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Mental Health Service provision in remote areas in Greece: the experience of the Mobile Mental Health Units in Cyclades islands
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RESUMO: O objetivo deste estudo foi identificar se e como a atuação das unidades móveis de
saúde mental nas Cíclades, na Grécia teve um efeito sobre a saúde mental da
população local. As ilhas Cíclades, embora mundialmente populares como destino de
verão, tinham um sistema quase inexistente de serviços de saúde mental. Devido à
falta de tais serviços, 2 unidades móveis foram fundadas há 10 anos, a fim de cobrir
esta lacuna. Oferecemos uma breve descrição da estrutura e dos mecanismos de
funcionamento das unidades móveis. Em seguida, apresentamos a situação atual e
sua evolução ao longo do tempo. Os dados foram processados em uma única base
de dados dos usuários das Unidades Móveis de Saúde Mental, em um período de 10
anos. Foram utilizados métodos quantitativos e análise descritiva para um conjunto
de variáveis e indicadores, para ajudar a chegar a uma conclusão sobre como medir
o impacto da prestação de serviço, bem como uma breve discussão em grupo focal
envolvendo os principais atores na comunidade.
A amostra do presente estudo é a população de 6.884 adultos, que foram
encaminhados para as unidades psiquiátricas móveis de EPAPSY do Oeste e Nordeste
de Cíclades entre os anos de 2003 e 2014. O presente estudo centrou-se na
identificação dos efeitos positivos da prestação de serviços das unidades para a
população local, bem como das barreiras e limitações durante a experiência de 10
anos nas Cíclades. Adicionalmente, abordamos alguns obstáculos atuais (como a
crise socioeconômica e de que forma tem afetado a prestação de serviços e o estado
de saúde mental dos usuários). Identificamos as principais razões para a variação e a
mudança no número de usuários por ano durante a década, o número e fonte dos
encaminhamentos, os pedidos iniciais dos pacientes aos serviços e como eles
evoluíram ao longo do tempo. Concluiu-se que os serviços oferecidos pelas unidades
móveis tiveram impacto positivo na redução da lacuna de tratamento e aumento da
sensibilização para as questões de saúde mental. Identificamos, ainda, alguns
indicadores que poderiam apontar para a redução do estigma nas comunidades.
Sugerimos alguns passos fundamentais para a melhoria dos serviços e,
eventualmente, sua avaliação, a fim de estudar o impacto geral sobre a saúde
mental da população das ilhas.
ABSTRACT:The aim of this study was to identify if and how the operation of the mental health mobile units in the Cyclades in Greece has had an effect on the mental health of the local population. The Cyclades islands, although very popular as a summer destination globally, had an almost inexistent system of mental health services. Due to the complete lack of such services, 2 mobile units were founded 10 years ago in order to cover for this lack. We give a short description of the structure and working mechanisms of the mobile units. We then present the current situation and how it has evolved across time. We processed the data into a unique database of the users of the Mobile Mental Health Units in a period of 10 years. We used quantitative methods and descriptive analysis to a set of variables and indicators to help us reach a conclusion of how to measure the impact of the provision of service, along with a short focus groups discussion involving the key players in the community. The sample of the present study is the clinical population of 6,884 adults, who were referred to the mobile psychiatric units of EPAPSY in West and North-East Cyclades between the years 2003 and 2014. The current study has focused on the identification of positive effects of the service provision of the units for the local population, as well as the barriers and limitations during the 10 year experience in the Cyclades. In addition, we tackled some present obstacles (such as the socioeconomic crisis and how these have affected service provision and users’ mental health status. we identified the main reasons behind the fluctuation and change in the number of users per year over the decade, the number and source of referrals, the initial requests of the patients for services and how they evolved across time. We concluded that the services offered by the Mobile units had a positive impact in the reducing treatment gap and increasing awareness for mental health issues. We also identified a few indicators that could point towards a reduction of stigma in the communities. We suggested some key steps forward for the improvement of services and, eventually, their evaluation, in order to examine the overall impact on the mental health of the population of the islands.
ABSTRACT:The aim of this study was to identify if and how the operation of the mental health mobile units in the Cyclades in Greece has had an effect on the mental health of the local population. The Cyclades islands, although very popular as a summer destination globally, had an almost inexistent system of mental health services. Due to the complete lack of such services, 2 mobile units were founded 10 years ago in order to cover for this lack. We give a short description of the structure and working mechanisms of the mobile units. We then present the current situation and how it has evolved across time. We processed the data into a unique database of the users of the Mobile Mental Health Units in a period of 10 years. We used quantitative methods and descriptive analysis to a set of variables and indicators to help us reach a conclusion of how to measure the impact of the provision of service, along with a short focus groups discussion involving the key players in the community. The sample of the present study is the clinical population of 6,884 adults, who were referred to the mobile psychiatric units of EPAPSY in West and North-East Cyclades between the years 2003 and 2014. The current study has focused on the identification of positive effects of the service provision of the units for the local population, as well as the barriers and limitations during the 10 year experience in the Cyclades. In addition, we tackled some present obstacles (such as the socioeconomic crisis and how these have affected service provision and users’ mental health status. we identified the main reasons behind the fluctuation and change in the number of users per year over the decade, the number and source of referrals, the initial requests of the patients for services and how they evolved across time. We concluded that the services offered by the Mobile units had a positive impact in the reducing treatment gap and increasing awareness for mental health issues. We also identified a few indicators that could point towards a reduction of stigma in the communities. We suggested some key steps forward for the improvement of services and, eventually, their evaluation, in order to examine the overall impact on the mental health of the population of the islands.
Descrição
Palavras-chave
Unidades móveis Prestação de serviços Redes comunitárias Promoção da saúde mental. Mobile units Service provision Community network Mental health promotion