Mental health: health worker narratives in the context of COVID-19 in Brazil.

Introduction: During the pandemic, "staying at home" was not an option for many people, especially health workers, who were on the front lines in the fight against COVID-19 and whose mental health was threatened.

Objectives: This study highlights the psychological repercussions of the pandemic and the coping strategies used by health workers in an effort to develop mental health resources.

Methods: This qualitative exploratory study investigated the narratives of 14 health workers from an online focus group between August and September 2020, transcribing the meetings and performing thematic content analysis.

[Shared decision-making of psychopharmaceutical treatment: survey with users of CAPS from four large Brazilian cities].

In this article we describe the characteristics of the treatment negotiation process with medications at the Centros de Atenção Psicossocial (CAPS) in four major Brazilian municipalities. A structured questionnaire was applied to 1,630 CAPS users in the cities of Campinas, Fortaleza, Porto Alegre and São Paulo. Most users undergoing treatment at the CAPS did not start using medication at the CAPS, but already in the first contact with health services.

Determinants of timely access to Specialized Mental Health Services and maintenance of a link with primary care: a cross-sectional study.

Background: Although access to specialized services is one of the main components of the study of paths to mental health care worldwide, the factors related to the continuity of the patient's link with Primary Care after admission to a Specialized Mental Health Services still need to be explored in greater depth. Thus, this study aimed to evaluate the determinants of timely access to Specialized Mental Health Services (outcome 1) and maintenance of a link with Primary Care after patients' admission (outcome 2).

Methods: This is a cross-sectional study, conducted with 341 users of Specialized Mental Health Services at outpatient and community level in a medium-sized city in Brazil between August and November 2019.

Primary care registration of the mental health needs of patients treated at outpatient specialized services: results from a medium-sized city in Brazil.

Background: Although matrix support seeks to promote integrating Primary Care with specialized mental health services in Brazil, little is known about the quantitative impact of this strategy on sharing cases between different levels of care. The aim of this study was to investigate the prevalence and factors associated with Primary Care registration of the mental health needs of patients treated at outpatient specialized services in a medium-sized city in Brazil with recent implementation of matrix support.

Methods: This is a document-based cross-sectional study conducted through an analysis of 1198 patients' medical records.

Cross-cultural adaptation of the Recovery Self-Assessment RSA-R Family/Brazil: Validity evidence based on test content.

In the cross-cultural adaptation of instruments, the qualitative component of adaptation is generally poorly reported, sometimes being superficially addressed. In this study we aimed to describe the qualitative component of the cross-cultural adaptation process and to demonstrate validity evidence based on test content of the Recovery Self-Assessment-RSA-R Family/Brazil. We conducted a qualitative study that included the steps of preparation, translation, back-translation, expert's assessment, workshop with a researcher from Yale University, and two pilot studies involving family members of patients attended at mental health services.

Mental health and human rights: Challenges for health services and communities.

The care of people with mental health problems requires health system and service reforms to build up proper mental health care. The challenges of the present moment continue to be immense. The viral pandemic that we are experiencing has exposed the fragility of our health and social services and certified the inequality and precariousness of the living conditions of many people.

[Mental healthcare in Brazil: a multifaceted study in four large cities].

This study aimed to assess characteristics of healthcare networks in four large Brazilian cities (Campinas, Fortaleza, Porto Alegre, and São Paulo), in the provision of mental healthcare. The following outcomes were used: (i) place of identification of the mental health problem; (ii) mental healthcare in primary care; (iii) pharmaceutical care in mental health; and (iv) social rehabilitation. This is a mixed-methods study with a concurrent and sequential approach, conducted with 10 administrators and 1,642 users of Centers for Psychosocial Care (CAPS, in Portuguese) in the four cities.

Notes for the study on health systems: multifaceted analysis and tracer indicators.

Objective: To present the methodological approach used in a research that analyzed the use and performance of specialized health care, from primary care access, in four major Brazilian cities: Fortaleza (CE), Campinas (SP), São Paulo (SP) and Porto Alegre (RS).

Methods: Presentation and discussion of the quantitative-qualitative components of the proposed research strategy.

Results: Four tracing conditions were studied: systemic arterial hypertension, high-risk pregnancy, breast cancer and severe mental disorder.

[Functioning of Psychosocial Care centers in four cities in BrazilActuación de los Centros de Atención Psicosocial en cuatro centros urbanos en Brasil].

Objective: To describe the functioning of Psychosocial Care centers (CAPS) in four Brazilian cities.

Methods: In this cross-sectional study (AcesSUS), 917 CAPS users were interviewed in the cities of Campinas, São Paulo, Porto Alegre, and Fortaleza. Only CAPS focused on severe mental disorders in adults were included, that is, CAPS focusing on substance abuse and on children and adolescents were excluded.

Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies.

Background: Pathways to care are actions and strategies employed by individuals in order to get help for health-related distress and the related processes of care providers. On several systematic reviews regarding pathways to mental health care (PMHC), studies regarding South American countries were not present. This review synthesizes qualitative and quantitative research about PMHC in Brazil.

[Health Planning and Evaluation: antagonism versus collaboration].

The authors analyze the relations between two subareas of Collective Health - Planning and Evaluation - through a bibliometric study of articles, theses, and dissertations published from 1980 to 2016. The overall production on Evaluation exceeds that of Planning, particularly since the 2000s. The capacity to influence health sector administration appears to drive the dispute between the two subareas.

Methodological challenges in the use of focus groups with people with severe mental illness.

This study addresses the practical, methodological and ethical challenges that were found in three studies that used focus groups with people with severe mental illness, in the context of community mental health services in Brazil. Focus groups are a powerful tool in health research that need to be better discussed in research with people with severe mental illness, in the context of community mental health facilities. This study is based on the authors' experience of conducting and analyzing focus groups in three different cities - Campinas, Rio de Janeiro and Salvador - between 2006-2010.

The mental health care model in Brazil: analyses of the funding, governance processes, and mechanisms of assessment.

Objective: This study aims to analyze the current status of the mental health care model of the Brazilian Unified Health System, according to its funding, governance processes, and mechanisms of assessment.

Methods: We have carried out a documentary analysis of the ordinances, technical reports, conference reports, normative resolutions, and decrees from 2009 to 2014.

Results: This is a time of consolidation of the psychosocial model, with expansion of the health care network and inversion of the funding for community services with a strong emphasis on the area of crack cocaine and other drugs.

[Relations between research and clinical care in co-management studies with mental health care users].

This paper is derived from the experience of conducting research with mental health users (not about them, nor for them), analyzing aspects of a study in which different ways of structuring the relationship between clinical practice and research were put into play, thereby questioning the boundaries and ethical issues involved. The clinical practice and research fields that are dealt with are studied with the input of authors who, on the basis of institutional analysis, propose the idea of interventional research, and in the context of public health, revert to the concept of broadened clinical care. The relationship between these two terms - interventional research and broadened clinical care - is based on the notion of subjectivity that operates within the scope of public health and which culminates in the concept of autonomy.

[Autonomous Medication Management: an analytical intervention in mental health care services].

In a context of high rates of medicalization of the population and in light of the scantly critical use of psychiatric medications in mental health services, this paper reports aspects of a qualitative study that had the opportunity to intervene in care practices in three major Brazilian cities. Following the principle of Brazilian Psychiatric Reform championing users' rights to participate in decisions about their treatment, the research intervened in psychosocial care centers (CAPS) seeking the empowerment of the users regarding the use of drugs in their therapeutic projects. Interviews were conducted and focus groups set up.

[Narratives in the study of mental health care practices: contributions of the perspectives of Paul Ricoeur, Walter Benjamin and of medical anthropology].

Narratives are ever more frequent in qualitative studies seeking to interpret experiences and the different viewpoints of individuals in a given context. Starting from this concept, the tradition that addresses narrative is reexamined, including the philosophy of Paul Ricoeur, the historical perspective of Walter Benjamin and the field of medical anthropology grounded in phenomenology. In Ricoeur, with hermeneutics as a variation derived from phenomenology, narrative is linked to temporality.

[Policies and practices in mental health: the evidence in question].

The paper analyzes some current questions related to the choice of evidence in order to provide guidelines for public policy and practices in mental health care. It starts with a critical reflection on the categories of evidence proposed by Evidence-Based Medicine, and also the concept of qualitative evidence. The issue is analyzed specifically in relation to mental health care users and their demands to have services organized in a way that incorporates their perceptions and values, and to the Psychiatric Reform field proper firmly grounded in ethical and political precepts.

[Participatory development of indicators for assessing mental health].

The specialized literature frequently cites the inclusion of different interest groups in evaluative research, referred to generically as "participatory evaluation". However, there is a lack of an empirical basis for discussion on ways to operate and (especially) qualify such participation. This article discusses the participatory development of mental health indicators for use in the Centers for Psychosocial Care (CAPS) in Brazil.

Evaluation of innovative strategies in the organization of Primary Health Care.

Objective: To compare the performance of Primary Care Units according to the implementation of new arrangements and strategies in primary care and mental health.

Methodological Procedures: Evaluative research with triangulation of methods and theoretical framework of critical hermeneutics, carried out at six Primary Care Units of the two most populous health districts of the city of Campinas (Southeastern Brazil) in 2007. The Primary Care Units were analyzed according to clinical resolution, articulation between the primary care and mental health networks and implementation of health promotion strategies.