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Resumo Neste trabalho, discute-se como a noção de infância vai se constituindo nas narrativas de profissionais de saúde que atuam em Centros de Atenção Psicossociais Infantojuvenis (Capsi) e que discursos sobre as infâncias se organizam, desdobrando-se nas ações de cuidado às crianças nos serviços de saúde mental. Trata-se de uma pesquisa qualitativo-exploratória, baseada em entrevistas semiestruturadas, observações participantes e diários de campo, discutidas através da análise temática. Como resultados desse processo, observa-se uma romantização da infância que perpassa a construção do cuidado nos serviços de saúde; a dificuldade da equipe quanto à decisão sobre o que é demanda de Capsi e o que não se enquadra na população adscrita frente à complexidade dos impactos sociais que implicam o diagnóstico; e a ênfase na medicalização em detrimento da construção de ações de caráter psicossocial. Abstract This paper discusses how the notion of childhood is built in the narrative of Psychosocial Care Centers (Capsi) and which discourses on childhood are articulated and extended to the actions for children care in mental health services. It is a qualitative-exploratory research, based on semi structured interviews, participant observations and field notes, from the theme analysis. As results of this process, it is possible to notice a romantic view of childhood which goes through the constructions of care in the health services; the team difficulty in deciding which is the Capsi demand and which does not adjust to the ascribed population in the face of the complexity of the social impact implied by the diagnosis; and the emphasis on medicalization to the detriment in the construction of psychosocial nature actions. Resumen En este trabajo se discute como se constituye la noción de infancia en las narrativas de los profesionales de la salud que actúan con niños en los Centros de Atención Psicosocial Infantil y Juvenil (Capsi) y qué discursos sobre la infancia se organizan y extienden a las acciones de cuidado de los niños en los servicios de salud mental. Se trata de una investigación cualitativa exploratoria, basada en entrevistas semiestructuradas, observaciones participantes y diarios de campo, que luego son discutidos mediante un análisis temático. Como resultados de ese proceso, se observa una “romantización” de la infancia que permea la construcción del cuidado en los servicios de salud; la dificultad del equipo para decidir cuál es la demanda de los Capsi y que no se ajusta a la población adscrita frente a la complejidad del impacto social que implica el diagnóstico; y el énfasis en la medicalización en detrimento de la construcción de acciones de carácter psicosocial.

The mental health of lesbian, gay, bisexual, transgender, queer, intersexual (LGBTQI) individuals is significantly influenced by many factors such as difficulties in coming-out, poor acceptance, isolation and discrimination as well as minority-related stress. LGBTQI individuals, in fact, show a significant higher risk of mental health conditions, substance- use disorders and suicide. In addition, mental health services access may be difficult for personal and social barriers as well as a lack of adequate and specific mental health support. This review aims to assess and describe international policies, guidelines, position statements and recommendations regarding the promotion and protection of mental health rights for LGBTQI people. The search has been focussed on peer-reviewed papers, Governmental and Mental Health Association- Guidelines and Position Statements, Health Agencies - Guidelines and Position Statements (with a specific focus on mental health), LGBTQI Alliances and Foundations Publishing (with a specific focus on mental health). In addition, relevant international initiatives, and projects in the field of LGBTQI mental health will be described.

Introduction: Brazilian’s history of psychiatric care is complex and has some dark periods, but the country managed to get international recognition for its mental health policies in the last years. Those have been currently suffering setbacks. Purpose: Review the historical context of mental health in Brazil, assessing the changes made after 2016, and carry out a critical analysis of the current inclination. Methodology: literature and narrative review using official governmental documents. Results and Discussion: Through its history, Brazil’s had ups and downs in the care of mental health patients. After almost 30 years of policies that are centered around the individual, and not only the individual’s disease, the hospitalocentric model of care has been subtly making its comeback, together with normatives that revogue rights before acquired and corroborates with segregation of the mentally ill. Conclusions: The current changes in the Mental Health politics are not walking alongside the line with movements responsible for the implementation of a biopsychosocial care. It provokes and invites us to continue fighting for fair health programs and for the continuation of the Universal Health System

Este artigo tem por objetivo analisar os impactos das atuais políticas de saúde mental no Brasil nas práticas e discursos dos chamados familiares de usuários de um serviço de atenção psicossocial. Foi realizada etnografia no Centro de Atenção Psicossocial (CAPS) II de Araraquara – interior de São Paulo –, com foco nos grupos de familiares e nas reuniões diárias da equipe técnica dos profissionais. Por meio da teoria da mediação cultural de Montero (2005), procura-se entender de que forma o envolvimento com este tipo de serviço de saúde mental produz mudanças nas práticas e discursos dos agentes ali atendidos. Foi observado que a participação na instituição propicia o pensar de relações sociais em termos médicos apor estes familiares, que ressignificam a conduta socialmente indesejável dos usuários como doença mental. Dessa forma, nossos resultados apontam que a participação destes chamados familiares no CAPS II resulta em uma tradução do projeto ético-político da instituição a seus contextos locais, de modo a modificar ou reproduzir suas práticas e discursos de acordo com suas condições de possibilidade e desejos de cuidado. The present paper aims to analyze the impacts of the currents public mental health policies in Brazil upon the discourses and practices of the so-calledrelativesof the users from a psychosocial attention service. We have made ethnography in the Araraquara’sPsychosocial Attention Center (CAPS) II between families groups and in the daily reunions of the professionals. Using the theory of intercultural mediation from Montero (2006), we aim to understand how the involvement with this kind of service changes the practices and discourses of the social agents there present. As results, we’ve observed that the attendance at the institution foment the possibility to think about social relations in medical terms by the relatives, who ressignify the users’ social undesirable behaviors as mental illness, applying what is lived in the mental health service to the their local contexts. Our result points that the participation of the so-calledrelatives in the CAPS II translates the ethical-political project of the institution to their local contexts changing or reproducing practices and discoursers accordingly to their possibilities and care demands.

Background It is widely recognised that mental health policies should be developed in consultation with those tasked with their implementation and the users affected by them. In the South African legislative context public participation in policymaking is assumed, with little guidance on how to conduct consultation processes, nor how to use consultation inputs in policy decisions. Methods The South African Mental Health Policy Framework and Strategic Plan was adopted in 2013 after an extensive consultation process. Focussing on the 2012 provincial and national consultation summit, this case-study conducted key informant interviews and undertook documentary analysis to explore the process through which consultation inputs were–or were not–transferred to inform this policy. Between 2013 and 2016 seven interviews were conducted, and 11 documents (policy drafts and summit outputs) and transcripts of 23 audio-recorded sessions from the national summit were analysed. Results Findings revealed that no substantive changes were made to the mental health policy following the consultation summits. There do not seem to have been systematic processes for facilitating and capturing knowledge inputs, or for transferring these inputs between provincial and national levels. There was also no further consultation regarding priorities identified for implementation prior to finalisation of the policy, with participants highlighting concerns about policy implementation at local levels as a result. This represents a lost opportunity for greater involvement of service users in policy development. Conclusions Together with poor service-user representation, the format of the consultation process limited participant interaction and the possibility for engagement with, or uptake of, more experiential forms of knowledge. Several procedural elements were found to limit the elicitation and transference of consultation contributions for uptake into policy. Recommendations for future policy consultations include adapting the format of participatory processes to enable optimal use of participant knowledge, as well as greater service-user participation.

Quality in health services may be expressed as an equilibrium scale of measurement of both dimensions, ie physical and mental. It is an individual but also a collective search for securing personal prosperity and social solidarity respectively. Its assurance stems from the assessment of basic, customized and predefined criteria based on structures, processes and results. The quality of mental health is still considered an underestimated concept, which will be an element of our larger focus, as its servicing resources remain elementary and therefore inadequate in many countries. The effects of mental health on the public health system are maximized by the impact of their direct and indirect costs. To address the cumulative effects of mental disorders, the World Health Organization issued in 2003 a package of instructions to deal with them. In Greece, the improvement of the quality of mental health has been a priority in recent years with the legislative initiative of Law 4421/2017 being an important step. The mental health policies of the states of the world community can exploit quality perspectives in mental health services as the key to safeguarding prosperity results, expressed in principle by deterring human rights abuses and secondly by smoothly reintegrating people facing mental disorders into society. A basic prerequisite for policymaking is therefore the awareness of the entire community of the burdens caused by mental disorders. Establishing more effective measures and mechanisms adapted to Greek standards, will contribute to further improvement of quality and normalization of mental disorders.

This paper draws on focus groups hold for the purpose of a mental health policy evaluation research. It argues that focus groups might be considered from a “meeting perspective”. Construed as meetings, focus groups stop standing for tools aimed at doing research and completing externally defined research or policy objectives. Instead, they constitute social systems built up by the participants, together with the meeting convener, or moderator. This paper suggests that having a close look at these social systems developing into the meeting room – or small writ societies, draws our attention to three overlapping phases combining in the system formation – a time for expression, a period of exploration and moments of meditation. These three phases stand for different but complementary contributions to the research process as well as the policy initiative in the framework of which the research occurs. These contributions, or social roles of meetings, include a diagnostic, a social knowledge production and a change broker’s roles. Taking advantage of the social roles of meeting requires specific attitudes and perhaps translation skills from the researcher, which are discussed at the end of the paper.

This article asks how policy learning is achieved and whether and how it impacts on policy change. By drawing on the empirical case of Belgian mental health reforms, it shows that policy learning occurs through the very practice of policy-making. In-depth analyses of the process of preparing and devising, a current reform of mental health care delivery, called Reform 107, evidence that the transformation of policy learning – through verbal expression, inscription in documents or enactment in social situations such as meetings – is crucial to its impact on policy change. A phenomenological approach to knowledge in policy helps to perceive and describe the transformation of policy learning through practical actions and interactions involved in devising policy change. Analytically, looking at this transformation entails shifting the focus from big and visible changes in policy objectives and instruments to micro policy practices such as meeting and writing documents. Placing the focus on micro policy practices should not lead, however, to a disregard for the social context in which they develop. The interactionist concept of linked ecologies provides the means to consider social regulations influencing policy learning without underestimating their very ephemeral and contingent nature.

O artigo analisa o processo de desinstitucionalização resultante do movimento de Reforma Psiquiátrica, discutindo, em especial, o lugar destinado pelas famílias das pessoas com transtornos mentais (PCTM), a partir das alterações nas funções do Estado neste processo. Baseia-se em revisão bibliográfica. No que concerne à trajetória histórica da família brasileira e, mais especificamente, da família no contexto da saúde mental, que deslocam os papéis e lugares dos diferentes grupos familiares na direção do processo de inserção comunitária das PCTM, constatou-se que não basta fechar os manicômios ou reduzir o número de leitos psiquiátricos, se antes não forem modificados os significados desses aparatos nos cernes familiar, comunitário e social. Para que a Reforma Psiquiátrica se efetive, a família tem que ser vista como agente fundamental de transformações da percepção de loucura, bem como ser incluída de forma responsável no processo de cuidado, recebendo suporte e partilhando atribuições juntamente com o Estado e a comunidade. This study analyses the deinstitutionalization process that resulted from the Psychiatric Reform movement, discussing, in particular, the destinations indicated by families of people with mental disturbances, based on changes in the functions of the state in this process. The study is based on a bibliographic review. For better contextualization of this issue, some aspects considered relevant were mentioned. Concerning the historic trajectory of the Brazilian family, and more specifically, of the family in the context of mental health, which shifts the roles and places of the different family groups in the community insertion of people with mental disturbances, the study found that it is not enough to close asylums or reduce the number of psychiatric beds, if the meanings of the apparatus at the family, community and social levels are not first modified. Moreover, for the psychiatric reform to be effective, the family must be seen as an essential agent in the transformations of the perception of madness, and be included in a responsible manner in the process of care, receiving support and sharing attributions with the state and the community.

Submitted by Jamile Barbosa da Cruz (jamile.cruz@ucsal.br) on 2016-09-14T18:45:04Z No. of bitstreams: 1 SILVA, MB-2016.pdf: 1566612 bytes, checksum: fc7f3b00b4f1d1cd91171d429e893d60 (MD5) Rejected by Maria Emília Carvalho Ribeiro (maria.ribeiro@ucsal.br), reason: Jamile, Por favor, cadastrar cada palavra-chave em um único campo. Em: "ADICIONAR +", criar um novo campo, sem utilizar pontuação: Políticas de saúde mental Rede de atenção psicossocial Acessibilidade Barreiras Centros de atenção psicossocial Mental health policies; Psychosocial care network Accessibility Barriers Psychosocial Care Centers on 2016-09-21T20:47:12Z (GMT) Submitted by Jamile Barbosa da Cruz (jamile.cruz@ucsal.br) on 2016-09-29T17:30:44Z No. of bitstreams: 1 SILVA, MB-2016.pdf: 1566612 bytes, checksum: fc7f3b00b4f1d1cd91171d429e893d60 (MD5) Approved for entry into archive by Maria Emília Carvalho Ribeiro (maria.ribeiro@ucsal.br) on 2016-11-18T19:36:13Z (GMT) No. of bitstreams: 1 SILVA, MB-2016.pdf: 1566612 bytes, checksum: fc7f3b00b4f1d1cd91171d429e893d60 (MD5) Made available in DSpace on 2016-11-18T19:36:13Z (GMT). No. of bitstreams: 1 SILVA, MB-2016.pdf: 1566612 bytes, checksum: fc7f3b00b4f1d1cd91171d429e893d60 (MD5) Previous issue date: 2016-03-29 A pesquisa fez uma análise, a partir da ótica do sujeito com transtorno mental, de suas vivências pelas trajetórias de acesso a Rede de Atenção Psicossocial - RAPS. Tem por referência o novo modelo em Saúde Mental instituído pela Reforma Psiquiátrica Brasileira de 2001. O problema é pautado da seguinte forma: Como o sujeito com transtorno mental vivencia a sua trajetória para o acesso à RAPS? Assim, o estudo objetivou compreender de que forma o sujeito com transtorno mental acessa os serviços da RAPS; como se dão os acessos e se existem barreiras postas em seu caminho que dificultem ou mesmo retardem a sua trajetória na busca de cuidados. Trata-se de um estudo de abordagem qualitativa, de caráter descritivo-exploratório, a partir de uma combinação de estratégias metodológicas, utilizando pesquisa documental por meio de consultas aos arquivos de prontuários de usuários do Centro de Atenção Psicossocial - CAPS, da observação direta a algumas trajetórias por meio da pesquisa etnográfica e de relatos de trajetórias e entrevistas semiestruturadas. Os resultados apontam que os participantes apresentam dificuldades em acessar a rede de cuidados, principalmente por não termos uma rede de serviços bem constituída e que o CAPS não tem conseguido fazer uma articulação em rede, assumindo hegemonicamente os cuidados com a saúde mental, o que não tem favorecido a complexidade de respostas às necessidades sentidas e ao fortalecimento dos exercícios de cidadania ativa dos sujeitos com transtorno mental na busca de direitos legalmente conquistados. The research is an analysis from the perspective of the individuals with mental illness, their experiences by trajectories of access to Psychosocial Care Network (RAPS). The reference is the new model on Mental Health established by the Brazilian Psychiatric Reform. The problem is guided as follows: How does the subject with mental disorder experiences his/her trajectory to access the Psychosocial Care Network (RAPS)? Thus, the study aims to understand how the subject with mental disorders access the services of RAPS; how to offer access and whether there are barriers put in their way that impede or even slow this trajectory for care seeking. It is a study of qualitative, descriptive and exploratory approach, from a combination of methodological strategies, using documentary research through consultations to CAPS user records files, direct observation to some paths through ethnographic research and trajectories and semi-structured interviews reports. The results show that participants have difficulties in accessing the network care, especially for not having a well-formed service network and CAPS has not been able to make a network joint, assuming hegemonically the care of mental health, which has not favored the complexity of answers to the needs and strengthening of active citizenship exercises of individuals with mental illness in the search for legal rights achieved.

RésuméCet article analyse la controverse suscitée par la loi du 30 juin 1975 d’orientation en faveur des personnes handicapées parmi les psychiatres français au cours de la seconde moitié des années 1970. Cette controverse a joué en effet un rôle déterminant pour stabiliser et imposer une définition et des représentations des catégories de handicap et de maladie psychique qui marquent encore aujourd’hui le débat sur le « handicap psychique » en France. Dans un premier temps, l’article éclaire les conditions de la controverse en la situant dans la trajectoire d’ensemble de la dynamique réformatrice dans le domaine sanitaire et social au cours des années 1960 et 1970. Le second temps de l’article examine le débat spécifique autour d’une mesure de la loi d’orientation, la création de foyers de post-cure pour malades mentaux chroniques, pour montrer comment celui-ci a participé à redéfinir les enjeux de la chronicité psychiatrique.AbstractThis article analyzes the controversy raised among psychiatrists by the law of the 30 June 1975 in favor of disabled people in France in the second half of the 1970s. This controversy played a major role in stabilizing definitions and representations of categories of disability and mental disorder, which still bear a strong influence on today's French debates upon “handicap psychique”. The first part of the article shows how the controversy emerged within the reform dynamics that dominated French health and social policies in the 1960s and 1970s. The second part examines the specific debate concerning a project of nursing homes for long-term mentally disordered people that took place within this controversy in order to show how it contributed to the redefinition of psychiatric chronicity.

El artículo sitúa el contexto de la Salud Mental (SM) partiendo de las políticas asistenciales europeas y como se concretan éstas en el territorio español. Hace un análisis del modelo de SM en Cataluña y de cómo se está implementando. La segunda parte del artículo se centra en identificar qué aspectos están condicionando el Trabajo Social (TS) en SM y qué papel están jugando dichos profesionales en el nuevo modelo asistencial. The article places the field of Mental Health in context, beginning with European welfare policies and how these take shape within Spain. It analyzes the model of mental health in Catalonia and how it is being implemented. The second part of the article centers on identifying what aspects are affecting Social Work in the field of Mental Health and what role said professionals play in the new care model.

O artigo aborda a compreensão dos profissionais que atuam na área de saúde mental sobre o movimento de construção da participação social no sistema de saúde de Fortaleza (CE). A metodologia adotada respalda-se na abordagem qualitativa, junto aos profissionais de saúde mental do referido município. Utilizamos a entrevista semiestruturada com dezessete participantes. O material empírico foi analisado através da técnica de análise de conteúdo categorial temática, na qual foram identificados três núcleos de análise: participação social como espaço de cidadania e formulação de políticas; orientada para a atenção às necessidades coletivas e de tomada de decisão. O estudo revela a participação social como uma possibilidade de ampliação da relação da sociedade civil com o Estado, o qual possibilita a intervenção social na proposição das políticas de saúde. Evidencia-se o direito à saúde articulado à consolidação da democracia na atenção às necessidades e edificação coletiva.The article approaches the comprehension of professionals that act in the mental health area about the movement of construction of social participation in the health system of Fortaleza, Ceará State. The methodology adopted is based upon qualitative approach. The study was developed with semi-structured interviews with 17 mental health professionals of the city above mentioned. The empirical data was analyzed through the technique of thematic content analysis, where it was identified three cores of analysis: social participation as space of citizenship and policy formulation; oriented to attention of collective needs; and decision taking. The study reveals that social participation represents a possibility of amplifying X the relations between the Civil Society and the State, which makes possible the social intervention in proposals of the health policies. It is highlighted the right to health linked to the consolidation of democracy in the attention to the needs and collective edification.

O artigo faz uma revisão da reforma psiquiátrica brasileira nas décadas de 1980 e 1990, até a promulgação da Lei de Saúde Mental, em abril de 2001. Aborda os conceitos básicos que distinguem o processo atual de iniciativas anteriores. Apresenta os antecedentes do processo atual; os conceitos e valores que caracterizam a reforma brasileira; as experiências inaugurais de Santos (SP) e do Centro de Atenção Psicossocial (Caps) Luiz Cerqueira em São Paulo; a iniciativa de revisão legislativa, com uma análise da lei finalmente aprovada; a tendência das políticas públicas de saúde mental no período aqui abarcado, incluindo as portarias 224/92 e 106/2000 do Ministério da Saúde; a situação atual do processo de substituição asilar no país e a reestruturação da assistência no município do Rio de Janeiro. This article presents a brief history of the Brazilian psychiatry reform from the 1980's and 1990's to April 2001, when the Mental Health Law was finally signed. The author discusses the basic concepts that characterize the present condition of the reform as opposed to those of previous initiatives. He also presents a general view of the preceding events to the present process; the concepts and values that characterize the Brazilian reform; the first experiments in São Paulo; the legislative initiative with an analysis of the new law; the different public policies in relation to mental health during the period analyzed with a copy of the Ministry of Health Ordinances 224/92 and 106/2000; the present condition of the de-institutionalization process in the country and the restructuring of the assistance system in the municipality of Rio de Janeiro.

O artigo tem por objetivo descrever e analisar o processo de inserção do tema da violência nos marcos legais da política pública brasileira de saúde mental, com vistas a contribuir para a identificação dos principais desafios e impasses presentes nessa área. Realizou-se análise documental das leis, decretos e portarias publicadas pelo Ministério da Saúde e publicações oficiais da Coordenação de Saúde Mental do ministério emitidas no período de janeiro de 2001 a dezembro de 2011. Observa-se a consolidação de três tendências nesses documentos, denominadas: a violência e a instituição psiquiátrica (2001-2003), marcada pela consolidação dos parâmetros norteadores da política na perspectiva da desinstitucionalização e garantia dos direitos dos indivíduos com transtornos mentais; a violência, o território e suas demandas (2004-2008), onde são identificadas a atenção às vulnerabilidades sociais e a integralidade dos cuidados em saúde; a violência e o desafio do uso prejudicial de álcool e outras drogas (2009-2011), evidenciando situações de risco e violência associadas a esse uso, e acirrando tensões entre forças políticas conservadoras no campo das políticas sociais. Conclui-se que a política de saúde mental adequou-se aos problemas sociais emergentes no país com vistas à promoção da qualidade de vida e a prevenção das violências. The paper aims to describe and analyze the process of inserting the issue of violence in the legal frameworks of the Brazilian public politics on mental health, with a view to contribute to the identification of challenges and dilemmas in this area. We conducted a documental analysis of laws, decrees and orders issued by the Health Ministry and official publications of this Coordination of Mental Health Ministry issued from January 2001 to December 2011. We observed the consolidation of three trends in these documents: Violence and psychiatric institution (2001-2003), marked by the consolidation of parameters guiding deinstitutionalization policies and ensuring the rights of individuals with mental disorders; violence, the territory and its demands (2004-2008), where attention to social vulnerabilities and integral health care are identified; violence and the challenge of harmful use of alcohol and other drugs (2009-2011), showing that risk situations and violence associated with this use sharpen tensions between conservative political forces in the field of social policies. We conclude that mental health policies were adapted to the emerging social problems in the country, with a view to enhancing the quality of life and prevention of violence.

International audience; This article analyzes the controversy raised among psychiatrists by the law of the 30 June 1975 in favor of disabled people in France in the second half of the 1970s. This controversy played a major role in stabilizing definitions and representations of categories of disability and mental disorder, which still bear a strong influence on today's French debates upon “handicap psychique”. The first part of the article shows how the controversy emerged within the reform dynamics that dominated French health and social policies in the 1960s and 1970s. The second part examines the specific debate concerning a project of nursing homes for long-term mentally disordered people that took place within this controversy in order to show how it contributed to the redefinition of psychiatric chronicity.; Cet article analyse la controverse suscitée par la loi du 30 juin 1975 d’orientation en faveur des personnes handicapées parmi les psychiatres français au cours de la seconde moitié des années 1970. Cette controverse a joué en effet un rôle déterminant pour stabiliser et imposer une définition et des représentations des catégories de handicap et de maladie psychique qui marquent encore aujourd’hui le débat sur le « handicap psychique » en France. Dans un premier temps, l’article éclaire les conditions de la controverse en la situant dans la trajectoire d’ensemble de la dynamique réformatrice dans le domaine sanitaire et social au cours des années 1960 et 1970. Le second temps de l’article examine le débat spécifique autour d’une mesure de la loi d’orientation, la création de foyers de post-cure pour malades mentaux chroniques, pour montrer comment celui-ci a participé à redéfinir les enjeux de la chronicité psychiatrique. This article analyzes the controversy raised among psychiatrists by the law of the 30 June 1975 in favor of disabled people in France in the second half of the 1970s. This controversy played a major role in stabilizing definitions and representations of categories of disability and mental disorder, which still bear a strong influence on today's French debates upon “handicap psychique”. The first part of the article shows how the controversy emerged within the reform dynamics that dominated French health and social policies in the 1960s and 1970s. The second part examines the specific debate concerning a project of nursing homes for long-term mentally disordered people that took place within this controversy in order to show how it contributed to the redefinition of psychiatric chronicity.

The World Mental Health Survey Consortium, a World Health Organization and Harvard University collaboration, totaling 28 countries participated in a uniform randomized general population survey, making use of translated versions of the WHO Composite International Diagnostic Interview. One of the major purposes of the survey was to help inform policy decision makers regarding mental health. However many obstacles prevent the direct translation of survey data to policies. We report on an investigation of the mechanisms involved in the transformation of survey data into mental health policies. After conducting 11 interviews of individuals representing 12 countries that participated in the survey, we found that although governments did take an active role in the conduct of the survey, this did not necessarily translate into direct policy changes. A number of factors were noted to influence the adoption and implement ation of mental health policy changes from the survey data: the establishment of links between the research group and policymakers; the identification of costs of mental disorder; definition of clear solutions; and lastly the generation of political will. The range of countries included in this investigation has enabled comparisons in the use of evidence to influence policies in different contexts. Gaining an understanding of why some countries were successful and why others struggled in transforming survey results to policies may help to inform researchers of translational issues of research to mental health policies in the future. publishersversion published

Background Mental illnesses are increasingly recognised as a leading cause of disability worldwide, yet many countries lack a mental health policy or have an outdated, inappropriate policy. This paper explores the development of appropriate mental health policies and their effective implementation. It reports comparative findings on the processes for developing and implementing mental health policies in Ghana, South Africa, Uganda and Zambia as part of the Mental Health and Poverty Project. Methods The study countries and respondents were purposively selected to represent different levels of mental health policy and system development to allow comparative analysis of the factors underlying the different forms of mental health policy development and implementation. Data were collected using semi-structured interviews and document analysis. Data analysis was guided by conceptual framework that was developed for this purpose. A framework approach to analysis was used, incorporating themes that emerged from the data and from the conceptual framework. Results Mental health policies in Ghana, South Africa, Uganda and Zambia are weak, in draft form or non-existent. Mental health remained low on the policy agenda due to stigma and a lack of information, as well as low prioritisation by donors, low political priority and grassroots demand. Progress with mental health policy development varied and respondents noted a lack of consultation and insufficient evidence to inform policy development. Furthermore, policies were poorly implemented, due to factors including insufficient dissemination and operationalisation of policies and a lack of resources. Conclusions Mental health policy processes in all four countries were inadequate, leading to either weak or non-existent policies, with an impact on mental health services. Recommendations are provided to strengthen mental health policy processes in these and other African countries.

O artigo aborda a compreensão dos profissionais que atuam na área de saúde mental sobre o movimento de construção da participação social no sistema de saúde de Fortaleza (CE). A metodologia adotada respalda-se na abordagem qualitativa, junto aos profissionais de saúde mental do referido município. Utilizamos a entrevista semiestruturada com dezessete participantes. O material empírico foi analisado através da técnica de análise de conteúdo categorial temática, na qual foram identificados três núcleos de análise: participação social como espaço de cidadania e formulação de políticas; orientada para a atenção às necessidades coletivas e de tomada de decisão. O estudo revela a participação social como uma possibilidade de ampliação da relação da sociedade civil com o Estado, o qual possibilita a intervenção social na proposição das políticas de saúde. Evidencia-se o direito à saúde articulado à consolidação da democracia na atenção às necessidades e edificação coletiva. The article approaches the comprehension of professionals that act in the mental health area about the movement of construction of social participation in the health system of Fortaleza, Ceará State. The methodology adopted is based upon qualitative approach. The study was developed with semi-structured interviews with 17 mental health professionals of the city above mentioned. The empirical data was analyzed through the technique of thematic content analysis, where it was identified three cores of analysis: social participation as space of citizenship and policy formulation; oriented to attention of collective needs; and decision taking. The study reveals that social participation represents a possibility of amplifying X the relations between the Civil Society and the State, which makes possible the social intervention in proposals of the health policies. It is highlighted the right to health linked to the consolidation of democracy in the attention to the needs and collective edification.

Background The Ugandan government recognizes mental health as a serious public health and development concern, and has of recent implemented a number of reforms aimed at strengthening the country's mental health system. The aim of this study was to provide a profile of the current mental health policy, legislation and services in Uganda. Methods A survey was conducted of public sector mental health policy and legislation, and service resources and utilisation in Uganda, in the year 2005, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2. Results Uganda's draft mental health policy encompasses many positive reforms, including decentralization and integration of mental health services into Primary Health Care (PHC). The mental health legislation is however outdated and offensive. Services are still significantly underfunded (with only 1% of the health expenditure going to mental health), and skewed towards urban areas. Per 100,000 population, there were 1.83 beds in mental hospitals, 1.4 beds in community based psychiatric inpatient units, and 0.42 beds in forensic facilities. The total personnel working in mental health facilities were 310 (1.13 per 100,000 population). Only 0.8% of the medical doctors and 4% of the nurses had specialized in psychiatry. Conclusion Although there have been important developments in Uganda's mental health policy and services, there remains a number of shortcomings, especially in terms of resources and service delivery. There is an urgent need for more research on the current burden of mental disorders and the functioning of mental health programs and services in Uganda.

Este texto visa delinear a relação entre saberes e políticas no campo da saúde mental. Discursos como a “tomada de responsabilidade do serviço pelo território”, o “aumento da responsabilidade do profissional pelo processo de trabalho” e a “possibilidade do sujeito advir como responsável por sua própria condição” são veiculados por diferentes disciplinas, como a psicanálise, a saúde pública e a análise institucional. Esses discursos se conjugam a um momento sócio-histórico particular no Brasil. Acredita-se que a descentralização, preconizada pelas políticas públicas de saúde, desencadeia um processo de “transferência de responsabilidades para unidades locais com concentração de poder em nível central”. Este texto visa delinear la relación entre saberes y políticas en el campo de la salud mental. Discursos como “recibir responsabilidad del servicio por el territorio”, el “aumento de la responsabilidad del profesional por el proceso de trabajo” y la “posibilidad del sujeto advenir como responsable por su propia condición” son vehiculados por distintas disciplinas, como el psicoanálisis, la salud pública y el análisis institucional. Esos discursos se conjugan con un momento socio-histórico particular en Brasil. Se cree que la descentralización, preconizada por las políticas públicas de salud, desencadena un proceso de “transferencia de responsabilidades para unidades locales con concentración de poder en el ámbito central”. Ce texte vise à discriminer la relation entre les savoirs et les politiques dans le champ de la santé mentale. Des propositions telles que “la prise de responsabilité du service par le territoire”, “l’augmentation de la responsabilité du professionnel” et “la possibilité du sujet de devenir responsable de sa propre condition” sont propagées par différentes disciplines, comme la psychanalyse, la santé publique et l’analyse institutionnelle. Ces discours se conjuguent à un moment socio-historique particulier au Brésil. On suppose que la décentralisation proposée par les politiques publiques de santé déclenche un processus de transfert de responsabilité pour les unités locales de santé, avec une concentration de pouvoir au niveau central. This text aims at outlining the relationship between knowledge and policies in mental health. The “shift of responsibility from service to territory”, the “increase of responsibility taken by mental health professionals”, and the “possibility that the subject accounts for his/her own condition” are propositions that spring from different discourses and disciplines, namely psychoanalysis, public health, and institutional analysis. Such discourses refer to a very particular social and historical moment in Brazil. It is believed that decentralization – proposed by public health policies – unchains a process of “transference of responsibility to local health units but keeps the concentration of power in central level”.

Background Approximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia. Methods The WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached. Results All four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities. Conclusions Six gaps which could impact on the policies' effect on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.