Redes de Atenção e Cuidados em Saúde Mental: espaços, pessoas e conexões

A Gestão do Cuidado em Saúde Mental

Flávio ResminiConsultor Saúde Mental MS

MENTAL ILL HEALTH: A Large Burden

6%

6%

4%

3%

3%

6%7%

5%

13%

3%

10%

4%3%

12% Cardiovascular diseases

Diabetes

Malignant neoplasms

Digestive diseases

Neuropsychiatric disorders

Other NCDs

Injuries

Other CD causes

Maternal conditions

MalariaChildhood diseases

Tuberculosis

Diarrhoeal diseases

Perinatal conditions

HIV/AIDS

Respiratory infections

Respiratory diseases

Nutritional deficiencies

Sense organ disorders

Diseases of the genitourinary systemMusculoskeletal diseases

Congenital abnormalities

Source: WHR 2002Disease burden measured by Disability Adjusted Life Years (DALYs)

Rank

2000 2020

1 Lower respiratory infections Ischaemic heart disease

2 Perinatal conditions Unipolar depressive disorders

3 HIV/AIDS Road traffic accidents

4 Unipolar depressive disorders Cerebrovascular disease

5 Diarrhoeal diseases Chronic obstructive pulmonary disease

(DALYs)

ProjectionsProjections

1 Unipolar depressive disorders 11.9%

2 Hearing loss, adult onset 4.6%

3 Iron-deficiency anaemia 4.5%

4 Chronic obstructive pulmonary disease 3.3%

5 Alcohol use disorders 3.1%

6 Osteoarthritis 3.0%

7 Schizophrenia 2.8%

8 Falls 2.8%

9 Bipolar affective disorder 2.5%

10 Asthma 2.1%

World Health Report. Geneva, World Health Organization, 2001

Both sexes, all ages, estimates for 2000 Both sexes, all ages, estimates for 2000 (YLDs)

Numbers of People Affected (Global)

• 450 million people with mental disorders– 150 million with depression– 25 million with schizophrenia– 38 million with epilepsy– 90 million with alcohol or drug use disorder– Nearly 1 million commit suicide every year

Number of deaths and burden of suicide (2001)

RegionNumbers of deaths DALYs (%)

Africa 28,000 0.2America 65,000 1.1E Mediter. 35,000 0.7Europe 168,000 2.3SE Asia 234,000 1.6W Pacific 318,000 2.5World 849,000 1.4

Numero de adultos (en millones) en America Latina y el Caribe que tienen

enfermedades mentales

• Depresion Mayor: 31,1 • Alcoholismo: 31,1 • Distimia: 11,8• Ansiedad Generalizada: 8,8• Trastorno Obsesivo Compulsivo: 6,1• Trastorno de Angustia: 5,4 • Psicosis no afectivas: 5,4• Abuso de Drogas: 5,1• Trastorno Bipolar:4,7

Treatment Gap

• Serious cases receiving no treatment during the last 12 months-– Developed countries- 35.5 to 50.3 %

– Developing countries- 76.3 to 85.4 %

WHO World Mental Health Consortium

JAMA, June 2nd 2004

Depression56.3%

Generalized Anxiety Disorder

57.5%

Alcohol Use Disorders

78.1%

Schizophrenia32.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Treatment Gap (Global)(Kohn, Saxena, Levav, Saraceno; 2004)

EL HIATO ASISTENCIAL EN AMERICA LATINA Y EL

CARIBE

• Psicosis no afectivas: 58% de las personas afectadas no estan tratadas

• Alcoholismo: 53,3% de las personas afectadas no estan tratadas

• Trastorno Bipolar: 46%• Trastornos de ansiedad: 41,1% de las

personas afectadas no estan tratadas

RECOMENDACIONES• Dispensar tratamiento en el nivel de atención primaria• Asegurar la disponibilidad de psicotrópicos• Dispensar atención en la comunidad• Educar al público• Involucrar a las comunidades, las familias y los

consumidores• Establecer políticas, programas y legislación nacionales• Desarrollar los recursos humanos• Establecer vínculos con otros sectores• Vigilar la salud mental de la comunidad • Apoyar la realización de nuevas investigaciones

C

A

P

Í

T

U

L

O

C

I

N

C

O

©2001

Psychiatric beds in each WHO Region and the world(ATLAS Data, per 10,000 population)

Gaps in Mental HealthSTIGMA

HUMAN RIGHTS

PREVENTION

ACCESS

QUALITYof CARE

PARADIGMAS EN CAMBIO

• de EXCLUSION a INCLUSION

• de una aproximacion BIO-MEDICA a una BIO-PSICO-SOCIAL

• de la CAMA al SERVICIO

• del HOSPITAL a la COMUNIDAD

• de la atencion a CORTO PLAZO a una de LARGO PLAZO (la REHABILITACION en serio)

• de la ACCION INDIVIDUAL al EQUIPO DE TRABAJO

• Del TRATAMIENTO a la RESPUESTA

The Gap Between the Burden and the Budget(ATLAS Data)