Braga Claudia Pellegrini, d'Oliveira Ana Flávia Pires Lucas
Faculdade de Filosofia, Letras e Ciências Humanas, Universidade de São Paulo, São Paulo, Brasil.
Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.
Cad Saude Publica. 2022 May 30;38(5):e00170821. doi: 10.1590/0102-311XPT170821. eCollection 2022.
Important strides in psychiatric reform include the implementation of mental health services that replace the traditional psychiatric logic. However, admissions to psychiatric hospitals continue to occur, including children and adolescents. This study analyzed the reasons for admission to a psychiatric hospital from the institution's perspective and that of the hospitalized children and adolescents. This was a qualitative study with a hermeneutic-dialectic approach, based on a reading of the institutional documents, open interviews with eight adolescents, and participant observation. The results showed that the main alleged reason for admission reported by the psychiatric hospital was "aggressiveness", justified by the idea of "risk to self and others", while the children reported multiple reasons for their hospitalization, including drug use, minor scuffles, and misdemeanors. The analysis showed that the mechanism for admission to the psychiatric hospital involve, during anamnesis, defining an individual as deviating from social norms and, subsequently, assignment of a diagnosis to back the psychiatric institutionalization. It also showed that the backing and continuity of psychiatric hospitalizations occur in a circuit of control that is operated between different institutions for the deviants' custody. The study demonstrates that to avoid psychiatric hospitalizations, besides closing psychiatric hospitals, it is necessary to overcome the psychiatric paradigm, which in turn requires deinstitutionalization of practices and psychosocial care in open, community and substitutive mental health services.
精神科改革的重要进展包括实施取代传统精神科逻辑的心理健康服务。然而，精神病院仍在收治患者，包括儿童和青少年。本研究从机构层面以及住院儿童和青少年的角度分析了入住精神病院的原因。这是一项采用诠释辩证方法的定性研究，基于对机构文件的研读、对八名青少年的开放式访谈以及参与观察。结果显示，精神病院报告的主要入院理由是“攻击性”，以“对自身及他人构成风险”的观念为依据，而儿童报告了住院的多种原因，包括吸毒、轻微打斗和行为不检。分析表明，入住精神病院的机制在问诊过程中涉及将个体界定为偏离社会规范，随后进行诊断以支持精神科住院治疗。研究还表明，精神病院住院治疗的支持与延续发生在一个管控循环中，该循环在不同的偏差行为监管机构之间运作。该研究表明，为避免精神病院住院治疗，除了关闭精神病院外，还必须克服精神科范式，这反过来又需要在开放、社区和替代性心理健康服务中实现实践和心理社会护理的去机构化。
