Call For Papers by Felipe Szabzon
Old Tensions, Emerging Paradoxes in Health: Rights, Knowledge and Trust. Proceedings of the 17 th Biennial ESHMS Conference; 6-8 June; Lisbon, Portugal., 2018
Objective: This study aimed at identifying the perspectives of family carers of persons with seve... more Objective: This study aimed at identifying the perspectives of family carers of persons with severe mental illness (PWSMI) about the challenges they face to support community living in Lisbon Metropolitan Area (LMA). Portugal implemented a National Mental Health Plan (NMHP) in 2008, aiming to change its model of organization and delivery of care. One year after the promulgation of the plan, a severe economic recession gained momentum in the country with potential detrimental impact for caregivers in the communitarian model of care. Early research suggested that the needs of relatives of chronic psychotic outpatients were not fully met by psychiatric services, and that family carers continued to represent a major resource for PWSMI in the country.
Methods: A sample of 40 caregivers of PWSMI from LMA were assessed by the Caring for Carers (C4C) questionnaire. The C4C is a closed answer questionnaire assessing several domains of burden and positive experiences of caregivers of PWSMI that was developed by the European Federation of Associations of Families of People with Mental illness (EUFAMI). In parallel, participant observation was performed in monthly meetings of three Mutual Support Groups of caregivers of PWSMI over the period of one year.
Results: The results are presented in two sections. The first section presents descriptive statistics of the quantitative results gathered from the C4C Portuguese sample. The second section, discuss these findings in light of the qualitative results gathered at the mutual support groups.
Discussion/Conclusion: The implementation of the NMHP significantly changed the model of mental healthcare provision and posed new challenges for caregivers of PWSMI. The aging of family caregivers that provide a large share of the caring work is an urgent challenge for the future of PWSMI living at the community. Current family carers of PWSMI are the first generation to reach advanced age in the communitarian model of care, and embody an emergent challenge in the near future. Important dimensions associated to independent living and planning for future care are still unaddressed by the current mental health reform and are discussed in this paper.
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The workshop Mapping new voices: towards a Latin American perspective in Global Mental Health aim... more The workshop Mapping new voices: towards a Latin American perspective in Global Mental Health aims to bring together PhD students and early researchers whose work focuses on mental health in Latin American countries, and whose theoretical, methodological and/or analytic approaches make explicit use of the social sciences and related disciplines.
This workshop aims to explore a range of issues, including:
Historical and emergent mental health issues in Latin American countries
Mental Health Policy in Latin American countries
Mental Health Research and the Social Sciences
Keynote speakers: Anne Lovell (Université Paris Descartes), Clara Han (Johns Hopkins University), Catherine Campbell (London School of Economics and Political Science)
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Papers by Felipe Szabzon
International Review of Psychiatry, 2022
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Health & Social Care in the Community, 2019
In Portugal, a mental health reform process is in place aiming to redefine the model of service p... more In Portugal, a mental health reform process is in place aiming to redefine the model of service provision. In 2008, a National Mental Health Plan (NMHP) was approved to provide policy guidance over the transition period. The NMHP intended, among others, to develop community‐based services, with a specific focus on rehabilitation and deinstitutionalization. This study aims to explore the perspectives of service managers of psychosocial rehabilitation services regarding the main challenges to support the community living of persons with severe mental illnesses (PWSMI) in the Lisbon Metropolitan Area (LMA). The paper also contextualises the provision of psychosocial services within the country's mental health reform process and characterises the profile of service users in socio‐occupational units (SOUs) of the LMA. Semi‐structured interviews were performed with all SOUs’ managers of the LMA (n = 13). Information regarding service user characteristics was collected based on service records (n = 344). Interviews were analysed according to the framework methodology. The results of the interviews were triangulated using document analysis. Fieldwork took place between June and July 2016. The findings suggest that the development of the mental health reform ensured significant changes to service delivery. Community‐based mental health organisations are an important actor for service provision. However, important asymmetries were identified in the provision of psychosocial care within the LMA. At the same time, family carers are perceived as responsible for ensuring a large part of the social needs of the PWSMI but there is an increasing concern with their own ageing processes. As conclusion, it highlights the current inequality between services and the need to contemplate a life‐course perspective that comprehends the ageing process of caregivers poses an emerging challenge for psychosocial rehabilitation. These findings are also important for other low‐ and middle‐income countries passing through similar reforms.
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SSM - Qualitative Research in Health, 2024
This article reports on the adaptation of ethnographic research to a virtual collaborative projec... more This article reports on the adaptation of ethnographic research to a virtual collaborative project to overcome social distancing measures during the COVID-19 pandemic in the city of S˜ao Paulo, Brazil.
The original research project sought to explore how individuals residing in environments characterised by pronounced social deprivation perceive, interpret, and cope with mental distress. In addition, the research project also sought to identify both formal and informal support systems that individuals turn to and the specific conditions influencing their decisions to engage with different forms of care. This project stems from prior research findings that established: a) an association between socioeconomic deprivation and mental disorders; and b) the significance of social niches and local forms of sociality, highlighting the intricate interplay of specific forms of life in contexts of adversity and subjective suffering (Andrade et al., 2012; Filho et al., 2013; Manning et al., 2022; N. Rose et al., 2021).
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CITIZENSHIP STUDIES, 2022
This paper harnesses the strengths of the recent affective turn in
citizenship studies. It makes ... more This paper harnesses the strengths of the recent affective turn in
citizenship studies. It makes three contributions to the literature.
First, against proponents and critics of neoliberalism who neglect
the reinventions of citizenship under ‘neoliberalism’, it emphasises
the politics of hope advanced by socially excluded people. Second,
while sympathetic to the affective turn in citizenship it addresses
what it believes to be its key limitations: a neglect of the care
people expect from the state and the feelings of solidarity that
remain central to citizenship. Third, by reflecting on the experience
of neighbourhood in Sao Paulo, the paper challenges the overwhelming
focus of the affective citizenship literature on the
Global North by drawing on perspectives from a key city in the
Global South.
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Frontiers in Psychiatry, 2022
During the COVID-19 pandemic, Brazilian urban peripheries have been severely affected both by the... more During the COVID-19 pandemic, Brazilian urban peripheries have been severely affected both by the spread of the virus and by social, political, and economical dynamics, raising concerns about the psychological wellbeing and mental health of the population living in these areas. The pandemic broke out in a context of reduced public spending in social and health policies as well as in a process of erosion of social rights, fostering processes of exclusion and highlighting the association between austerity, the increase in poverty and inequality as well as in health and mental health problems indicators.
This article presents the results of a qualitative participatory research that investigated subjective experiences in a peripheral neighborhood of São Paulo, Brazil, aiming to understand how contextual dynamics played a role in shaping
mental health experiences during the COVID-19 pandemic. A multidisciplinary team of researchers worked closely with local volunteers trained to provide emotional support calls to neighbors of the community who signed up for the project. This article presents three ethnographic cases of women who had their routines strongly affected by the suspension of public and social protection services for the containment of the SARS-CoV-2 pandemic, leading to psychological suffering due to the increased demand of “domestic circuits of care”. We argue that within a context of austerity, the pandemic was remarkably harsh in urban peripheries and, specifically, for women with caring responsibilities. In addition to highlighting the pervasive “social protection gap”, the cases presented in this paper also reveals the unequal dynamics of the social reproduction work in several layers, which falls mainly on women’s shoulders. The “crisis of care”, proposed by gender and feminist scholars, can contribute to understanding the psychological outcomes of the COVID-19 pandemic for these women.
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Tratado de Psiquiatria da Associação Brasileira de Psiquiatria, 2021
Este capítulo apresenta e atualiza aspectos históricos, conceituais e práticos sobre a epidemiolo... more Este capítulo apresenta e atualiza aspectos históricos, conceituais e práticos sobre a epidemiologia psiquiátrica, sobretudo seus desenvolvimentos mais recentes no Brasil. Aqui, o leitor encontrará uma cuidadosa revisão sobre a constituição do campo da epidemiologia psiquiátrica, seus desdobramentos e achados científicos mais atuais. São
apresentadas reflexões acerca das limitações da pesquisa epidemiológica em saúde mental e potenciais caminhos de desenvolvimento futuro.
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International Review of Psychiatry, 2022
Urban mental health studies traditionally search for causal relationships between elements of the... more Urban mental health studies traditionally search for causal relationships between elements of the city and the prevalence of mental disorders. This paper discusses the importance of (re)thinking the 'lived urban experience' from the perspective of city residents about how the immediate environment affects their mental health and how people cope with inequalities. A participatory-action research was implemented in a peripheral area of São Paulo-Brazil, in which volunteers from the territory made phone calls to neighbours to provide emotional support during the COVID-19 pandemic. Weekly supervision meetings were held between volunteers and researchers to discuss the experiences shared by community counterparts. Narratives have shown that the lived experience in the city is mediated by multiple layers of 'urban insecurities'. These difficulties pressured people to organise and resist in face of pervasive inequalities as well as to respond to unfolding experiences of social suffering. We highlight the potential of participatory methodologies to observe the ways in which subjects face their structural issues and the suffering that emerge in these circumstances. The understanding of how these conflicts are lived at a subjective level can support studies that are wondering about the mechanisms of how social conflicts 'get under the skin'.
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Global Public Health, 2021
Responses to COVID-19 have included top-down, command-and-control measures, laissez-faire approac... more Responses to COVID-19 have included top-down, command-and-control measures, laissez-faire approaches, and bottom-up, community-driven solidarity and support, reflecting long-standing contradictions around how people and populations are imagined in public health—as a ‘problem’ to be managed, as ‘free agents’ who make their own choices, or as a potential ‘solution’ to be engaged and empowered for comprehensive public health. In this rapid review, we examine community-engaged responses that move beyond risk communication and instead meaningfully integrate communities into decision-making and multi-sectoral action on various dimensions of the response to COVID-19. Based on a rapid, global review of 42 case studies of diverse forms of substantive community engagement in response to COVID-19, this paper identifies promising models of effective community-engaged responses and highlights the factors enabling or disabling these responses. The paper reflects on the ways in which these community-engaged responses contribute to comprehensive approaches and address social determinants and rights, within dynamics of relational power and inequality, and how they are sometimes able to take advantage of the ruptures and uncertainties of a new pandemic to refashion some of these dynamics.
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Event Report by Felipe Szabzon
This article describes the creation of a collaborative initiative started by PhD students interes... more This article describes the creation of a collaborative initiative started by PhD students interested in mental health issues in Latin America. It reports on its first workshop “Mapping new voices. Towards a Latin American perspective in Global Mental Health” held at the Maison de Sciences de l’Homme in Paris on the 26-27 of June 2017. The article is collaboratively authored by the members of the Platform for Social Research on Mental Health in Latin America (PLASMA).
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Conference Presentations by Felipe Szabzon
Division of Social and Transcultural Psychiatry, McGill University, 2024
This workshop will explore potential contributions of a variety of disciplines to the most import... more This workshop will explore potential contributions of a variety of disciplines to the most important challenges and debates in the field of global mental health. The aim is to broaden and diversify the discussion about the core concepts in global mental health (such as illness, suffering, care or culture), and to nuance our understanding of the field’s development and impact in specific political and social contexts. The workshop will engage with the complex history of ideas about global psychiatry and global mental health, as some of the core problems and challenges which global mental health is currently facing occurred with significant frequency and regularity at different points in the twentieth century. A sustained anthropological and historical analysis can draw attention to possible recurrent challenges or underlying and problematic assumptions. Moreover, it can also foster an inspiring, creative exercise that highlights alternative (and forgotten) solutions, geographies, and ways of thinking about mental health. This might enable the field to engage with actors, ideas and structures outside the borders of psychiatry. The workshop will bring together psychiatrists, social scientists, and humanities scholars in order to investigate new approaches to understanding mental illness and healing, and their relationship to culture, social/political equality, justice and well-being.
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Late-breaking Session proposal, AAA/CASCA Annual Meeting, Toronto, Canada, 2023
Since the beginning of the COVID-19 pandemic, mental health has emerged as a prominent concern wi... more Since the beginning of the COVID-19 pandemic, mental health has emerged as a prominent concern with profound implications for both the present and future repercussions of the global health crisis (Bambra 2020; Moreno et al 2020; Rose 2020; Lancet Psychiatry editors 2020).
Mainstream journals (e.g., Lancet and Nature) presented conclusive findings that the pandemic was detrimental to mental health (Burgess 2020; The Lancet Psychiatry 2023). Leading international health organizations such as the WHO and World Psychiatric Association have issued guidance for preserving mental health in times of Covid-19.
In most discussions, researchers and policymakers assume the universality of such mental health consequences around the world – after all, the pandemic-related circumstances and social measures appear to be strikingly similar in most socio-cultural contexts, and in the current climate of global mental health the same guidelines, research instruments, diagnoses and questionnaires are often used across the globe. Within the history of transcultural psychiatry and medical anthropology, however, which have shed light on the multifaceted relationship between culture, society and mental illness, such assumptions about the global universality of psychological problems and emotional worlds should also be questioned (Bains 2020; Antic 2021; Kleinman 2023). In fact, the universalization of psychiatric concepts and instruments without considering complex sociocultural contexts can lead to the marginalization of both patients and experts from developing countries, may reinforce Eurocentric tendencies and power structures in mental health, and often results in ineffective policies (Mills & Fernando 2014; Kirmayer 2006; Napier 2014). Moreover, with the pandemic being declared to be over, the initial fervour surrounding pandemic-related prognostications has gradually abated, which brings forth the need for a more nuanced and comprehensive examination of the pandemic’s transformative effects. This session brings researchers from interdisciplinary fields working with local communities and medical professionals (psychologists, psychiatrists, and therapists) in the Global South and Global North to explore how local languages, cultures and context have shaped communities and medical professionals’ responses to the pandemic, and how cultural and social difference is constructed and worked into the mental health research during and after the pandemic.
Bringing the diversity of voices and experiences to the fore, we ask: ‘How can we conceptualize, understand, and alleviate pandemic-related distress and afflictions?’ ‘To what extent was the pandemic suffering universal, and to what extent it was culturally determined or constructed?’ Ultimately, ‘How can we conceptualize “mental health” in the post-pandemic world?’ and ‘What can we do to advance change?’ The session will help to share the findings generated by the “COVID-19 and Global Mental Health: The Importance of Cultural Context” project, based at the Center of Culture and the Mind,
University of Copenhagen. It will also provide a platform for scholars and younger researchers, working in the fields of transcultural psychiatry, psychiatric epidemiology, anthropology, medical humanities, and public health, to present up-to-date findings and debate new pathways to understanding post-pandemic transitions and emerging mental health problems.
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Paper prepared for the conference “Normale ou ordinaire, accomplie ou autonome? La vie et ses for... more Paper prepared for the conference “Normale ou ordinaire, accomplie ou autonome? La vie et ses formes pour les personnes souffrant d’un trouble mental chronique dans et après la psychiatrie”
The Portuguese national mental health plan (NMHP), approved in 2008, aimed, among other priorities, at defining best practices in long-term mental healthcare, with a specific focus in rehabilitation and deinstitutionalization. One year after the promulgation of the plan, a severe economic recession gained momentum in the country, resulting in austerity measures with cuts in the health budget and, at the same time, a decrease in families’ revenues. This study aims at understanding how the NMHP was effectively put in practice in such adverse circumstances and the consequences of the implementation path to families and carers of the mentally ill.
We first performed an extensive narrative review of policy documents related to the historical context of the NMHP and its implementation process. Secondly, we interviewed professionals and managers of long-term mental health services created under the NMHP, in order to characterise the provision of psychosocial rehabilitation in Lisbon Metropolitan Area.
On the one hand, the development of community-oriented policies was encouraged mainly to avoid the iatrogenic effects of institutionalization and to promote a “recovery” environment. On the other hand, the transference of caring activities to communitarian milieu should be performed carefully to avoid an excess burden for families, from whom a greater involvement is expected in this new model of care.
The analysis of the NMHP context showed a mix of long-term care providers, mostly private not-for-profit, with very different practices and target population. The lack of instruments to stimulate new solidarity associations, to encourage innovation, support management capacity and to ensure participation brought on obstacles to the emergence of new practices and expected advances. The countries’ path dependency and its fragile economic situation, posed great difficulties in the implementation of the plan accordingly to its own guidelines with potentially detrimental consequences on the well-being of families and patients.
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MA Thesis by Felipe Szabzon
Introdução: O Brasil vem passando por um processo de redirecionamento do modelo de atenção à saúd... more Introdução: O Brasil vem passando por um processo de redirecionamento do modelo de atenção à saúde mental, que tinha o hospital psiquiátrico como principal equipamento assistencial, para um novo modelo pautado pela ampliação dos serviços comunitários, redução no número de leitos em hospitais especializados e na criação de enfermarias psiquiátricas de retaguarda em hospitais gerais. Este processo ganhou força no ano de 2001, quando foi promulgada a Lei Federal 10.216 que tornou a assistência à saúde mental no país parte de uma política nacional compatível com as premissas do Sistema Único de Saúde (SUS). Objetivo: Este trabalho analisa o perfil das internações psiquiátricas hospitalares na cidade de São Paulo no período de 2000 a 2010. Procura evidenciar se o
processo de reestruturação da assistência psiquiátrica em nível hospitalar teve repercussão na utilização destes serviços e quais foram as mudanças decorrentes deste processo no
âmbito municipal e intramunicipal. Métodos: Trata-se de um estudo exploratório de natureza quantitativa. Os dados desta pesquisa foram obtidos a partir do Sistema de Informações Hospitalares (SIH-SUS), e são referentes à “Autorização para Internação Hospitalar” (AIH). As informações sobre as internações foram organizadas em um banco de dados e processados através do programa SPSS. Foram selecionadas as informações relativas às internações de especialidade psiquiátrica e de pacientes cujo município de residência fosse São Paulo. A seguir foi realizado o georreferenciamento do CEP de residência do paciente. Resultados: Foram analisadas 153.208 internações psiquiátricas. Os resultados apontam que após uma redução inicial, seguiu-se um aumento no total de
internações. Nesse processo houve a ampliação do percentual de internações realizadas em hospitais gerais e a diminuição do percentual de internações em hospitais especializados. Ressalta que houve uma queda no percentual de internações de longa duração e em hospitais situados em outros municípios do Estado. O georreferenciamento das internações mostra que a criação de leitos em enfermarias psiquiátricas de hospitais gerais ampliou o acesso a estes serviços para a população residente das subprefeituras com os indicadores
socioeconômicos (IDH) mais baixos da cidade.
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Poster by Felipe Szabzon
Over the past 20 years Brazil has made important advances in the
provision of health care service... more Over the past 20 years Brazil has made important advances in the
provision of health care services. Great strides were also made in the field of mental health care, and a sectoral reform was set, replacing the psychiatric model, characterized by the long term hospitalization, for an integrated network of primary care services, recognized for its multi-professional care, its integration with local health devices and offering of psychological and social assistance services. The main goal of the reformers was the defense of a public health system with a more equitable provision of services. It was only after the institutionalization of SUS over the 1990’s and especially reinforced by the law Paulo Delgado in 2001 (Federal Law 10.216) that a major reform in mental health care model was held across the country. Since then, a the major trend has being taking place in the city of São Paulo.
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BA Thesis by Felipe Szabzon
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Project Collaborator by Felipe Szabzon
Este documento faz um ponto de situação sobre a Saúde Mental em Portugal em 2016.
Dele constam um... more Este documento faz um ponto de situação sobre a Saúde Mental em Portugal em 2016.
Dele constam um sumário das atividades feitas em 2016, uma previsão do que está a ser realizado em 2017/2018 e o que se prevê fazer até 2020.
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Call For Papers by Felipe Szabzon
Methods: A sample of 40 caregivers of PWSMI from LMA were assessed by the Caring for Carers (C4C) questionnaire. The C4C is a closed answer questionnaire assessing several domains of burden and positive experiences of caregivers of PWSMI that was developed by the European Federation of Associations of Families of People with Mental illness (EUFAMI). In parallel, participant observation was performed in monthly meetings of three Mutual Support Groups of caregivers of PWSMI over the period of one year.
Results: The results are presented in two sections. The first section presents descriptive statistics of the quantitative results gathered from the C4C Portuguese sample. The second section, discuss these findings in light of the qualitative results gathered at the mutual support groups.
Discussion/Conclusion: The implementation of the NMHP significantly changed the model of mental healthcare provision and posed new challenges for caregivers of PWSMI. The aging of family caregivers that provide a large share of the caring work is an urgent challenge for the future of PWSMI living at the community. Current family carers of PWSMI are the first generation to reach advanced age in the communitarian model of care, and embody an emergent challenge in the near future. Important dimensions associated to independent living and planning for future care are still unaddressed by the current mental health reform and are discussed in this paper.
This workshop aims to explore a range of issues, including:
Historical and emergent mental health issues in Latin American countries
Mental Health Policy in Latin American countries
Mental Health Research and the Social Sciences
Keynote speakers: Anne Lovell (Université Paris Descartes), Clara Han (Johns Hopkins University), Catherine Campbell (London School of Economics and Political Science)
Papers by Felipe Szabzon
The original research project sought to explore how individuals residing in environments characterised by pronounced social deprivation perceive, interpret, and cope with mental distress. In addition, the research project also sought to identify both formal and informal support systems that individuals turn to and the specific conditions influencing their decisions to engage with different forms of care. This project stems from prior research findings that established: a) an association between socioeconomic deprivation and mental disorders; and b) the significance of social niches and local forms of sociality, highlighting the intricate interplay of specific forms of life in contexts of adversity and subjective suffering (Andrade et al., 2012; Filho et al., 2013; Manning et al., 2022; N. Rose et al., 2021).
citizenship studies. It makes three contributions to the literature.
First, against proponents and critics of neoliberalism who neglect
the reinventions of citizenship under ‘neoliberalism’, it emphasises
the politics of hope advanced by socially excluded people. Second,
while sympathetic to the affective turn in citizenship it addresses
what it believes to be its key limitations: a neglect of the care
people expect from the state and the feelings of solidarity that
remain central to citizenship. Third, by reflecting on the experience
of neighbourhood in Sao Paulo, the paper challenges the overwhelming
focus of the affective citizenship literature on the
Global North by drawing on perspectives from a key city in the
Global South.
This article presents the results of a qualitative participatory research that investigated subjective experiences in a peripheral neighborhood of São Paulo, Brazil, aiming to understand how contextual dynamics played a role in shaping
mental health experiences during the COVID-19 pandemic. A multidisciplinary team of researchers worked closely with local volunteers trained to provide emotional support calls to neighbors of the community who signed up for the project. This article presents three ethnographic cases of women who had their routines strongly affected by the suspension of public and social protection services for the containment of the SARS-CoV-2 pandemic, leading to psychological suffering due to the increased demand of “domestic circuits of care”. We argue that within a context of austerity, the pandemic was remarkably harsh in urban peripheries and, specifically, for women with caring responsibilities. In addition to highlighting the pervasive “social protection gap”, the cases presented in this paper also reveals the unequal dynamics of the social reproduction work in several layers, which falls mainly on women’s shoulders. The “crisis of care”, proposed by gender and feminist scholars, can contribute to understanding the psychological outcomes of the COVID-19 pandemic for these women.
apresentadas reflexões acerca das limitações da pesquisa epidemiológica em saúde mental e potenciais caminhos de desenvolvimento futuro.
Event Report by Felipe Szabzon
Conference Presentations by Felipe Szabzon
Mainstream journals (e.g., Lancet and Nature) presented conclusive findings that the pandemic was detrimental to mental health (Burgess 2020; The Lancet Psychiatry 2023). Leading international health organizations such as the WHO and World Psychiatric Association have issued guidance for preserving mental health in times of Covid-19.
In most discussions, researchers and policymakers assume the universality of such mental health consequences around the world – after all, the pandemic-related circumstances and social measures appear to be strikingly similar in most socio-cultural contexts, and in the current climate of global mental health the same guidelines, research instruments, diagnoses and questionnaires are often used across the globe. Within the history of transcultural psychiatry and medical anthropology, however, which have shed light on the multifaceted relationship between culture, society and mental illness, such assumptions about the global universality of psychological problems and emotional worlds should also be questioned (Bains 2020; Antic 2021; Kleinman 2023). In fact, the universalization of psychiatric concepts and instruments without considering complex sociocultural contexts can lead to the marginalization of both patients and experts from developing countries, may reinforce Eurocentric tendencies and power structures in mental health, and often results in ineffective policies (Mills & Fernando 2014; Kirmayer 2006; Napier 2014). Moreover, with the pandemic being declared to be over, the initial fervour surrounding pandemic-related prognostications has gradually abated, which brings forth the need for a more nuanced and comprehensive examination of the pandemic’s transformative effects. This session brings researchers from interdisciplinary fields working with local communities and medical professionals (psychologists, psychiatrists, and therapists) in the Global South and Global North to explore how local languages, cultures and context have shaped communities and medical professionals’ responses to the pandemic, and how cultural and social difference is constructed and worked into the mental health research during and after the pandemic.
Bringing the diversity of voices and experiences to the fore, we ask: ‘How can we conceptualize, understand, and alleviate pandemic-related distress and afflictions?’ ‘To what extent was the pandemic suffering universal, and to what extent it was culturally determined or constructed?’ Ultimately, ‘How can we conceptualize “mental health” in the post-pandemic world?’ and ‘What can we do to advance change?’ The session will help to share the findings generated by the “COVID-19 and Global Mental Health: The Importance of Cultural Context” project, based at the Center of Culture and the Mind,
University of Copenhagen. It will also provide a platform for scholars and younger researchers, working in the fields of transcultural psychiatry, psychiatric epidemiology, anthropology, medical humanities, and public health, to present up-to-date findings and debate new pathways to understanding post-pandemic transitions and emerging mental health problems.
The Portuguese national mental health plan (NMHP), approved in 2008, aimed, among other priorities, at defining best practices in long-term mental healthcare, with a specific focus in rehabilitation and deinstitutionalization. One year after the promulgation of the plan, a severe economic recession gained momentum in the country, resulting in austerity measures with cuts in the health budget and, at the same time, a decrease in families’ revenues. This study aims at understanding how the NMHP was effectively put in practice in such adverse circumstances and the consequences of the implementation path to families and carers of the mentally ill.
We first performed an extensive narrative review of policy documents related to the historical context of the NMHP and its implementation process. Secondly, we interviewed professionals and managers of long-term mental health services created under the NMHP, in order to characterise the provision of psychosocial rehabilitation in Lisbon Metropolitan Area.
On the one hand, the development of community-oriented policies was encouraged mainly to avoid the iatrogenic effects of institutionalization and to promote a “recovery” environment. On the other hand, the transference of caring activities to communitarian milieu should be performed carefully to avoid an excess burden for families, from whom a greater involvement is expected in this new model of care.
The analysis of the NMHP context showed a mix of long-term care providers, mostly private not-for-profit, with very different practices and target population. The lack of instruments to stimulate new solidarity associations, to encourage innovation, support management capacity and to ensure participation brought on obstacles to the emergence of new practices and expected advances. The countries’ path dependency and its fragile economic situation, posed great difficulties in the implementation of the plan accordingly to its own guidelines with potentially detrimental consequences on the well-being of families and patients.
MA Thesis by Felipe Szabzon
processo de reestruturação da assistência psiquiátrica em nível hospitalar teve repercussão na utilização destes serviços e quais foram as mudanças decorrentes deste processo no
âmbito municipal e intramunicipal. Métodos: Trata-se de um estudo exploratório de natureza quantitativa. Os dados desta pesquisa foram obtidos a partir do Sistema de Informações Hospitalares (SIH-SUS), e são referentes à “Autorização para Internação Hospitalar” (AIH). As informações sobre as internações foram organizadas em um banco de dados e processados através do programa SPSS. Foram selecionadas as informações relativas às internações de especialidade psiquiátrica e de pacientes cujo município de residência fosse São Paulo. A seguir foi realizado o georreferenciamento do CEP de residência do paciente. Resultados: Foram analisadas 153.208 internações psiquiátricas. Os resultados apontam que após uma redução inicial, seguiu-se um aumento no total de
internações. Nesse processo houve a ampliação do percentual de internações realizadas em hospitais gerais e a diminuição do percentual de internações em hospitais especializados. Ressalta que houve uma queda no percentual de internações de longa duração e em hospitais situados em outros municípios do Estado. O georreferenciamento das internações mostra que a criação de leitos em enfermarias psiquiátricas de hospitais gerais ampliou o acesso a estes serviços para a população residente das subprefeituras com os indicadores
socioeconômicos (IDH) mais baixos da cidade.
Poster by Felipe Szabzon
provision of health care services. Great strides were also made in the field of mental health care, and a sectoral reform was set, replacing the psychiatric model, characterized by the long term hospitalization, for an integrated network of primary care services, recognized for its multi-professional care, its integration with local health devices and offering of psychological and social assistance services. The main goal of the reformers was the defense of a public health system with a more equitable provision of services. It was only after the institutionalization of SUS over the 1990’s and especially reinforced by the law Paulo Delgado in 2001 (Federal Law 10.216) that a major reform in mental health care model was held across the country. Since then, a the major trend has being taking place in the city of São Paulo.
BA Thesis by Felipe Szabzon
Project Collaborator by Felipe Szabzon
Dele constam um sumário das atividades feitas em 2016, uma previsão do que está a ser realizado em 2017/2018 e o que se prevê fazer até 2020.
Methods: A sample of 40 caregivers of PWSMI from LMA were assessed by the Caring for Carers (C4C) questionnaire. The C4C is a closed answer questionnaire assessing several domains of burden and positive experiences of caregivers of PWSMI that was developed by the European Federation of Associations of Families of People with Mental illness (EUFAMI). In parallel, participant observation was performed in monthly meetings of three Mutual Support Groups of caregivers of PWSMI over the period of one year.
Results: The results are presented in two sections. The first section presents descriptive statistics of the quantitative results gathered from the C4C Portuguese sample. The second section, discuss these findings in light of the qualitative results gathered at the mutual support groups.
Discussion/Conclusion: The implementation of the NMHP significantly changed the model of mental healthcare provision and posed new challenges for caregivers of PWSMI. The aging of family caregivers that provide a large share of the caring work is an urgent challenge for the future of PWSMI living at the community. Current family carers of PWSMI are the first generation to reach advanced age in the communitarian model of care, and embody an emergent challenge in the near future. Important dimensions associated to independent living and planning for future care are still unaddressed by the current mental health reform and are discussed in this paper.
This workshop aims to explore a range of issues, including:
Historical and emergent mental health issues in Latin American countries
Mental Health Policy in Latin American countries
Mental Health Research and the Social Sciences
Keynote speakers: Anne Lovell (Université Paris Descartes), Clara Han (Johns Hopkins University), Catherine Campbell (London School of Economics and Political Science)
The original research project sought to explore how individuals residing in environments characterised by pronounced social deprivation perceive, interpret, and cope with mental distress. In addition, the research project also sought to identify both formal and informal support systems that individuals turn to and the specific conditions influencing their decisions to engage with different forms of care. This project stems from prior research findings that established: a) an association between socioeconomic deprivation and mental disorders; and b) the significance of social niches and local forms of sociality, highlighting the intricate interplay of specific forms of life in contexts of adversity and subjective suffering (Andrade et al., 2012; Filho et al., 2013; Manning et al., 2022; N. Rose et al., 2021).
citizenship studies. It makes three contributions to the literature.
First, against proponents and critics of neoliberalism who neglect
the reinventions of citizenship under ‘neoliberalism’, it emphasises
the politics of hope advanced by socially excluded people. Second,
while sympathetic to the affective turn in citizenship it addresses
what it believes to be its key limitations: a neglect of the care
people expect from the state and the feelings of solidarity that
remain central to citizenship. Third, by reflecting on the experience
of neighbourhood in Sao Paulo, the paper challenges the overwhelming
focus of the affective citizenship literature on the
Global North by drawing on perspectives from a key city in the
Global South.
This article presents the results of a qualitative participatory research that investigated subjective experiences in a peripheral neighborhood of São Paulo, Brazil, aiming to understand how contextual dynamics played a role in shaping
mental health experiences during the COVID-19 pandemic. A multidisciplinary team of researchers worked closely with local volunteers trained to provide emotional support calls to neighbors of the community who signed up for the project. This article presents three ethnographic cases of women who had their routines strongly affected by the suspension of public and social protection services for the containment of the SARS-CoV-2 pandemic, leading to psychological suffering due to the increased demand of “domestic circuits of care”. We argue that within a context of austerity, the pandemic was remarkably harsh in urban peripheries and, specifically, for women with caring responsibilities. In addition to highlighting the pervasive “social protection gap”, the cases presented in this paper also reveals the unequal dynamics of the social reproduction work in several layers, which falls mainly on women’s shoulders. The “crisis of care”, proposed by gender and feminist scholars, can contribute to understanding the psychological outcomes of the COVID-19 pandemic for these women.
apresentadas reflexões acerca das limitações da pesquisa epidemiológica em saúde mental e potenciais caminhos de desenvolvimento futuro.
Mainstream journals (e.g., Lancet and Nature) presented conclusive findings that the pandemic was detrimental to mental health (Burgess 2020; The Lancet Psychiatry 2023). Leading international health organizations such as the WHO and World Psychiatric Association have issued guidance for preserving mental health in times of Covid-19.
In most discussions, researchers and policymakers assume the universality of such mental health consequences around the world – after all, the pandemic-related circumstances and social measures appear to be strikingly similar in most socio-cultural contexts, and in the current climate of global mental health the same guidelines, research instruments, diagnoses and questionnaires are often used across the globe. Within the history of transcultural psychiatry and medical anthropology, however, which have shed light on the multifaceted relationship between culture, society and mental illness, such assumptions about the global universality of psychological problems and emotional worlds should also be questioned (Bains 2020; Antic 2021; Kleinman 2023). In fact, the universalization of psychiatric concepts and instruments without considering complex sociocultural contexts can lead to the marginalization of both patients and experts from developing countries, may reinforce Eurocentric tendencies and power structures in mental health, and often results in ineffective policies (Mills & Fernando 2014; Kirmayer 2006; Napier 2014). Moreover, with the pandemic being declared to be over, the initial fervour surrounding pandemic-related prognostications has gradually abated, which brings forth the need for a more nuanced and comprehensive examination of the pandemic’s transformative effects. This session brings researchers from interdisciplinary fields working with local communities and medical professionals (psychologists, psychiatrists, and therapists) in the Global South and Global North to explore how local languages, cultures and context have shaped communities and medical professionals’ responses to the pandemic, and how cultural and social difference is constructed and worked into the mental health research during and after the pandemic.
Bringing the diversity of voices and experiences to the fore, we ask: ‘How can we conceptualize, understand, and alleviate pandemic-related distress and afflictions?’ ‘To what extent was the pandemic suffering universal, and to what extent it was culturally determined or constructed?’ Ultimately, ‘How can we conceptualize “mental health” in the post-pandemic world?’ and ‘What can we do to advance change?’ The session will help to share the findings generated by the “COVID-19 and Global Mental Health: The Importance of Cultural Context” project, based at the Center of Culture and the Mind,
University of Copenhagen. It will also provide a platform for scholars and younger researchers, working in the fields of transcultural psychiatry, psychiatric epidemiology, anthropology, medical humanities, and public health, to present up-to-date findings and debate new pathways to understanding post-pandemic transitions and emerging mental health problems.
The Portuguese national mental health plan (NMHP), approved in 2008, aimed, among other priorities, at defining best practices in long-term mental healthcare, with a specific focus in rehabilitation and deinstitutionalization. One year after the promulgation of the plan, a severe economic recession gained momentum in the country, resulting in austerity measures with cuts in the health budget and, at the same time, a decrease in families’ revenues. This study aims at understanding how the NMHP was effectively put in practice in such adverse circumstances and the consequences of the implementation path to families and carers of the mentally ill.
We first performed an extensive narrative review of policy documents related to the historical context of the NMHP and its implementation process. Secondly, we interviewed professionals and managers of long-term mental health services created under the NMHP, in order to characterise the provision of psychosocial rehabilitation in Lisbon Metropolitan Area.
On the one hand, the development of community-oriented policies was encouraged mainly to avoid the iatrogenic effects of institutionalization and to promote a “recovery” environment. On the other hand, the transference of caring activities to communitarian milieu should be performed carefully to avoid an excess burden for families, from whom a greater involvement is expected in this new model of care.
The analysis of the NMHP context showed a mix of long-term care providers, mostly private not-for-profit, with very different practices and target population. The lack of instruments to stimulate new solidarity associations, to encourage innovation, support management capacity and to ensure participation brought on obstacles to the emergence of new practices and expected advances. The countries’ path dependency and its fragile economic situation, posed great difficulties in the implementation of the plan accordingly to its own guidelines with potentially detrimental consequences on the well-being of families and patients.
processo de reestruturação da assistência psiquiátrica em nível hospitalar teve repercussão na utilização destes serviços e quais foram as mudanças decorrentes deste processo no
âmbito municipal e intramunicipal. Métodos: Trata-se de um estudo exploratório de natureza quantitativa. Os dados desta pesquisa foram obtidos a partir do Sistema de Informações Hospitalares (SIH-SUS), e são referentes à “Autorização para Internação Hospitalar” (AIH). As informações sobre as internações foram organizadas em um banco de dados e processados através do programa SPSS. Foram selecionadas as informações relativas às internações de especialidade psiquiátrica e de pacientes cujo município de residência fosse São Paulo. A seguir foi realizado o georreferenciamento do CEP de residência do paciente. Resultados: Foram analisadas 153.208 internações psiquiátricas. Os resultados apontam que após uma redução inicial, seguiu-se um aumento no total de
internações. Nesse processo houve a ampliação do percentual de internações realizadas em hospitais gerais e a diminuição do percentual de internações em hospitais especializados. Ressalta que houve uma queda no percentual de internações de longa duração e em hospitais situados em outros municípios do Estado. O georreferenciamento das internações mostra que a criação de leitos em enfermarias psiquiátricas de hospitais gerais ampliou o acesso a estes serviços para a população residente das subprefeituras com os indicadores
socioeconômicos (IDH) mais baixos da cidade.
provision of health care services. Great strides were also made in the field of mental health care, and a sectoral reform was set, replacing the psychiatric model, characterized by the long term hospitalization, for an integrated network of primary care services, recognized for its multi-professional care, its integration with local health devices and offering of psychological and social assistance services. The main goal of the reformers was the defense of a public health system with a more equitable provision of services. It was only after the institutionalization of SUS over the 1990’s and especially reinforced by the law Paulo Delgado in 2001 (Federal Law 10.216) that a major reform in mental health care model was held across the country. Since then, a the major trend has being taking place in the city of São Paulo.
Dele constam um sumário das atividades feitas em 2016, uma previsão do que está a ser realizado em 2017/2018 e o que se prevê fazer até 2020.
health, there was also a small increase in the inequality in the distribution of basic consultations within the poorest areas. These distributive results are discussed in the light of two dynamics: decentralization and public participation.
have known very little from the demand-side about clients’ interactions with banking correspondents
and the extent to which correspondents are used for banking transactions, savings, and credit. This
research set out to investigate whether agents (known as banking correspondents in Brazil) improve
financial inclusion. The findings have implications for agent network development internationally, as
being able to successfully offer a wider range of services than bill pay and cash-in cash-out services
has implications for profitability as well as meaningful financial inclusion. We find that although the
proportion of Brazilians who are using BCs to access financial services is low, those who are using
these services through BCs are poorer, less educated, more likely to be women, and more likely to
live in small towns and rural areas, suggesting that correspondents are improving inclusion by
reaching underserved populations.
for all.