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Objective: Communication between patients and mental health professionals by means of messaging platforms in the interval between synchronous encounters became a kind of asynchronous teleconsultation (AT) whose usefulness and effect on providers’ workload have not been explored. Method: Mental health providers working in Argentina were invited to answer a survey exploring the intensity and usefulness of AT, and the resulting overload., Results: A total of 527 responses from professionals working throughout the country were received. As much as 69% of respondents exchanged messages with a mean of 1-10 patients/day and 31% with more than 10 patients/day; 75% answered messages over mobile phones on weekends. While 68% rated these interactions as positive for clinical follow-up, 47% considered them as a source of work overload., Conclusions: The generalized adoption of AT may require additional self-regulation by clinicians and regular monitoring of overload levels (particularly, among psychiatrists) to make their daily clinical practice efficient and sustainable., (CC BY NC ND)

Background: Mental health problems represent a growing global concern. This has intensified since the coronavirus pandemic and is also partly due to greater awareness of the extent of mental health problems and the lack of attention they have received over time. In many high-income countries, increases in service provision have been accompanied by efforts to increase the mental health literacy of the general population. One example of this in Australia, is the mental health first aid training program which is informed by the mental health first aid guidelines created to promote mental health literacy among the general population, reduce stigma, and enable lay people to provide timely support, and facilitate access to health services for a person developing a mental health problem or in a mental health crisis., Methods: Between March 2020 and May 2023, a consortium of researchers from Australia, Argentina and Chile carried out the cultural adaptation of five guidelines (drinking problems, depression, suicide risk, trauma, and psychosis) using the Delphi consensus methodology. Health professionals with expertise in each of the topics and people with lived experience (their own or as informal caregivers) from Argentina and Chile were grouped into separate panels. Over two survey rounds, they evaluated the items from the Australian guidelines and gave their opinion on the importance of their inclusion in the local guidelines. Additionally, they suggested items not included in the Australian guidelines., Results: This report presents the details of the methodology used and the most significant results of each of the five adapted guidelines, particularly, those of relevance to the Argentinian and Chilean context. The general acceptance of the role of the first aider stands out as an important outcome. However, in comparison to Australia, the first aider’s role was reduced and the health professional role was expanded. Self-help recommendations were typically not endorsed by local experts, suggesting skepticism toward these strategies. Other specific recommendations for each of the guidelines are described and analyzed in this report., Conclusions: A study of the implementation of training courses based on these guidelines is required to make the necessary adaptations and determine their local usefulness., (CC BY NC ND)

Background: Neighbors are an important component of personal social network (PSN) and despite their peripheral role and being considered as familiar strangers, they typically provide instrumental support. For people who is discharged after long-term psychiatric hospitalizations, neighbors would offer other types of social support and play a different role fostering the process of becoming full member of a given community., Aims: To analyze the effects of neighboring on both, those who have had long-term psychiatric hospitalizations and their neighbors., Method: Data was collected between 2020 and 2021, including interviews with formal care staff of three housing support experiences in Argentina, and short testimonies from formerly discharged mental health service users living in the community and their neighbors. We analyzed the data using the Framework Method with a focus on the different aspects of social support and equity and reciprocity theories., Results: Results suggest that emotional support was a frequent function displayed by neighbors toward people with a history of long-term psychiatric hospitalizations, which differs from typical neighboring relationships., Conclusions: Despite reciprocity was observed, users and neighbors displayed an unbalanced helping relationship.

Background: Exposure to potentially traumatic events increases the risk of a person developing a mental disorder. Training community members to offer support to a person during and after a traumatic situation may help lower this risk. This study reports on the cultural adaptation of Australian mental health first aid guidelines for individuals exposed to a potentially traumatic event to the Chilean and Argentinian context., Methods: A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of trauma (either their own or as a carer; n = 26) and another one of health professionals (n = 41). A total of 158 items, drawn from guidelines developed by Australian experts in 2019, were translated to Spanish and evaluated in a two-round survey process. The panellists were asked to rate each item on a five-point Likert scale; statements were included in the final guidelines if 80% of both panels endorsed the item as "essential" or "important"., Results: Consensus was achieved on 142 statements over two survey rounds. A total of 102 statements were included from the English-language guidelines, and 40 locally generated statements were accepted in the second round. Local experts endorsed a larger number of items compared to their counterparts in Australia and emphasised the importance of acknowledging the first aider's limitations, both personally and as part of their helping role. Additional items about working as a team with other first responders and considering helping the person's significant others were endorsed by the local panellists., Conclusions: The study showed a high level of acceptance of the original actions suggested for inclusion in the guidelines for Australia, but also a significant number of new statements that highlight the importance of the adaptation process. Further research on the dissemination of these guidelines into a Mental Health First Aid training course for Chile and Argentina is still required., (© 2024. The Author(s).)

Background: Psychotic symptoms may be less common than anxiety or affective symptoms, but they are still frequent and typically highly debilitating. Community members can have a role in helping to identify, offer initial help and facilitate access to mental health services of individuals experiencing psychosis. Mental health first aid guidelines for helping a person experiencing psychosis have been developed for the global north. This study aimed to adapt the English- language guidelines for Chile and Argentina., Methods: A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of psychosis (either their own or as a carer; n = 29) and another one of health professionals (n = 29). Overall, 249 survey items from the original English guidelines and 26 items suggested by the local team formed a total of 275 that were evaluated in the first round. Participants were invited to rate how essential or important those statements were for Chile and Argentina, and encouraged to suggest new statements if necessary. These were presented in a second round. Items with 80% of endorsement by both panels were included in the guidelines for Chile and Argentina., Results: Data were obtained over two survey rounds. Consensus was achieved on 244 statements, including 26 statements locally generated for the second round. Almost 20% of the English statements were not endorsed (n = 50), showing the applicability of the original guidelines but also the importance of culturally adapting them. Attributions and tasks expected to be delivered by first aiders were shrunk in favour of a greater involvement of mental health professionals. Self-help strategies were mostly not endorsed and as were items relating to respecting the person's autonomy., Conclusions: While panellists agreed that first aiders should be aware of human rights principles, items based on recovery principles were only partially endorsed. Further research on the dissemination of these guidelines and development of a Mental Health First Aid training course for Chile and Argentina is still required., (© 2024. The Author(s).)

Background: Suicide continues to pose a significant global public health challenge and ranks as one of the leading causes of death worldwide. Given the prevalence of suicide risk in the community, there is a significant likelihood of encountering individuals who may be experiencing suicidal thoughts or plans, creating an opening for non-health professionals to offer support. This study aims to culturally adapt the original Australian Mental Health First Aid Guidelines for suicide risk to the Chilean and Argentine context., Methods: A two-round Delphi expert consensus study was conducted involving two panels, one comprising individuals with personal experience in suicide thoughts/attempts or caregiving for those with such experiences (n = 18), and the other consisting of professionals specialized in suicide assessment and support for individuals at risk (n = 25). They rated a total of 179 items mainly derived from guidelines developed by Australian experts and translated into Spanish (168), and new items included by the research team (11). The panel members were requested to assess each item utilizing a five-point Likert scale. During the second round, items that received moderate approval in the initial round were re-evaluated, and new items suggested by the local experts in the first round were also subjected to evaluation in the next round. Inclusion in the final guidelines required an 80% endorsement as "essential" or "important" from both panels., Results: Consensus of approval was reached for 189 statements. Among these, 139 statements were derived from the English-language guidelines, while 50 locally generated statements were accepted during the second round. A significant difference from the original guideline was identified concerning the local experts' reluctance to discuss actions collaboratively with adolescents. Furthermore, the local experts proposed the inclusion of an entirely new section addressing suicide risk in older individuals, particularly focusing on suicide methods and warning signs., Conclusions: A Delphi expert consensus study was conducted to culturally adapt mental health first aid guidelines for assessing suicide risk in Chile and Argentina. This study involved professionals and individuals with lived experience. While many items were endorsed, some related to inquiring about suicide risk and autonomy, particularly for adolescents, were not. An additional section for older individuals was introduced. Future research should explore the implementation and impact of these adapted guidelines in training courses. This is vital for enhancing mental health support and implementing effective suicide prevention strategies in Chile and Argentina., (© 2023. The Author(s).)

This article presents the results of a qualitative study conducted to understand the barriers and facilitators in implementing a pilot trial of Critical Time Intervention-Task-Shifting-a time-limited, community-based, recovery-oriented intervention for individuals with psychosis-in Rio de Janeiro, Brazil, and Santiago, Chile. Data included 40 semi-structured interviews with service users, task-shifting providers, and administrators. Analysis proceeded in three iterative phases and combined inductive and deductive approaches. Coding frameworks for implementation factors, and whether or not they acted as barriers and facilitators, were developed and refined using many domains and constructs from the Consolidated Framework for Implementation Research. Barriers and facilitators were ultimately grouped into five domains: 1-Personal; 2-Interpersonal; 3-Intervention; 4-Mental Health System; and 5-Contextual. A rating system was also developed and applied, which enabled comparisons across stakeholders and study sites. Major facilitators included intervention characteristics such as the roles of the task-shifting providers and community-based care. Top barriers included mental health stigma and community conditions (violence). Nevertheless, the findings suggest that Critical Time Intervention-Task-Shifting is largely acceptable and feasible, and could contribute to efforts to strengthen community mental health systems of care for individuals with psychosis in Latin America, especially in advancing the task-shifting strategy and the recovery-oriented approach., Competing Interests: Conflict of interest The authors have no competing interests to declare that are relevant to the content of this article.

A psychiatric reform is underway in Latin America and the Caribbean. Specifically in Argentina, a model of community mental health is being built, and prolonged psychiatric hospitalizations are still taking place, especially in neuropsychiatric hospitals. Therefore, it is necessary to closely monitor the psychiatric reform. One of the possible ways to monitor the reform is by analyzing society's attitudes towards prolonged psychiatric hospitalization as a mean of mental health treatment. Thus, an analytical observational study was conducted at the Buenos Aires Province, Argentina, in 2021, to analyze the behavior of neighbors of people who had prolonged psychiatric hospitalizations and who received housing support. Questionnaires were applied to neighbors and non-neighbors, addressing the behaviors toward prolonged psychiatric hospitalization as a mean of treatment, social distance toward people who were hospitalized, as well as specific interviews with key informants from neighborhoods where people with severe mental health disorders and who receive housing support live. Based on the answers of neighbors and non-neighbors, no statistically significant differences were identified in behaviors toward prolonged psychiatric hospitalization as a mean of treatment, nor for social distance in relation to people who were hospitalized. Key informants conditioned their assessment of prolonged hospitalization and valued the role of support teams in making community life viable.

Background: Lockdowns have been one of the government's primary measures to control COVID-19, especially during the initial waves of the pandemic, but there is concern on the impact of lockdowns on people's mental health. Confinement is still today the reality of many people with severe mental illness in many places of the world., Objective: Given that the general population experienced confinement during the COVID-19 pandemic, we sought to explore if that affected perceptions about long-term psychiatric hospitalizations., Methods: About 134 residents from middle-class neighborhoods in urban settings in the Province of Buenos Aires, Argentina, were surveyed. Participants were asked if they felt emotionally affected by the pandemic and lockdown, and about their perceptions of long-term psychiatric hospitalizations. Association between personal emotional impact by the pandemic or lockdown with perceptions about long-term psychiatric hospitalization were analyzed using chi-square test. Qualitative analysis of pandemic and lockdown effects was held., Results: Respondents tended to overlap the emotional effects of the pandemic and the lockdown. Some responses explicitly referred to confinement. No association was observed between emotional impact by the pandemic or lockdown and perceptions about long-term psychiatric hospitalization among the sample. The general population's perceptions of long-term psychiatric hospitalization do not appear to be affected by the first-hand experience of confinement, which suggest persistence of stigma, and the need to reconsider public policies and actions that attempt to impact on it.

Background: Depression is one of the most common mental health problems worldwide and, while prevalence rates in Latin America are relatively high, most people who meet the criteria for diagnosis do not receive treatment. Family and friends of a person with depression can play an important role in supporting a person to seek and engage with treatment. However, many people do not have the necessary skills or confidence to help. English-language mental health first aid guidelines have been developed to support people to provide such help. The aim of this study was to culturally adapt these guidelines for Chile and Argentina., Methods: A Delphi expert consensus study was conducted with two expert panels, one of people with lived experience of depression (either their own or as a carer; n = 26) and one of health professionals (n = 29). Overall, 172 statements from the English-language guidelines were translated and compiled into a questionnaire. Participants were asked to rate statements based on how essential or important those statements were for Chile and Argentina and to suggest new statements if necessary., Results: Data were obtained over two survey rounds. Consensus was achieved on 172 statements. A total of 137 statements were adopted from the English-language guidelines, whereas 35 new endorsed statements were generated from panel suggestions. There were similarities between the English-language guidelines and those for Chile and Argentina. The adapted guidelines did not include some of the items from the English-language guidelines related to commenting on a person's strengths or making judgements about their character, and also incorporated new items related to the incorporation of sociocultural considerations as causes of depression and attention to inequities in mental health., Conclusions: The significant number of new items underscores the importance of undertaking a careful process of cultural adaptation. Further research on dissemination and incorporation of the guidelines into the Mental Health First Aid training course for Chile and Argentina is still required., (© 2023. The Author(s).)

Objetive: To characterise the impact of the COVID-19 pandemic on psychiatric hospitalisations in the Latin American and Caribbean (LAC) region., Methods: Descriptive study. 85 semi-structured interviews were conducted with health workers involved with psychiatric hospitalisations in general hospitals (GHs) and specialised psychiatric hospitals (SHs) from 18 LAC countries. The interviews were done between 8 May and 30 June 2020. The data were analysed quantitatively and qualitatively., Results: An initial decrease in the demand for hospitalisation is reported, attributed to the population's fear of approaching health services as well as restrictions on mobility. Stricter criteria for hospitalisation were reported with a double focus on the acute within the acute. The length of hospitalisations were mixed, with both increases and decreases in GHs and SHs. The therapeutic offer was drastically reduced, and interaction between hospitalised people and their support networks was restricted., Conclusions: In the COVID-19 context, hospitalisation seems to be not the last but the only alternative for psychiatric treatment. The decrease in the number of beds in SHs could be a positive aspect for the reform of psychiatric care, but it is questioned since this reduction also occurs in GHs., (© 2021 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: The personal impact of COVID-19 on mental health care workers (MHWs) has received scarce attention despite their work addressing the emotional wellbeing of those affected by the pandemic. This study aims to analyze Latin American and Caribbean's MHWs' subjective impact in connection to working during the initial times of the pandemic. Methods: One hundred and fifty-five persons ( n = 155) from seventeen countries were contacted in May-June 2020 through a snowball approach. Complementary methodological strategies of analysis used for data triangulation included content analysis, thematic analysis, and interpretative phenomenological analysis. Results: Participants reported feelings of fear, anxiety, anguish, and fatigue. Milder negative impacts (e.g., uncertainty, concern), and complex feelings (e.g., ambivalence) were also frequent. One third of participants acknowledged their capacity to learn from this situation and/or experience satisfaction. Conclusion: Mental health of MHWs in Latin America and the Caribbean were under severe strain and the ongoing mental health reforms at risk during the pandemic's beginning. More research and additional care may be needed to offer support to those involved in caring for the wellbeing of others., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Agrest, Rosales, Fernández, Kankan, Matkovich, Velzi-Díaz and Ardila-Gómez.)

Background: Affective polarization and stigma toward individuals with schizophrenia and toward immigrants in Argentina are not new despite its importance and dissemination. However, no research has been conducted taking into consideration political partisanship and attitudes toward these groups., Aims: Political polarization and attitudes toward socialization across party lines are studied in conjunction with attitudes toward immigrants and toward individuals with schizophrenia., Method: Individuals from Buenos Aires ( n  = 712) were surveyed for their political partisanship and their attitudes toward Peruvian and Bolivian immigrants, people with schizophrenia and partisans from the opposing political party. A modified version of the Bogardus scale was used., Results: Social distance was from highest to lowest toward people with schizophrenia, political opponents, and immigrants. Individuals with schizophrenia were strongly discriminated against by most participants: 86% would definitely or probably not want them to take care of their children, 83% would not want them to be their healthcare provider, and 81% would not want to marry them. Immigrants were comparatively not discriminated against: 10% would not want them to take care of their children, 8% would not want to receive health care from them, and 28% would not want to marry them. Cristina Fernández de Kirchner partisans showed the lowest level of discrimination toward these two groups, compared to Mauricio Macri partisans and to independent voters. However, the former group had greater discriminatory attitudes toward Mauricio Macri partisans than the latter., Conclusions: As compared to other discriminatory attitudes, discrimination toward persons with schizophrenia is widespread and pervasive. Lower levels of discrimination toward people with schizophrenia and toward immigrants would not predict attitudes toward the opposing political partisans.

Background: Among all psychoactive substances, alcohol consumption presents the most significant public health problem and is a leading risk factor for overall disease burden in Latin America. However, most people who meet criteria for a substance use disorder do not receive treatment in primary or secondary care sources. Community members can play a role in helping people to seek help as they are likely to encounter people experiencing problem drinking and recognize the signs. However, many do not have adequate mental health first aid knowledge or skills to provide help. We aimed to culturally adapt the existing English-language mental health first aid guidelines for helping someone with problem drinking for Argentina and Chile., Methods: The Delphi consensus method was used to determine the importance of helping actions translated from the English-language guidelines and to add new actions suggested by expert panellists. The importance of each statement was rated by two expert panels. Panel one included people with lived experience (either their own or as a support person, n = 23) recruited in Argentina and panel two included health professionals (n = 31) recruited in Argentina and Chile., Results: Overall, 165 helping actions were endorsed by panellists across two consecutive survey rounds. Endorsed items included 132 of the 182 items translated into Spanish from the English-language guidelines and 33 of the 61 new items generated from panellists' comments in the first survey round., Conclusions: While there were some similarities in recommended helping actions between English-speaking countries, and Argentina and Chile, key differences were seen in attitudes to low-risk drinking. While there was a relatively high level of agreement between health professionals and people with lived experience, some divergence of opinion was seen, particularly in the area of commitment to recovery as a condition for help. Future research should explore the implementation of the guidelines., (© 2022. The Author(s).)

This study explores the beliefs and attitudes about the psychosocial mechanisms of peer support work among users who participated in Critical Time Intervention-Task Shifting (CTI-TS), which tested the acceptability and feasibility of a peer support work model to improve community-based mental health care for individuals with psychosis in Latin America. We conducted a secondary analysis of 15 in-depth interviews with CTI-TS participants in Chile, using the framework method and defined the framework domains based on five major mechanisms of peer support work identified by a recent literature review. The analysis revealed that users' perceptions of peer support work mechanisms were strongly shaped by personal motivations, beliefs about professional hierarchies, familial support, and the Chilean mental health system's incipient recovery orientation. The findings underscore the importance of adopting culturally tailored strategies to promote peer support work, such as involving mental health professionals and fostering equal-powered relationships between PSWs and users., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

Introduction: The impact of the COVID-19 pandemic on health workers has been studied on an international level. However, mental health workers, who are also called upon to address such ailments both in the general population as well as in the health personnel, have not been asked about their experiences., Methods: Seventy mental health workers in five regions of Argentina were interviewed between May and June 2020 regarding the subjective impact of changes in their work due to the pandemic. The responses were analyzed quantitatively and qualitatively., Results: The results indicate emotions and experiences associated with a negative impact, in connection to feelings of tiresome, uncertainty, fear, anguish and anxiety and, to a lesser extent, some positive impacts are also described. More than a third of participants mentioned mixed feelings (i.e., being surprised, ambivalent, alert and sensitive)., Conclusions: The personnel who are supposed to support the rest of the health workers are affected and experience having been relegated one more time to other aspects within the health care system. Focusing on learnings, having management roles, counting on colleagues, and agreeing with macro policies could be protective factors against the difficulties associated with the changes in work that the pandemic has imposed., Competing Interests: The authors have no conflicts of interest to declare.

Background: Few studies provide clear rationale for and the reception of adaptations of evidence-based interventions. To address this gap, we describe the context-dependent adaptations in critical time intervention-task shifting (CTI-TS), a manualized recovery program for individuals with psychosis in Rio de Janeiro, Brazil and Santiago, Chile. Implications of the adaptations - incorporating a task-shifting approach and modifying the mode of community-based service delivery - are examined from users' perspectives., Methods: A secondary analysis of in-depth interviews with CTI-TS users ( n = 9 in Brazil; n = 15 in Chile) was conducted. Using the framework method, we thematically compared how participants from each site perceived the main adapted components of CTI-TS., Results: Users of both sites appreciated the task-shifting worker pair to provide personalized, flexible, and relatable support. They wanted CTI-TS to be longer and experienced difficulty maintaining intervention benefits in the long-term. In Chile, stigma and a perceived professional hierarchy toward the task-shifting providers were more profound than in Brazil. Engagement with community-based services delivery in homes and neighborhoods (Chile), and at community mental health centers (Brazil) were influenced by various personal, familial, financial, and social factors. Uniquely, community violence was a significant barrier to engagement in Brazil., Conclusion: CTI-TS' major adaptations were informed by the distinct mental health systems and social context of Santiago and Rio. Evaluation of user experiences with these adaptations provides insights into implementing and scaling-up task-shifting and community-oriented interventions in the region through the creation of specialized roles for the worker pair, targeting sustained intervention effects, and addressing socio-cultural barriers., (© The Author(s) 2021.)

The mental health users' movement is a worldwide phenomenon that seeks to resist disempowerment and marginalisation of people living with mental illness. The Latin American Collective Health movement sees the mental health users' movement as an opportunity for power redistribution and for autonomous participation. The present paper aims to analyze the users' movement in Argentina from a Collective Health perspective, by tracing the history of users' movement in the Country. A heterogeneous research team used a qualitative approach to study mental health users' associations in Argentina. The local impact of the Convention on the Rights of Persons with Disabilities and the regulations of Argentina's National Mental Health Law are taken as fundamental milestones. A strong tradition of social activism in Argentina ensured that the mental health care reforms included users' involvement. However, the resulting growth of users' associations after 2006, mainly to promote their participation through institutional channels, has not been followed by a more radical power distribution. Associations dedicated to the self-advocacy include a combination of actors with different motives. Despite the need for users to form alliances with other actors to gain ground, professional power struggles and the historical disempowerment of 'patients' stand as obstacles for users' autonomous participation.

Background: Latin America, and Chile in particular, has a rich tradition of community mental health services and programs. However, in vivo community-based psychosocial interventions, especially those with a recovery-oriented approach, remain scarce in the region. Between 2014 and 2015, a Critical Time Intervention-Task Shifting project (CTI-TS) was implemented in Santiago, Chile, as part of a larger pilot randomized control trial. CTI is a time-limited intervention delivered at a critical-time to users, is organized by phases, focuses on specific objectives and decreases in intensity over time. CTI-TS, which combines both the task-shifting strategy and the use of peers, introduces a novel approach to community mental health care that has not yet been tried in Chile., Aims: We aim to evaluate the feasibility, acceptability and applicability of such a community-based psychosocial intervention in urban settings in Latin America - specifically, in Santiago (Chile) from a user perspective., Method: We analyzed 15 in-depth interviews ( n = 15) with service users who participated in the intervention about their perceptions and experiences with CTI-TS through thematic analysis., Results: Three themes were revealed. The first was related to the structural characteristics of CTI-TS, especially regarding the timing, duration and phasic nature of the intervention. The second pertained to the acceptability of the in vivo community-based approach. The third theme dealt with the task-shifting aspect, that is, users' perceptions of the peer support workers and the community mental health workers., Conclusions: CTI-TS was generally acceptable in this Latin American context. Users' perspectives pointed to the need to make adjustments to some of the structural characteristics of the CTI model and to combine this type of intervention with others that can address stigma. Thus, future adaptations of CTI-TS or similar psychosocial interventions in Latin American contexts are feasible and can enhance community mental health in the region.

This paper describes and analyzes the psychiatric reform process in three Latin American countries (Brazil, Chile and Colombia) based on the Caracas Declaration of 1990. It compares the psychiatric reform processes in these three countries and highlights the role of national mental health laws in these processes. Our goal when investigating the experiences in other countries of Latin America is to draw conclusions for the Argentine psychiatric reform and for the future of such reforms in the region.

Background: Scarce information is available about how users experience treatment at mental health day hospitals, particularly in South America., Aims: To explore users' perspectives about elements of day hospital treatment that facilitate or hinder the recovery process in a mental health facility in Buenos Aires, Argentina., Methods: Semi-structured individual interviews (n = 8) and focus groups (n = 4) were carried out with a convenience sample of users of a mental health day hospital program based on a formulation, testing and redevelopment of propositions approach. Results were analyzed through grounded theory techniques., Results: Categories indicating recovery were: starting to do things, being able to see themselves from a new perspective, mood improvement and changes in interpersonal relationships. Aspects facilitating recovery were: activities organized by the facility, the group approach, the care provided by facility workers and the physical environment. Hindering aspects were: heterogeneity of users in terms of age, severity, diagnosis and being underestimated by staff., Conclusions: Being active again was considered to be the main recovery indicator in this cultural context and participating in activities led by skilled facilitators was the most beneficial factor of the program according to the users.

The concept of "recovery" is still controversial as to what its principal components/dimensions are. From the perspective of a mental health professional, recovery is related to a clinical improvement and to a higher functioning. However, from a users' perspective, its major component is related to hope and having a meaningful life. The present paper analyses recovery by studying English and Spanish scales designed to measure recovery. A total of 44 recovery scales were found, of which only 19 had been made public, evaluated personal recovery from a users' perspective, used a Likert scale for all items and could be adapted to different contexts. The existential dimension (i.e., hope, self-esteem) was addressed by 84% of scales, but only 47% of scales had items tapping on social functioning (i.e., daily life activities). A broad dimension related to general aspects of health, illness management and seeking for treatment, named as "health-sickness continuous", was addressed by 63% of the scales. A fnal category of social and family relationships (including connectedness) was addressed by 58% of scales. According to our fndings, scales evaluating personal recovery are organized in terms of privileging a vision of recovery centered on hope over symptomatology or social functioning, posing a severe challenge to articulating results obtained from recovery scales, with other professional instruments used for mental health evaluation.

Recovery narratives and first-person accounts of people living with mental disorders are not really new. Nevertheless, scarce attention has been paid to them by mental health professionals. What is it like to live with a mental disorder, receive a diagnosis, or hide previous experiences of treatment in mental health centers or with psychiatric medication in the context of a job interview or trying to start a relationship with another person? What is it like to learn new coping strategies, to be able to contribute to society and to assume an identity that neither denies the pathology nor is reduced to it? These narratives are analysed in order to stablish both the novelty in their production, and who and how could benefit from them. In addition, mental health professionals could challenge their illusions based on the continuous bias of working with people during the exacerbation of their symptoms, but barely seeing those who have been able to make significant progress in their recovery processes.

Studies regarding stigma towards mental illness in Argentina blossomed after the first National Mental Health Law was passed in 2010. Methodological limitations and contradictory results regarding community perceptions of stigma hinder comparisons across domestic and international contexts but some lessons may still be gleaned. We examine this research and derive recommendations for future research and actions to reduce stigma. These include tackling culture-specific aspects of stigma, increasing education of the general population, making more community-based services available and exposing mental health professionals to people with mental illness who are on community paths to recovery., Competing Interests: Conflict of interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The present paper reviews some psychotherapy's features through the light of it's alleged supposedly invariant usefulness and incapacity to harm consultants. Differences between general health field and mental health field are discussed with the assistance of the concepts of necessity, supply and demand, in order to understand psychotherapeutic supply dynamics. Its use with non-diagnosed clients and the explicit decission to give assistance to people ailed with discomfort are discussed based on international studies on prevalence and efficacy of psychotherapy. Its harmfulness, underreporting by psychotherapists and specific proposals to reduce it are reviewed. Some considerations regarding psychotherapy as part of the health field are discussed.

Including peers to the mental health workforce has been part of a larger debate regarding specificity and incumbencies of peers' work, as well as their relationship with other workers. While some members of the workforce are proposing to train peers to have them help in different settings and interventions, others see them as unfair and underprepared competitors trying to replace them. Based on this debate, and from a Collective Health perspective on the concept of "care", this paper supports the idea that, since they put "care" as central to anything done by the mental health workforce, peers could be crucial to practices in Mental Health. An experience that took place in a Day Hospital in Buenos Aires City, conversed within a group dedicated to reflect on peers' support, is analyzed in order to unveil the relationship between peers and professionals, as well as peers' specificity. It is withstand that one of the main contributions of including peers is to help professionals think more about the relational dimension of their work and about the way they treat, call and refer to patients.

Users' participation in mental health services isn't precisely a novelty but its recent form is that of a movement impossible to imagine twenty years ago. The present paper distinguishes the terms "consumer", "client", "patient" and "user", as well as "participation", "perspective", "inv olvement" and "users' control of services". Some historical milestones are described and also the relationship between users' movement and the recovery concept, the Human Rights doctrine and the development of Post Psychiatry. Self-help and mutual-aid groups, participation in planning, provision and evaluation of services, and also in selection and training of mental health professionals are pointed as the main types of participation. Some aspects of the local users' movement are also depicted. Finally, the personal narratives are presented as potentially subjectivity creators and ways of coming out of isolation and fighting stigma.

The present paper develops the concept of recovery and its relationship with clinical aspects or symptomatic remission, as well as with other dimensions such as the experiential, physical, functional and social ones. Internal and external factors conditioning recovery are reviewed giving special emphasis to stigma, a powerful external factor that deeply affects recovery in mental illness. Users' perspective and participation in this process are considered to be essential and are compared to their place in traditional psychopharmological and psychotherapeutic treatments. As a conclusion, it is mentioned that users' participation movement and the concept of recovery could be central axes of mental health services and a turning point of a service delivery transformation for the next decades.

The diagnosis of "hysteria" has recently become part of the history of Psychiatry. Although fully trained dynamic psychiatrists, followers of psychoanalytic theories, still make use of some clinical and theoretical production upon hysteria, for many of the young psychiatrists this term has disappeared from their scope. They only know of dissociative disorders, somatoform disorders and histrionic personality disorders, or they rather distinguish other diagnosis with which hysteria could be mistaken for. Despite the diagnosis of hysteria has been removed from the DSM, the difficulties these patients frequently imposed to physicians still prevail.

Background: although psychopharmacotherapy and psychotherapy are very frequent in Buenos Aires city and its surroundings, there is no data about their combination., Method: an anonymous survey was used to bring up psychiatrists and psychotherapists opinions upon combined, integrated and split treatments., Results: 411 persons answered the survey; 95% of all psychiatrists and 91% of the psychotherapists had any kind of experience sharing treatments; 63% of psychiatrists' patients received a combination of psychopharmacological and psychological treatments; the condition of being a biological or dynamical psychiatrist showed to be related to the percentage of patients to which they only prescribed medication and to the percentage of patients under integrated treatments; on a 1 to 5 points Likert scale, the psychiatrist and psychotherapists assigned an average of 4,2 and 4,1 points respectively to the utility of shared treatments. 35% of the patients treated by psychotherapists also received medication; criticisms to how the psychiatrists do their job were different depending on the psychotherapists theoretical orientation., Conclusions: triangular devices (between patients, psychiatrists and psychotherapists) are very frequent in Buenos Aires city and its surroundings, presenting important differences depending on the theoretical orientation of psychiatrists and psychotherapists. Their understanding and the preparation for the performance within them will have to be a priority in the curriculum of these professionals.

Departing from Daniel Dennett's and Douglas Hofstadter's ideas, the present paper explores what the self and consciousness are and puts forward a possible explanation of their relationship with the brain. The paper deconstructs the illusions of my self and those of my consciousness, how they are produced and which the key elements to understand our reluctance to see ourselves as brains are. The self is considered a powerful myth but, at the same time, from a functionalist perspective, also an indispensable device in our daily life and in our explanations about others and about ourselves.

The cinematographic version of the science fiction classical book by Isaac Asimov (I, Robot) is used as a starting point, from the Artificial Intelligence perspective, in order to analyze what it is to have a self. Uniqueness or the exchange impossibility and the continuity of being one self are put forward to understand the movie's characters as well as the possibilities of feeling self conscious.

The present paper analyzes the combination of psychiatric and psychological treatments, exploring the clinical aspects that turn them into split or collaborative treatments. A historical sketch is presented and the current state of the psychiatrist-psychotherapist relationship is depicted, putting special emphasis on the frequent causes of tension usually hard to resolve. Two case vignettes are put forward to shed light on how combined treatments are much more than a simple addition of medication and psychotherapy, including subtle and complex aspects of both professionals work and a particular relationship between them.

Objective: This paper addresses the issue of monitoring the features of the psychiatric inpatient population of a Prepaid Medical System in Buenos Aires City, paying special attention to its length of stay, diagnosis and readmission rate., Method: Between april 1 2000 and march 31 2002 all the psychiatric admissions have been registered and readmission rates and diagnosis prevalence were studied in a naturalistic setting., Results: There were 244 admissions (0.8 per thousand enrollees per year) and 17% was readmitted during this period (1 out of every 4 readmissions in the month following discharge). Their length of stay was an average of 11,8 days. 66% was admitted due to a suicidal attempt or suicidal thoughts. 42% had a discharge diagnosis of Mood disorder, 34% Personality disorder and 12% Schizophrenia or other psychosis., Conclusions: Inpatients belonging to this Prepaid Medical System seem to be different from other inpatient populations making the comparison among them hard to analyze. Future research should bring more data in order to perform further matching and benchmarking. This kind of information should be no secret and every System should be requested to show its results to allow users' and buyers auditory as well as State's control.

Once the parameters to design and assess a Mental Health System have been put forward it's necessary to operationalize them into quality indicators and outcome measures. These indicators allow us to compare processes and results with other systems and services, they let us do the economic assessment and the allotment of resources, they give way to treatment guidelines and external evaluation, generating a new type of organizations evidence-based. This paper reviews the conceptual aspects of performance indicators and its use in some developed countries. It also discusses their usefulness, at the input, the process and the outcome level, to treat patients and to organize Mental Health Services and Systems. Despite therapists not benefiting directly from the use of this type of indicators, its importance should not be disregarded in order to organize a Mental Health System for large populations.

Objective: To assess the subjective perception of Clinical Psychology and Psychiatry Residents from Buenos Aires regarding their training in the year 2000., Methodology: During the Seventh Annual Meeting of Mental Health Residents from the metropolitan area of Buenos Aires, an anonymous and self completed survey was carried out by Clinical Psychology and Psychiatry Residents. These quantitative results were combined with a qualitative analysis of Residents' papers published in a previous article., Results: 62% of the sample answered the survey. 90% of Clinical Psychology Residents and 77% of Psychiatry Residents are satisfied with their clinical training. Regarding their theoretical training, Psychology and Psychiatry Residents are pleased in 52% and 43% of cases respectively. Both think clinical presentations are more important to share than clinical practice itself. Only 6% see themselves as being prepared for conducting any kind of research. Mental Health Residents desire and believe that it is possible to work in private practice at the end of their training and only 36% of cases see the hospital as part of their future work., Conclusions: Psychiatry Residents are increasingly separating themselves from the Psychologists with an increased satisfaction with their training. This transformation has taken place simultaneously with a greater compromise of Mental Health Residents with the activities that gather all Metropolitan Area Residents and an updated psychiatric curricula