Amaral Carlos Eduardo, Onocko-Campos Rosana, de Oliveira Pedro Renan Santos, Pereira Mariana Barbosa, Ricci Éllen Cristina, Pequeno Mayrá Lobato, Emerich Bruno, Dos Santos Roseléia Carneiro, Thornicroft Graham
1Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas, Brazil.
Department of Psychology, University Centre Unicatólica of Quixadá, Quixadá, Brazil.
Int J Ment Health Syst. 2018 Oct 31;12:65. doi: 10.1186/s13033-018-0237-8. eCollection 2018.
Pathways to care are actions and strategies employed by individuals in order to get help for health-related distress and the related processes of care providers. On several systematic reviews regarding pathways to mental health care (PMHC), studies regarding South American countries were not present. This review synthesizes qualitative and quantitative research about PMHC in Brazil.
LILACS, MEDLINE and SCIELO databases were searched for papers regarding PMHC in Brazil. The results were organized in pathway stages, based on Goldberg and Huxley's 'model of Levels and Filters' and on Kleinman's framework of 'Popular, Folk and Professional health sectors'. Analysis also considered the changes in national mental health policy over time.
25 papers were found, with data ranging from 1989 to 2013. Complex social networks were involved in the initial recognition of MH issues. The preferred points of first contact also varied with the nature and severity of problems. A high proportion of patients is treated in specialized services, including mild cases. There is limited capacity of primary care professionals to identify and treat MH problems, with some improvement from collaborative care in the more recent years. The model for crisis management and acute care remains unclear: scarce evidence was found over the different arrangements used, mostly stressing lack of integration between emergency, hospital and community services and fragile continuity of care.
The performance of primary care and the regulation of acute demands, especially crisis management, are the most critical aspects on PMHC. Although primary care performance seems to be improving, the balanced provision and integration between services for adequate acute and long-term care is yet to be achieved.
就医途径是个人为获得与健康相关困扰的帮助而采取的行动和策略，以及护理提供者的相关流程。在几项关于心理健康护理途径（PMHC）的系统评价中，未出现关于南美国家的研究。本综述综合了巴西关于PMHC的定性和定量研究。
在LILACS、MEDLINE和SCIELO数据库中搜索关于巴西PMHC的论文。结果根据戈德堡和赫胥黎的“层次与筛选模型”以及克莱曼的“大众、民间和专业卫生部门”框架，按就医途径阶段进行整理。分析还考虑了国家心理健康政策随时间的变化。
共找到25篇论文，数据涵盖1989年至2013年。复杂的社会网络参与了心理健康问题的最初识别。首次接触的首选点也因问题的性质和严重程度而异。包括轻症病例在内的很大一部分患者在专科服务中接受治疗。初级保健专业人员识别和治疗心理健康问题的能力有限，近年来通过协作护理有了一些改善。危机管理和急性护理模式仍不明确：关于所采用的不同安排的证据很少，大多强调急诊、医院和社区服务之间缺乏整合以及护理的连续性脆弱。
初级保健的表现以及急性需求的管理，尤其是危机管理，是PMHC中最关键的方面。尽管初级保健表现似乎在改善，但急性和长期护理服务之间的均衡提供和整合仍有待实现。
