Fulone Izabela, Barreto Jorge Otavio Maia, Barberato-Filho Silvio, Bergamaschi Cristiane de Cássia, Silva Marcus Tolentino, Lopes Luciane Cruz
Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, Brazil.
Fiocruz School of Government, Fiocruz Brasília, Oswaldo Cruz Foundation, Brasília, Brazil.
Front Psychiatry. 2021 Apr 26;12:575108. doi: 10.3389/fpsyt.2021.575108. eCollection 2021.
The deinstitutionalization process is complex, long-term and many countries fail to achieve progress and consolidation. Informing decision-makers about appropriate strategies and changes in mental health policies can be a key factor for it. This study aimed to develop an evidence brief to summarize the best available evidence to improve care for deinstitutionalized patients with severe mental disorders in the community. We used the SUPPORT (Supporting Policy Relevant Reviews and Trials) tools to elaborate the evidence brief and to organize a policy dialogue with 24 stakeholders. A systematic search was performed in 10 electronic databases and the methodological quality of systematic reviews (SRs) was assessed by AMSTAR 2. Fifteen SRs were included (comprising 378 studies and 69,736 participants), of varying methodological quality (3 high-quality SRs, 2 moderate-quality SRs, 7 low-quality SRs, 3 critically low SRs). Six strategies were identified: (i). Psychoeducation; (ii). Anti-stigma programs, (iii). Intensive case management; (iv). Community mental health teams; (v). Assisted living; and (vi). Interventions for acute psychiatric episodes. They were associated with improvements on a global status, satisfaction with the service, reduction on relapse, and hospitalization. Challenges to implementation of any of them included: stigma, the shortage of specialized human resources, limited political and budgetary support. These strategies could guide future actions and policymaking to improve mental health outcomes.
非机构化进程复杂且耗时长久，许多国家未能取得进展和巩固成果。让决策者了解心理健康政策的适当策略和变化可能是其中的一个关键因素。本研究旨在撰写一份证据摘要，以总结现有的最佳证据，改善对社区中非机构化严重精神障碍患者的护理。我们使用了SUPPORT（支持与政策相关的综述和试验）工具来撰写证据摘要，并与24位利益相关者组织了一次政策对话。在10个电子数据库中进行了系统检索，并通过AMSTAR 2评估了系统综述（SRs）的方法学质量。纳入了15篇系统综述（包括378项研究和69736名参与者），方法学质量各不相同（3篇高质量系统综述、2篇中等质量系统综述、7篇低质量系统综述、3篇极低质量系统综述）。确定了六种策略：（i）心理教育；（ii）反污名化项目；（iii）强化个案管理；（iv）社区心理健康团队；（v）辅助生活；以及（vi）急性精神病发作的干预措施。它们与整体状况的改善、对服务的满意度、复发率降低以及住院率降低相关。实施其中任何一项策略的挑战包括：污名化、专业人力资源短缺、政治和预算支持有限。这些策略可为未来的行动和政策制定提供指导，以改善心理健康结果。
