Mental Health Collaborative Care in Brazil and the Economy of Attention: Disclosing Barriers and Therapeutic Negotiations

IF 1.5 4区医学 Q2 ANTHROPOLOGY

Culture Medicine and Psychiatry Pub Date : 2024-04-23 DOI:10.1007/s11013-024-09852-w

Manuela Rodrigues Müller, Francisco Ortega

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Abstract

The introduction of mental health collaborative care (MHCC) is one of the strategies to scale up access to mental health care in primary health care in Brazil. This article investigates an experience of mental health collaborative care in the city of Rio de Janeiro, Brazil. It is a qualitative study involving interviews with physicians and mental health professionals working in primary health care units located in the northern part of the city of Rio de Janeiro, Brazil. The aim is to examine the various strategies and negotiations that primary health care professionals deploy to identify mental distress and plan health care interventions. We discuss the results within the economy of attention framework. We argue that divergences in diagnostic design and therapeutic planning carried out by professionals and users or observed in MHCC meetings illustrate the health-disease-care seeking phenomenon as a negotiated process, entangled in complex interactions. Our results evince that those interactions are not always evident and configure 'what is at stake' in mental suffering. The incorporation of cultural and structural determinants in collaborative care may enable the expansion of mental health initiatives sensitive to local needs and realities.

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巴西的心理健康合作护理与关注经济：揭示障碍与治疗协商

在巴西，心理健康协作医疗（MHCC）是扩大初级医疗保健中心理健康医疗覆盖面的策略之一。本文调查了巴西里约热内卢市的心理健康协作医疗经验。这是一项定性研究，对巴西里约热内卢市北部初级医疗保健单位的医生和心理健康专业人员进行了访谈。目的是研究初级医疗保健专业人员在识别精神痛苦和制定医疗保健干预计划时所采用的各种策略和协商方式。我们将在注意力经济框架内讨论研究结果。我们认为，专业人员和用户在诊断设计和治疗计划方面的分歧，或在精神健康中心会议上观察到的分歧，说明了寻求健康-疾病护理的现象是一个协商的过程，纠缠在复杂的互动中。我们的研究结果表明，这些相互作用并不总是显而易见的，它们决定了精神痛苦的 "利害关系"。将文化和结构性的决定因素纳入合作护理中，可以使心理健康倡议的扩展更贴近当地的需求和现实。

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来源期刊

Culture Medicine and Psychiatry Multiple-

CiteScore

3.70

自引率

5.90%

发文量

期刊介绍： Culture, Medicine, and Psychiatry is an international and interdisciplinary forum for the publication of work in three interrelated fields: medical and psychiatric anthropology, cross-cultural psychiatry, and related cross-societal and clinical epidemiological studies. The journal publishes original research, and theoretical papers based on original research, on all subjects in each of these fields. Interdisciplinary work which bridges anthropological and medical perspectives and methods which are clinically relevant are particularly welcome, as is research on the cultural context of normative and deviant behavior, including the anthropological, epidemiological and clinical aspects of the subject. Culture, Medicine, and Psychiatry also fosters systematic and wide-ranging examinations of the significance of culture in health care, including comparisons of how the concept of culture is operationalized in anthropological and medical disciplines. With the increasing emphasis on the cultural diversity of society, which finds its reflection in many facets of our day to day life, including health care, Culture, Medicine, and Psychiatry is required reading in anthropology, psychiatry and general health care libraries.