Browsing by Author "Pires, Johann"
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- O fim das instituições? Uma revisão sistemática de literatura sobre o panorama da desinstitucionalização da saúde mentalPublication . Pires, Johann; Moniz, Maria João VargasA Desinstitucionalização, é um tema recorrente desde a metade do século passado e no entanto continua a ser um tema atual. Diversos países ao redor do mundo, adotaram a desinstitucionalização em suas respetivas políticas públicas e planos para a saúde mental, porém quando fala-se em desinstitucionalização da saúde mental, nem sempre é adequado referir-se à desinstitucionalização como se fosse um processo único, uniforme ou equivalente entre os diversos países em que acontece. De uma maneira geral, é coerente dizer que a desinstitucionalização da saúde mental corresponde a saída das pessoas dos hospitais psiquiátricos, para serem integradas em serviços de saúde de base comunitária (Bachrach, 1976; Brown, 1975; Shen & Snowden, 2014). Porém, quando se diz respeito às respostas póshospitalização, estas, demonstram ser das mais variadas e por conseguinte, surtem diferentes efeitos. Esta tese pretende categorizar os serviços de saúde de base comunitária oferecidos em diferentes países, de acordo com seus atributos intrínsicos, de modo a compreender as qualidades que os compõem e que os assemelham ou diferenciam. A partir disto, tendo em vista o contexto que estão inseridos e as nuances dos serviços oferecidos, far-se-á possivel, comparar os resultados e consequências do processo de desinstitucionalização em cada pais.
- Putting mental health deinstitutionalisation back on track: A scoping review of what empirically hinders and drives deinstitutionalisation of adults who experience mental illnessPublication . Sá-Fernandes, Luís; Sacchetto, Beatrice; Pires, Johann; Ornelas, José; Vargas-Moniz, MariaMental health deinstitutionalisation continues to be a global human rights priority. After over half a century, the discharge to the community often means the transition to smaller-scale institutions, segregation environments, and limited opportunities for community inclusion. This scoping review aims to identify what hinders and drives the deinstitutionalisation process of adults experiencing mental health challenges. Method: A scoping review was conducted following the Joanna Briggs Institute methodology and reported under the PRISMA extension for scoping reviews (PRISMA-ScR). A systematic search of four electronic databases, PubMed, APA PsycINFO, Web of Science, and Scopus, was undertaken between January and March 2024. Only empirical studies focusing on the deinstitutionalisation process of adults with mental health challenges, published in English, from 1991 to 2024 were eligible for inclusion. A template in Microsoft Excel was created for data extraction. Results were descriptively synthesised and organised into the system change framework’s four fundamental dimensions (norms, resources, regulations, and operations). A total of 57 studies were included. Most of those included studies, 53% were qualitative ( = 30), 60% were published from 2014 to 2024 ( = 34), 26% were from North Americas ( = 15), and 25% were from Europe ( = 14). Factors that hindered mental health deinstitutionalisation included the exclusiveness of the medical model, social discrimination, insufficient community services, transinstitutionalisation, lack of support for community inclusion, most funds allocated to institutionalisation, economic incentives for institutionalisation, institutional policies, inefficient governance, professional control, and limited advocacy. Drivers included a model for community inclusion, an inclusive society, resourcing community alternatives, independent housing, individualised context-oriented support, economic pressures, policy and legal reform, consumer participation in services, and consumer advocacy. The study findings constitute an important basis to inform the ongoing or future deinstitutionalisation processes of adults with mental illness diagnoses.