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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
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©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)
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