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In the past people suffering from some mental disorders were seen as subjects taken by evil forces. At another time, they were seen as insane and expunged from their own family, being isolated in their own homes. Over time, places were set up to allocate these persons, future psychiatric hospitals, and persons with mental disorders, who committed crimes, to confinement in Hospital of Custody and Psychiatric Treatment (HCTP), which in essence groups hospital characteristics and of prison. The general objective of this research was to understand the meaning of family for different social actors within HCTP. The specific objectives were to allow the expression of nine subjects through expressive activity on family; To understand the perception about the family of these inmates from the point of view of the reference team and to describe the professionals' perception of the work performed within the HCTP. For this, a qualitative methodology was used with a socio-historical theoretical-methodological basis, and for the data collection the open interview technique was used. The results make clear the importance of the profession in this environment for the maintenance of the occupational roles within the family context, providing the maintenance or the strengthening of the same ones, allowing a better adhesion of the inmates to the treatment within the HCTP, treatment that often can bring disbelief To the professionals, because of constant recidivism, of the own attitudes of the inmate, besides the difficulty of the continuity of the treatment when leaving the HCTP, due to the own network. En el pasado, las personas que padecían algún trastorno mental eran vistas como sujetos dominados por fuerzas del mal. En otro momento, los tomaron por locos y los purgaron de su propio entorno familiar, quedando aislados en sus propios hogares. Con el tiempo, se crearon plazas para destinar a estas personas, los futuros hospitales psiquiátricos, y para las personas con trastornos mentales, que han cometido delitos, el internamiento en un Hospital de Custodia y Tratamiento Psiquiátrico (HCTP) que, en esencia, agrupa las características hospitalarias y de prisión. El objetivo general de esta investigación fue comprender el significado de familia para diferentes actores sociales dentro del HCTP. Los objetivos específicos fueron permitir la expresión de nueve sujetos a través de la actividad expresiva sobre la familia; comprender la percepción de la familia de estos internos desde la perspectiva del equipo de referencia y describir la percepción de los profesionales sobre el trabajo que realizan dentro del HCTP. Para ello se utilizó una metodología cualitativa con fundamento teórico-metodológico sociohistórico, y para la recolección de datos se utilizó la técnica de entrevista abierta. Los resultados evidencian la importancia de la profesión en este entorno para el mantenimiento de los roles ocupacionales dentro del contexto familiar, previendo el mantenimiento o fortalecimiento de los mismos, permitiendo una mejor adherencia de los internos al tratamiento dentro del HCTP, un tratamiento que puede Muchas veces llevan a la incredulidad de los profesionales, debido a las constantes recaídas, las propias actitudes del interno, además de la dificultad para continuar el tratamiento cuando salen del HCTP, debido a la propia red. No passado as pessoas que sofriam de algum transtorno mental eram vistas como sujeitos tomados pelas forças malignas. Em outro momento, tidas como loucas e expurgadas do seu próprio seio familiar ou sendo isoladas nas suas próprias casas. Com o passar do tempo foram criados lugares para alocar essas pessoas, os futuros hospitais psiquiátricos, e para pessoas com transtornos mentais, que cometeram delitos, a reclusão em Hospital de Custódia e Tratamento Psiquiátrico (HCTP) que em sua essência, agrupa características hospitalares e de presídio. O objetivo geral desta pesquisa foi compreender o significado de família para diferentes atores sociais, dentro do HCTP. Os objetivos específicos foram permitir a expressão de nove sujeitos por meio de atividade expressiva sobre família; compreender a percepção sobre família desses internos sob a ótica da equipe de referência e descrever a percepção dos profissionais quanto ao trabalho realizado dentro do HCTP. Para isto utilizou-se da metodologia qualitativa com base teórico-metodológica sócio-histórica, e para a coleta de dados foi utilizada a técnica de entrevista aberta. Os resultados deixam claro a importância da profissão nesse ambiente para a manutenção dos papéis ocupacionais dentro do contexto familiar, proporcionando a manutenção ou o fortalecimento dos mesmos, permitindo uma melhor adesão dos internos ao tratamento dentro do HCTP, tratamento este que muitas vezes pode trazer descrença aos profissionais, por conta de constantes reincidências, das próprias atitudes do interno, além da dificuldade da continuidade do tratamento quando saem do HCTP, devido à dificuldade da própria rede.

Accessible Summary What is known on the subject? Humanizing the world of health is a complex process that includes all the dimensions of the person. When a person has from a mental illness, the humanization of care becomes more important, as the disorder itself prevents the person to participate in their health process, even when showing self-harm or aggressive behaviours. These situations jointly with other factors related with professionals (insufficient ratio, inadequate treatment or lack of training) may cause the patient admitted to the acute psychiatric hospitalization unit to require the use of restrictive measures (involuntary admissions, mechanical restraints or forced administration of medication). What the paper adds to existing knowledge? We identify the relevance of the perception the patient and family have regarding the care received, as well as the relevance of factors related to the professionals, among which the attitude, the staff ratio, the nursing time of direct dedication, and the therapeutic environment and safety of the patient and the professionals. All patients must be treated with dignity, respect, regardless of the aggressive manifestations caused by their pathology. What are the implications for practice? A greater understanding of the care offered to admitted people affected by a mental disorder, their families and professionals who care for them in acute mental health units, giving greater importance to "caring" and not exclusively to "curing." Introduction Humanization in Mental Health refers to give the same relevance to the clinical needs and to the social, emotional and psychological needs. Aim To identify the published knowledge on current care models related to the humanization of care in acute psychiatric units. Method Scoping review based on the methodological model of Arksey and O'Malley, and PRISMA methodology. Database searches (Pubmed, Cinahl, Virtual Library, Cuiden, Academic Google and PsycInfo) with the terms: "Humanization," "Hospitals Psychiatric," "Emergency Psychiatric," "Psychiatric Service" and "Psychiatric intensive care units." Results Twenty-two articles met the inclusion criteria. Four thematic units were identified: aspects related to (i) patient perceptions; (ii) Government policies and hospitality organizational culture; (iii) external factors such as the environment, family or associations; and (iv) safety and security. Discussion Only one of the articles mentions the concept analysed, although all of them contribute with key aspects of healthcare humanization, such as the empowerment of the patient, the care model, the staff ratio, the therapeutic relationship, the nursing time of direct dedication to the patient, the therapeutic environment, safety and patient and staff perception of feeling safe. Implications for Practice The present study can help to improve the care offered in acute mental health units.

WHAT IS KNOWN ON THE SUBJECT?: Humanizing the world of health is a complex process that includes all the dimensions of the person. When a person has from a mental illness, the humanization of care becomes more important, as the disorder itself prevents the person to participate in their health process, even when showing self-harm or aggressive behaviours. These situations jointly with other factors related with professionals (insufficient ratio, inadequate treatment or lack of training) may cause the patient admitted to the acute psychiatric hospitalization unit to require the use of restrictive measures (involuntary admissions, mechanical restraints or forced administration of medication). WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We identify the relevance of the perception the patient and family have regarding the care received, as well as the relevance of factors related to the professionals, among which the attitude, the staff ratio, the nursing time of direct dedication, and the therapeutic environment and safety of the patient and the professionals. All patients must be treated with dignity, respect, regardless of the aggressive manifestations caused by their pathology. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A greater understanding of the care offered to admitted people affected by a mental disorder, their families and professionals who care for them in acute mental health units, giving greater importance to "caring" and not exclusively to "curing." DDEUIT

The patient with mental disorder may experience an accelerated aging process when compared to the general population. Psychiatric hospitalization is a moment of disruption of mental function, which can contribute to the worsening of pre-existing clinical conditions, or even the emergence of comorbidities, increasing the complexity of the patient's condition. This study aimed to investigate the health care demands of aging patients with mental disorders. Quantitative approach, with temporal cut and use of simple descriptive statistics and measures of central tendency in data analysis. It was possible to prove, through the collected medical records, that almost half of the patients had clinical diagnosis and/or health problems related to physical problems. Considering the complexity of care towards aging patients with mental disorders, which can present comorbidities of physical nature, it is important to identify physical health problems early, as well as to prevent chronic non-communicable diseases, during and after hospitalization. El paciente con trastorno mental puede experimentar un proceso de envejecimiento acelerado en comparación con la población general. La hospitalización psiquiátrica es un momento de alteración de la función mental, que puede contribuir al empeoramiento de condiciones clínicas preexistentes, o incluso al aparecimiento de comorbilidades, aumentando la complejidad de la condición del paciente. Este estudio tuvo como objetivo investigar las demandas asistenciales de los pacientes con trastornos mentales en el proceso de envejecimiento. Enfoque cuantitativo, con corte temporal y uso de estadística descriptiva simple y medidas de tendencia central en el análisis de datos. Se pudo comprobar, a través de la historia clínica recopilada, que casi la mitad de los pacientes tenían diagnóstico clínico y/o problemas de salud relacionados con problemas físicos. Considerando la complejidad de la atención al paciente con trastornos mentales, que pueden presentar comorbilidades de carácter físico y se encuentra en proceso de envejecimiento, es importante identificar precozmente problemas de salud física, así como prevenir enfermedades crónicas no transmisibles, durante y después de la hospitalización. O paciente com transtorno mental pode apresentar um processo de envelhecimento acelerado quando comparado com a população em geral. A internação psiquiátrica é um momento de desestruturação da função mental, que pode contribuir para o agravamento de condições clínicas pré-existentes, ou até mesmo o surgimento de comorbidades, aumentando a complexidade do quadro do paciente. Este estudo teve como objetivo investigar as demandas de cuidado em saúde do paciente com transtorno mental em processo de envelhecimento. Abordagem quantitativa, com corte temporal e utilização de estatística descritiva simples e medidas de tendência central na análise dos dados. Foi possível comprovar, através dos prontuários coletados, que quase metade dos pacientes apresentava diagnóstico clínico e /ou problemas de saúde relacionados a agravos físicos. Considerando a complexidade do cuidado ao paciente com transtorno mental, que pode apresentar comorbidades de ordem física e está em processo de envelhecimento, é importante a identificação precoce de agravos à saúde física, assim como, a prevenção de doenças crônicas não transmissíveis, durante e após a internação.

Objective: To understand nursing care based on recovery practices in a psychiatric hospital. hospitalized. Qualitative study method with a sociopoetic approach. The data were produced in two meetings with hospitalized people, through participant observation. The group consisted of eight people. The data analyzed and divided into three categories: Institutional Care, Institutional Care and Internal Care-Action. Discussion / Results: Based on the categories found, the discussion was based on reflections anchored in Foucault, Goffman and Lourau. The study revealed that hospitalized people look for resources to deal with the daily routine of hospitals, as they are crossed by power and hierarchy relationships; report that it is necessary to establish links between them and the professionals, finally they believe that trust must be mutual. Conclusion: There is a need for productions where hospitalized people are protagonists of the actions. He understands that nursing care needs to encompass psychosocial dimensions in order to build a unique care of strategies to deal with the hospitalized person, which it confers as good care practices. Objetivo: comprender la atención de enfermería basada en las prácticas de recuperación en un hospital psiquiátrico. hospitalizado Método de estudio cualitativo con enfoque sociopoético. Los datos se produjeron en dos reuniones con personas hospitalizadas, a través de la observación participante. El grupo estaba formado por ocho personas. Los datos analizados y divididos en tres categorías: Atención Institucional, Atención Institucional y Atención-Acción Interna. Discusión / Resultados: Basado en las categorías encontradas, la discusión se basó en reflexiones ancladas en Foucault, Goffman y Lourau. El estudio reveló que las personas hospitalizadas buscan recursos para lidiar con la rutina diaria de los hospitales, ya que se ven atravesadas por relaciones de poder y jerarquía; informan que es necesario establecer vínculos entre ellos y los profesionales, finalmente creen que la confianza debe ser mutua. Conclusión: existe la necesidad de producciones donde las personas hospitalizadas sean protagonistas de las acciones. Él entiende que la atención de enfermería debe cubrir las dimensiones psicosociales para construir estrategias de atención únicas para tratar con la persona hospitalizada, lo que confiere como buenas prácticas de atención. Objetivo: Compreender o cuidado de enfermagem a partir de práticas de recovery em um hospital psiquiátrico. internadas. Método: estudo qualitativo com abordagem sociopoética. Os dados foram produzidos em dois encontros com pessoas internadas, pela observação participante. O grupo constou de oito pessoas. Os dados analisados e divididos em três categorias: Cuidado Instituído, Cuidado Instituinte e Cuidado Interna-Ação. Discussão/Resultados: A partir das categorias encontradas a discussão se deu por reflexões ancoradas em Foucault, Goffman e Lourau. O estudo revelou que as pessoas internadas procuram recursos para lidar no cotidiano dos hospitais, pois são atravessados por relações de poder e hierarquia; relatam que é preciso estabelecer vínculos entre eles e os profissionais, por fim consideram que a confiança deve ser mútua. Conclusão: É necessário produções onde pessoas internadas sejam protagonistas das ações. Compreende que o cuidado de enfermagem precisa abranger dimensões psicossociais para assim construir um cuidado singular de estratégias para o lidar com a pessoa internada o que confere como boas práticas de cuidado.

Health workers are among the hardest hit by workplace violence. The rates of violence perpetrated by patients towards health professionals are known to be higher in psychiatry than in other fields. Objective: to investigate the understanding of healthcare professionals regarding the violence suffered in the psychiatric hospital; to describe the feelings experienced by these professionals; to discuss strategies proposed by professionals to minimize the effects of this violence; and to analyze the impact of the feeling / suffering of the professionals through the perspective of the worker's health. Quanti-qualitative study, carried out with health professionals from a public, federal psychiatric university hospital in the city of Rio de Janeiro. The violence caused by psychiatric patients causes physical and emotional damage to the professional, even though they consider it common, expected and believe they are prepared to deal with it. Stress was identified as the major consequence of experiencing workplace violence, followed by anger. The study suggests that the professionals daily prepare themselves through the understanding of the patient's clinical aspect, through empathy, through the bond built and through the involvement with the care given towards these individuals. Los trabajadores de la salud se encuentran entre los más afectados por la violencia en el lugar de trabajo. Se sabe que las tasas de violencia perpetradas por pacientes en profesionales de la salud son más altas en psiquiatría que en otros campos. Objetivos: investigar la comprensión de los profesionales de la salud sobre la violencia sufrida en el hospital psiquiátrico; describir los sentimientos experimentados por estos profesionales; discutir estrategias propuestas por estos profesionales para minimizar los efectos de esta violencia y analizar la implicación del sentimiento/sufrimiento de los profesionales en la perspectiva de la salud del trabajador. Estudio cuantitativo y cualitativo, realizado con profesionales de la salud de un hospital universitario público psiquiátrico federal de la ciudad de Río de Janeiro. La violencia causada por pacientes psiquiátricos causa daños físicos y emocionales al profesional, aunque la consideren común, esperada y que crean estar preparados para enfrentarla. El estrés se identificó como la principal consecuencia de sufrir violencia en el lugar de trabajo, seguido de sentimientos de irritación. El estudio sugiere que estos profesionales se preparan diariamente través la comprensión de la clínica del paciente, la empatía, el vínculo creado y la actitud de participación con el cuidado de estas personas. Os trabalhadores da saúde estão entre os mais atingidos pela violência laboral. As taxas de violência perpetrada pelos pacientes em profissionais de saúde são conhecidas por serem maiores em psiquiatria do que em outros campos. Objetivo: investigar entendimento dos profissionais de saúde em relação à violência sofrida no hospital psiquiátrico; descrever os sentimentos vivenciados por esses profissionais; discutir estratégias propostas pelos profissionais para minimizar os efeitos desta violência e analisar a implicação do sentimento/sofrimento dos profissionais na perspectiva da saúde do trabalhador. Estudo quanti-qualitativo, realizado com os profissionais de saúde de um hospital universitário psiquiátrico público, federal, do município do Rio de Janeiro. A violência provocada por pacientes psiquiátricos causa danos físicos e emocionais no profissional, ainda que estes a considerem comum, esperada e acreditem estar preparados para lidar com a mesma. O estresse foi apontado como a maior consequência de sofrer violência no ambiente de trabalho seguido do sentimento de irritação. O estudo sugere que os profissionais se preparem diariamente a través da compreensão da clínica do paciente, da empatia, do vínculo construído e da atitude de envolvimento com o cuidar destes indivíduos.

Este estudo objetivou verificar o perfil dos moradores dos hospitais psiquiátricos do Estado de São Paulo segundo raça/cor. Para isso, foi realizado um levantamento do Censo Psicossocial de moradores em hospitais psiquiátricos próprios e conveniados pelo SUS do Estado de São Paulo que estavam com tempo de internação igual ou superior a um ano, a partir de 30/11/2007. Ao caracterizar o perfil dessa população, foi identificado que a população branca é predominante nesses hospitais, totalizando 60,29% do total de moradores. No entanto, os dados de raça/cor do censo demográfico do ano 2000 informam que 27,4% da população do estado de São Paulo é preta e parda e na população moradora de hospitais psiquiátricos, esse número alcançou 38,36%. Como resultados, constatou-se uma maior proporção de negros que estão internados porque não têm renda e/ou lugar para morar. Essa população possui uma rede social frágil, recebe menos visitas, - precariedade social - associada ao transtorno mental ou doenças clínicas. Apesar de existir a Portaria GM 106/2000 que instituiu os Serviços de Residenciais Terapêuticos (SRTs) para egressos de internações psiquiátricas de longa permanência com ausência e/ou fragilidade de redes sociais de suporte, supõe-se que os negros não são contemplados por esta resolução. Os efeitos psicossociais do racismo e o impacto dos processos de preconceito, exclusão e apartamento social na saúde mental são evidenciados neste artigo. This study aimed to determine the profile of the residents of psychiatric hospitals in the State of São Paulo, according to race/color. For this secondary data was used from the Psychosocial Census of residents of psychiatric hospitals owned and insured by SUS State of São Paulo, which featured people with a length of stay equal to or higher than one year as of 30/11/2007. When characterizing the profile of this population, it was identified that in regards to race/color, the greater expressiveness was among the white population, which equals 60.29% of total residents. Data on race/color of the 2000 Census reports that out of the total population of the State of São Paulo, 27.4% are black and brown, but when considering the population living in psychiatric hospitals, this number reached 38.36%. It was observed that there is a higher proportion of blacks who are admitted because they have no income or place to live, weak social network, receive fewer visits - precarious social life - associated with mental disorders or medical conditions. Despite the GM Ordinance 106/2000, which establishes RTSs for former patients of psychiatric long stay, with absent and/or fragile social support networks, it can be assumed that these were not covered by this resolution. The psychosocial effects of racism and the impact of processes of prejudice, exclusion and social separation on mental health are highlighted in the article.

The present study is aimed at describing the perception of the nursing team concerning the care in a psychiatric hospital. The research used a qualitative approach, exploratory type, using focus group technique, with five participants, in August 2011, in Niteroi, RJ, Brazil. From the data analysis five categories emerged, covering: sensitive listening; personal availability; therapeutic projects; human issues of the team; Traditional Psychiatry vs. Psychosocial Paradigm tension. It was concluded that despite the research, the subjects were still working at the hospital model. It was possible to bring awareness in a human, comprehensive and complete manner. But this perception of care has frailties once it does not bring any evidence of scientific basis of nursing. It is recommended that the professional nursing team invest in their role of caring in the context of the Psychiatric Reform, in the pursuit of an approach centered on the subject and in his way of living.

El texto que hemos desarrollado pretende ser una contribución útil para facilitar, al personal sanitario que trabaja en el ámbito de prisiones, el necesario conocimiento teórico y técnico que les posibilite una mejor comprensión y atención a las personas, privadas de libertad, que sufren estos trastornos. En la medida en que sabemos que la integración cognitiva de un modelo descriptivo y comprensivo, el tener en la mente una teoría sobre el fenómeno observado, actúa como factor emocional de contención de las propias ansiedades que experimentamos en la relación terapéutica con los pacientes, queremos también contribuir, con esta aportación, a mejorar los recursos emocionales de los asistentes que desempeñan sus tareas sanitarias en un contexto tan ansiogeno como es el medio carcelario, a la vez que señalamos los riesgos de que cualquier teoría pueda ser utilizada para enmascarar la realidad clínica. This study sets out to make a worthwhile contribution to healthcare personnel working in the prison sector by providing theoretical and technical knowledge to enable them to better understand and care for people in prison who suffer from these disorders. As far as we know, the cognitive integration of a descriptive and comprehensive model, bearing in mind a theory of the observed phenomenon acts as an emotionally constraining factor for the anxieties we suffer in the therapeutic relationship with our patients. Consequently we also wish to contribute with this study to improving the emotional resources of personnel working in a context as anxiety-provoking as is a prison, while also pointing out the risks inherent to any theory that might be used to conceal clinical realities

SUMMARYAims - This study aims to present data on structural and human resources of public mental health services located in the Veneto Region, Italy, and to discuss them in the light of implementation of the first National Target Plan for Mental Health (“Progetto Obiettivo 1994-1996”) ten years after its launch. Methods - The study was conducted in the context of the PICOS (Psychosis Incident Cohort Outcome Study) Project, a large first-presentation multisite study on patients with psychotic disorders attending community mental heath services in the Veneto Region. Human and structural resources were surveyed in 26 study sites using a structured interview administered by the PICOS local referents. Results - CMHCs and Day Centres were homogeneously distributed across the Region and their overall rates per resident population met the national standards; a wide variability in the distribution of Day Hospitals was found, with the overall rate per resident population very far from meeting the national standard; the overall rate for Residential Facilities beds was higher than the recommended national standard, showing however an high variability across sites. The overall rate of mental health professionals per resident population was only slightly below the national standard: this was mainly achieved thanks to non-profit organizations which supplement the public system with unspecialised professionals; however, a wide variability in the local rates per resident population was found, with the 50% of the sites showing rates far lower the national standard. Specific lack of trained professionals involved in the provision of psychosocial interventions was found in most sites. Conclusions - A marked variability in human and structural resources across community mental health services in the Veneto Region was found. Possible reasons for this heterogeneity were analysed and implications for mental health care provision were further discussed.Declaration of Interest: The study has been supported by the Regione del Veneto, Giunta Regionale, Ricerca Sanitaria Finalizzata 2004, Venezia, Italia (grant to Professor M. Ruggeri).

Background A small number of patient-level variables have replicated associations with the length of stay (LOS) of psychiatric inpatients. Although need for housing has often been identified as a cause of delayed discharge, there has been little research into the associations between LOS and homelessness and residential mobility (moving to a new home), or the magnitude of these associations compared to other exposures. Methods Cross-sectional study of 4885 acute psychiatric admissions to a mental health NHS Trust serving four South London boroughs. Data were taken from a comprehensive repository of anonymised electronic patient records. Analysis was performed using log-linear regression. Results Residential mobility was associated with a 99% increase in LOS and homelessness with a 45% increase. Schizophrenia, other psychosis, the longest recent admission, residential mobility, and some items on the Health of the Nation Outcome Scales (HoNOS), especially ADL impairment, were also associated with increased LOS. Informal admission, drug and alcohol or other non-psychotic diagnosis and a high HoNOS self-harm score reduced LOS. Including residential mobility in the regression model produced the same increase in the variance explained as including diagnosis; only legal status was a stronger predictor. Conclusions Homelessness and, especially, residential mobility account for a significant part of variation in LOS despite affecting a minority of psychiatric inpatients; for these people, the effect on LOS is marked. Appropriate policy responses may include attempts to avert the loss of housing in association with admission, efforts to increase housing supply and the speed at which it is made available, and reforms of payment systems to encourage this.