care models that follow different logics in the relationship between the modes of management policies, supply and service organization, and the relationship between professionals and user. In Rio Grande do Sul (RS), in particular, the state policy has been using public funds to encourage the mental health care in general hospitals in the last three governments, with appropriate differences in contexts and policy proposals, thus setting a scenario of concentration of beds in relation to other states. A thesis about social policies using public resources to complement the National Health System, in the care of mental health, using mental health beds in general hospitals was a challenge that arose from several other questions that surround this issue, thus enabling discuss the contexts this type of care and in special care models in the processes of work team. To the construction of this thesis we used a quantitative and qualitative research in order to understand which models of mental health care are expressed in the organization and management of attention from the expansion of mental health beds in general hospitals in RS, for this were used as sources laws, Datasus, reports and therapeutic projects general hospitals, as well as interviews and nominal groups. The care crisis in the hospital still has a reference too strong, you can find the different institutions a hybrid model, which includes various experiences and backgrounds, and has the potential of motion that can dislodge stricter practices and promote care with host and uniqueness, challenges to for networking. These and other results are presented in this thesis that meets the research work connected with the professional experience of the researcher.

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A HistÃria da Enfermagem, em seus distintos contextos, traz a elucidaÃÃo e interpretaÃÃo de fatos e acontecimentos oportunizando o entendimento de lacunas existentes na sua evoluÃÃo, evidenciadas ao longo do tempo, dando condiÃÃes para reflexÃo e anÃlise perpassando nas mudanÃas ocorridas. Este estudo, de cunho histÃrico-social, teve como propositura reconstituir a HistÃria da Enfermagem do Hospital Walter CantÃdio da Universidade Federal do CearÃ, agregando fragmentos de sua trajetÃria na instituiÃÃo, desde sua inserÃÃo ocorrida em 1952 atà 2012. A HistÃria Oral foi utilizada como mÃtodo de pesquisa, e a entrevista, instrumento para coleta de dados. Como fontes primÃrias foram utilizadas a documentaÃÃo oral, obtida mediante as entrevistas, e documentos escritos, como legislaÃÃes, projetos, atas e regimentos. Como fontes secundÃrias, livros, artigos cientÃficos, dissertaÃÃes, teses e pesquisas, entre outros materiais que deram subsÃdios para contemplar o objetivo proposto. O trabalho se debruÃa nas memÃrias de enfermeiras que participaram desse processo, no decorrer do referido perÃodo, amparado por documentos escritos, iconogrÃficos, que registraram os fatos histÃricos, e evoca, nÃo somente elementos historicamente construÃdos pelo grupo em questÃo, mas destaca a Enfermagem, pelas dimensÃes do saber-conhecer o passado da profissÃo. Os resultados mostram que as profissionais de enfermagem pioneiras do Hospital Walter CantÃdio delinearam, com galhardia, o desafio das diretrizes do ensino, da pesquisa e assistÃncia, nesta instituiÃÃo, visando o compromisso profissional. Notabilizamos grandes nomes que abrilhantaram a evoluÃÃo do ServiÃo de Enfermagem desta renomada instituiÃÃo, sempre na perspectiva de diferenciaÃÃo profissional, atravÃs de estratÃgias para qualificar o cuidado Ãtico. Ao referirmos sobre suas aÃÃes, assinalamos o processo da SistematizaÃÃo da AssistÃncia, que impulsionou e subsidiou o desempenho do trabalho do grupo, que desenvolve um cuidado integral e individual, fundamentado em evidÃncias cientÃficas e no trabalho interdisciplinar. A enfermeira assume o papel de gestora, vislumbrando direcionar as aÃÃes do cuidar. Em sua funÃÃo assistencial, està envolvida no cuidado ao paciente, e à direcionada para o ensino em prol da formaÃÃo de outros profissionais da Ãrea, assumindo inÃmeros papÃis no contexto da organizaÃÃo desse cuidado, distanciando-se gradativamente das aÃÃes diretas ao paciente. Engaja-se na pesquisa fomentando a investigaÃÃo e estudos que possam ter influÃncia positiva em sua prÃtica assistencial. O desenvolvimento tÃcnico-cientÃfico, como uma das suas principais diretrizes, propiciou a capacitaÃÃo profissional e a humanizaÃÃo do atendimento, fornecendo subsÃdios à implantaÃÃo do modelo assistencial institucional e o atendimento ao paciente. Hoje, a Enfermagem contempla e celebra sua trajetÃria exitosa, nos mostrando suas liÃÃes, e, ao mesmo tempo nos guiando a fim de traÃarmos novos rumos. Esse grupo sedimenta e amplia conhecimentos, consolidando a prÃtica de assistir, oportunizando o desenvolvimento de habilidades, orientando o respeito na conduta e postura profissionais. Propomos, no entanto, a investigaÃÃo da delimitaÃÃo das funÃÃes de cada membro da equipe de Enfermagem, enfermeiros, auxiliares e tÃcnicos, quanto Ãs aÃÃes que realizam nas unidades de internaÃÃo. Percebemos que as atribuiÃÃes designadas a esses profissionais geram sobrecarga de trabalho em torno da Enfermagem, que, acreditamos estar assumindo papÃis nÃo prÃprios da categoria, de forma a favorecer uma reflexÃo sobre esses papÃis e atribuiÃÃes, a fim de contribuir para a prÃtica assistencial da Enfermagem na instituiÃÃo.
The History of Nursing in its various contexts, behind the elucidation and interpretation of facts and events providing opportunities for the understanding of gaps in their evolution, evidenced over time, giving conditions for reflection and analysis permeating the changes. This study, of historical social, was to reconstitute the initiation of the History of Nursing Walter CantÃdio Hospital, Federal University of CearÃ, adding fragments of his career at the institution since its insertion occurred in 1952 through 2012. The Oral History was used as a research method, and the interview instrument for data collection. As primary sources were used oral documentation obtained through interviews and written documents, such as laws, projects, acts and regulations. As secondary sources, books, journal articles, dissertations, theses and research, among other materials which gave grants to contemplate the proposed objective. The work focuses on the memoirs of nurses who participated in this process, the propriety of that period, supported by written documents, iconographic, who recorded the historical facts, and evokes not only elements historically constructed by the group in question, but highlights the Nursing by the dimensions of know-know the past of the profession. The results show that professional nursing pioneer Hospital Walter CantÃdio outlined, with gallantry, the challenge guidelines in teaching, research, and service in this institution, seeking professional commitment. Stands out big names that punctuated the evolution of the nursing service of this renowned institution, always from the perspective of professional differentiation through strategies to qualify the ethical care. When referring about his actions, noted the process of Care System, who drove and supported the work performance of the group, which develops a comprehensive care and individual, based on scientific evidence and interdisciplinary work. The nurse assumes the role of managing, viewing direct the actions of caring. In his role of care, is involved in patient care, and is targeted for teaching in favor of training other professionals, taking on numerous roles in the organization of care, gradually distancing himself from direct actions to the patient. Engages in research by promoting research and studies which have a positive influence on their practice care. O technical and scientific development, as one of its main lines, provided professional training and humanization of care, providing support to the implementation of institutional care model and patient care. Today, nursing contemplates and celebrates their successful trajectory, showing us its lessons, and at the same time leading us to trace new paths. This group consolidates and expands knowledge, consolidating the practice of watching and the opportunity to develop skills, guiding the respect in professional conduct and attitudes. We propose, however, the research division of the functions of each member of the nursing staff, nurses, and technicians, as the actions they carry out on inpatient units Yeah, it is clear that the tasks assigned to these professionals generate workload around nursing, which, it is believed, is assuming roles not own category. In order to encourage a discussion about these roles and responsibilities in order to contribute to the practice of nursing care in the institution.

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Esta dissertação versa sobre a negociação de poder entre médicos psiquiatras e pacientes usuários de um serviço público de saúde mental. Pautados na teoria da analítica do poder de Michel Foucault, autor de referência nesse campo, investigamos como circula o poder nos atos terapêuticos exercidos pelos médicos entrevistados, bem como na relação do hospital com os outros serviços da rede de atenção à saúde mental. O estudo foi realizado em um hospital psiquiátrico da rede de atenção à saúde mental pública de Minas Gerais. A escolha por este tipo de serviço, dentre outros na rede pública, se deu uma vez que os dados históricos e a literatura atestam terem sido, os hospitais psiquiátricos, os maiores alvos de critica numa época de uma psiquiatria disciplinar. Há ainda a importante constatação da permanência desse tipo de serviço em todo país, apesar de todos os esforços para que fosse substituído. O movimento da reforma psiquiátrica – fenômeno histórico que engendra novas teorias e práticas – surge como uma resposta política e epistêmica a essa psiquiatria e seu dispositivo mais evidente, o hospital. Uma das mais fundamentais propostas da reforma psiquiátrica é a de subverter as relações disciplinares da psiquiatria para com a loucura. Essa investigação qualitativa, feita por meio de entrevistas semiestruturadas com médicos psiquiatras, focou-se finalmente na permanência de atos violentos – que foram analisados através do conceito de violência em Hannah Arendt –, e na importância do dispositivo hospital na prática de uma psiquiatria que insiste em permanecer asilar. Encontrou-se fundamentalmente duas transformações: a passagem do cárcere hospitalar para uma antinomia de funcionamento da rede; e o exercício do poder psiquiátrico não mais como produtor de exclusões sistemáticas, mas de subjetivações normativas. Conclui-se que a loucura continua encarcerada no discurso médico e verifica-se a necessidade da reforma psiquiátrica de inventar novas formas de subjetivação.
This dissertation deals with the power negotiation between psychiatrists and patients, or users, of a mental health public service. Based on Michel Foucault analytic of power we investigate how the power surrounds the therapeutic practices of the interviewed psychiatrics, as well as on the relation of the hospital with other services of mental health care network. The study was made in a psychiatric hospital of the public mental health care network of Minas Gerais state, Brazil. This particular type of service was chosen since historical data and literature testify that the psychiatric hospitals were the major target of criticism in a time of disciplinary psychiatric practice. Further, there is the important confirmation that this kind of service is still present in the whole country, notwithstanding all the efforts made to its replacement. The psychiatric reform movement, a historical phenomenon which generates new theories and practices, arises as a political and epistemic response to that psychiatric and its most evident dispositive, namely the hospital. One of the most fundamental proposals of the psychiatric reform is to subvert the psychiatric disciplinary relations in regard to madness. This qualitative research, made through semi-structured interviews with psychiatrists, was ultimately focused on the permanence of violent acts — analyzed in the light of Hannah Arendt’s concept of violence — and on the importance of the hospital dispositive in a psychiatric practice that insists on being an asylum one. Two fundamental transformations were found: first, the passage from the hospital gaol to an antinomy of the network functioning; second, the exercise of psychiatric power as a producer of normative subjectification instead of systematic exclusions. It is concluded that madness is still confined in medical discourse, and the necessity of psychiatric reform in reinventing new ways of subjectification is verified.