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Órgano Oficial del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz

2003, Number 5

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Salud Mental 2003; 26 (5)

Servicios de salud mental: veinticinco años de investigación.

Berenzon GS, Medina-Mora IME, Lara CMA

Language: Spanish
References: 63
Page: 61-72
PDF size: 303.45 Kb.


ABSTRACT

The aim of this article is to present a review of the studies on mental health services conducted over the past twenty-five years by the Head Offices of Epidemiological and Psychosocial Research of the Ramón de la Fuente National Institute of Psychiatry (INP) and to propose further lines of research to be developed in this field.

Health services and addictions
The study of the types of care needed and the characteristics of the use of services among the population that abuses substances has been an area of interest at INP. The Institute has information drawn from surveys, the Drug Information Registration System and studies focussing on specialized services. It also has results obtained from specific populations such as women and teenagers and groups that are difficult to reach, such as street children and cocaine users.
Since 1974, INP has conducted a series of household surveys that has shed light on trends in the use of services by the population with drug-related problems. Several studies have shown that drug- and alcohol-users rely mainly on relatives, friends and ministers of the Church. The use of home remedies and self-medication are also common. Conversely, users rarely seek specialized services. In the 1988 survey, a mere 5% of this population sought the latter, a figure that had risen only slightly to 6.1% by 1998 (59, 57, 30).
The main aim of the Drug Information Registration System (SRID), in operation since 1987, is to evaluate trends in the use of psychoactive substances, identify the changes that have occurred and estimate the trajectory of use. Approximately 60% of the cases reported came from health institutions and 40% from penal institutions. The main reason why the former had been admitted to health centers was to receive treatment, whereas the latter had been sent to penal institutions as a result of crimes involving robbery or damage to health (39,40,41).
The information provided by SRID has served as the basis for conducting studies that analyze in greater depth the characteristics of services designed to deal with problems of drug dependence. One example of this is the project carried out to study the patterns of cocaine use, associated problems and perceptions and attitudes towards treatment services (37).
Other research projects have been designed to assess or analyze the way specialized services operate in the treatment of addictions. Two examples of this are the Center of Assistance for Alcoholics and their Relatives (CAAF) (61, 62, 35) and the Alcoholics Anonymous movement (AA) (49, 44, 50, 51).
For over a decade, Gutiérrez and Vega have studied children that live on the streets and consume substances and they have found that the resources available for dealing with this population are extremely limited. The lack of success of the interventions implemented can be attributed to unrealistic goals, a fragmented perception of the problem and therefore of its solution and failure to consider the perceptions and needs of the children whom these programs are intended to benefit (16, 28, 63).
Since the early 1990s, the study of drug use among women has attracted the attention of a group of INP researchers. The results of various studies have repeatedly shown that there are hardly any programs specifically designed to deal with the needs of female addicts (45, 46, 47, 27, 31, 32). The few types of treatment offered at specialized centers only cover part of women’s needs. For example, patients undergo detoxification or receive pharmacological treatment, while others problems are ignored (27).
Natera, Mora and Tiburcio (34) analyzed the obstacles that prevent relatives from seeking help to deal with the physical and psychological effects of having to cope with a family member’s drug use. On the basis of the information obtained from 100 interviews, the authors observed that only 50% of the interviewees had sought some kind of assistance while only 20% had found it useful. The reasons for failing to seek assistance were related as much to cultural values and norms as to the lack of financial resources, fear, shame and lack of information.

Mental health care services
The information presented below is drawn from household surveys and studies on populations attended at the primary health care level and in mental health service facilities. It also analyzes research conducted on special groups such as children, teenagers, women and the rural population and studies focussing on issues such as curative trajectories and the use of alternative services.
As part of the 1988 National Survey on Addictions, a mental health survey was carried out on a fifth of the urban population selected (n=2,025). The results of this study show that friends and relatives constituted the first source of help (54%), followed by self-medication (15%) and priests or ministers (10%). Only 5% resorted to general medical services, while a similar percentage used centers specializing in mental health. The main reasons for not requesting assistance were lack of knowledge about the services, prejudice towards the latter and lack of time and financial resources (27). Similar results were reported in subsequent surveys (7,9,10,29).
INP has a long tradition of studying the needs and demands for care at the primary health care level. The earliest projects focussed on the adaptation, modification and standardization of instruments used for detection and diagnosis (2,11). These instruments subsequently permitted the detection of psychiatric disorders among the population that made appointments to see their local GP. The most common disorders were depression and anxiety (26, 42, 22, 3). Subsequent studies have shown that although the population initially seeks help from a GP (27, 29, 14, 8), a high percentage of cases are not detected, far less referred in time, which in turn increases the cost of care (23, 42, 43).
Since 1978, studies have been undertaken to determine the characteristics of specialized mental health services. The earliest studies showed that the main reasons for a patient’s admission were relapses caused by discontinuing treatment, the inability to survive on their own and aggressiveness (12, 52). In 1992, a national survey was carried out on 4,539 hospitalized psychiatric patients (6). In general, almost half the cases could be treated as outpatients.
The use of health services by the child and adolescent population has been studied by Zimmerman and collaborators (64) and by Caraveo and collaborators (10). The first two studies showed that there is a low perception of mental health care among children and youth and that even less formal assistance is provided.
The use of services by the female population has also been widely studied. Results have shown that women tend to seek professional help because of emotional disorders whereas men do so because of problems related to alcoholism and drug dependence (43). Data yielded by various studies show that friends, relatives, priests or ministers and home remedies are the main resources used by women (27, 59, 29, 53). Very few women seek specialized mental health care services. The main reasons why women do not seek them are that they do not feel anyone can help them, they are ashamed to talk about their problems and they do not know where to go.
Snyder and collaborators have found that although the presence of emotional malaise such as depression or “nerves” is common among the female rural population, there is a lack of specialized services in rural settings. Consequently, women resort to other sources of support such as friends or relatives, priests, local healers and self-medication (53, 54, 55).
Data yielded by various surveys have served as the basis for carrying out studies to analyze the characteristics of alternative services in greater depth. The main studies have been carried out with groups of Neurotics Anonymous (25), spiritualist churches such as the Marian Trinitarians (24) and traditional doctors (1).
The paths followed by psychiatric patients in search of care have also been evaluated. One of the most striking results is that in comparison with other countries, Mexico shows the greatest lag between the emergence of symptoms and the first attempt to seek help. As for the characteristics of the trajectories followed, people resort mainly to their GPs, traditional doctors, healers or ministers and priests (15,5).

Discussion
The information reviewed in this article highlights the need for further research on treatment, prevention and health promotion programs. Studies should include an analysis of various related factors such as the beliefs, attitudes and behavior of patients and providers, the type of disorder involved, the complexity of the therapeutic regime, the system of service provision and certain determinants of health and mental illness.


REFERENCES

  1. BERENZON S: La medicina tradicional urbana como recurso alternativo para el tratamiento de problemas de salud mental. Tesis para obtener el grado de doctora en Psicología, Facultad de Psicología, UNAM, México, 2003.

  2. CAMPILLO C, CARAVEO J, MEDINA-MORA ME, MARTÍNEZ P: Confiabilidad entre clínicos utilizando la “Entrevista Psiquuiátrica Estandarizada” de Goldberg en una versión mexicana. Acta psiquiát . psicol Amér. Lat. 27:44-53, 1981.

  3. CARAVEO J, MEDINA-MORA ME, MARTÍNEZ P, CAMPILLO C: Clinical indicators of psychiatric disorders in the elderly in a hospital’s general practice service. Clinical Gerontologist, 3(1):3-14, 1984.

  4. CARAVEO J, GONZÁLEZ-FORTEZA C, RAMOS L, MENDOZA AP: Necesidades y demandas de atención en los servicios de salud mental. Salud Pública de México, 28(5):504-514, 1986.

  5. CARAVEO J, MAS C: Demandas de atención en salud mental. Tres diferentes ámbitos. Anales. Reseña de la V Reunión de Investigación, IMP, 23-27, 1990.

  6. CARAVEO J, GÓMEZ M, SALDÍVAR G, GONZÁLEZ RE: Encuesta Nacional de pacientes psiquiátricos hospitalizados.Salud Mental, 18(4):1-9, 1995.

  7. CARAVEO J, MARTÍNEZ NA, RIVERA E, POLO A: Prevalencia en la vida de episodios depresivos y utilización de servicios especializados. Salud Mental, 20(Suplemento julio), 15-23, 1997.

  8. CARAVEO J, COLMENARES E, SALDIVAR G: Morbilidad psiquiátrica en la ciudad de México: prevalencia y comorbilidad a lo largo de la vida. Salud Mental, 22(Número especial):62-67, 1999.

  9. CARAVEO J, COLMENARES E: Prevalencia de los trastornos de ansiedad fóbica en la población adulta de la ciudad de México. Salud Mental, 23(5):10-19, 2000.

  10. CARAVEO, J., COLMENARES E; MARTÍNEZ N: Síntomas, percepción y demanda de atención en salud mental en niños y adolescentes de la Ciudad de México, 2002.

  11. CASTRO ME, MEDINA-MORA ME, MARTÍNEZ P: Poder discriminativo de un cuestionario que detecta padecimientos emocionales entre sujetos que requieren y no requieren atención especializada con bajo nivel de escolaridad. Enseñanza e Investigación en Psicología, 2(16):229-235, 1982.

  12. DE LA PARRA A, ESCOBAR O, RUBIO S: Características psicosociales de pacientes psiquiátricos crónicos hospitalizados, Salud Pública 25(2):161-172, 1983.

  13. DESJARLAIS R, EISENBERG L, GOOD B, KLEINMAN A: World Mental health . Problems and priorities in lowincome countries. Oxford University Press. New York, 1995.

  14. GARCÍA-SÍLBERMAN S: Necesidades de atención y utilización de servicios de salud mental. Salud Mental, 20(Suplemento julio):39-46, 1997.

  15. GATER R, DE-ALMEIDA B, SOUSA E, BARRIENTOS G, CARAVEO J. ET AL: The pathways to psychiatric care: a cross cultural study. Psychological Medicine, 21:761-774, 1991.

  16. GUTIERREZ R, VEGA L: Las interpretaciones, las prácticas y las reacciones sociales del uso de solventes inhalables entre los llamados niños de la calle. Anales del Instituto Mexicano de Psiquiatría,140-l45, 1995.

  17. LARA MA, SALGADO N: Mujer, pobreza y salud mental. En: J. Alatorre (comp.) Mujeres en la pobreza. Colegio de México, México, 243-294, 1994.

  18. LARA MA, ACEVEDO M: Patrones de utilización de servicios de salud mental. Salud Mental, (suplemento-abril):14-18, 1996.

  19. LARA MA, SALGADO N. (comp.) Cálmese son sus nervios, tómese un tecito... La salud mental de las mujeres mexicanas. Pax, México, 2002.

  20. LARA MA, NAVARRO C, RUBÍ NA, MONDRAGÓN L. Outcome of two levels of intervention in low-income women with depressive symptoms. American Journal of Orthopsychiatry, 73(1):35-43, 2003a.

  21. LARA MA, NAVARRO C, RUBÍ NA, MONDRAGÓN L. Two levels of intervention in low-income women with depressive symptoms. Compliance and programme assessment. International Journal of Social Psychiatry, 49(1):43-57, 2003b.

  22. MARTÍNEZ P, MEDINA-MORA ME, PADILLA P, CORONA J, CAMPILLO C: Prevalencia de trastornos emocionales en personas de edad avanzada. Salud Pública, 25(6):612- 619, 1983.

  23. MARTÍNEZ P, MEDINA-MORA ME, CAMPILLO C: Evaluación del costo de utilización de servicios en la práctica general. Salud Mental, 7(3):63-67, 1984.

  24. MAS C, CARAVEO J: La medicina folklórica un estudio sobre la salud mental. Revista Interamericana de Psicología, 25(2):147-160, 1991.

  25. MAS C, CARAVEO J: Resultados preliminares del estudio de un grupo de Neuróticos Anónimos. Anales 3, VIII Reunión de Investigación. IMP, 180-183, 1993.

  26. MEDINA-MORA, ME; PADILLA, G; MAS C; EZBÁN, M; CARAVEO, J; CAMPILLO, C; CORONA, J. Prevalencia de trastornos mentales y factores de riesgo en una población de práctica médica general. Acta Psiquiátrica y Psicológica de América Latina, 31:53-61, 1985.

  27. MEDINA-MORA ME, RASCÓN ML, TAPIA R, MARIÑO MC, JUÁREZ F, VILLATORO J, CARAVEO J, GÓMEZ M: Trastornos emocionales en población urbana mexicana: resultados de un estudio nacional. Anales. Reseña de la VII Reunión de Investigación, 48-55, 1992.

  28. MEDINA-MORA ME, GUTIÉRREZ R, VEGA L: What Happened to Street Kids? An Analysis of the Mexican Experience. Substance Use & Misuse, 32(3):293-316, 1997

  29. MEDINA-MORA ME, BERENZON S, LÓPEZ EK, SOLÍS L, CABALLERO MA, & GONZÁLEZ J. Uso de los servicios de salud por los pacientes con trastornos mentales: resultados de una encuesta en una población de escasos recursos. Salud Mental, 20(suplemento julio):32-38, 1997.

  30. MEDINA-MORA ME, CRAVIOTO P, VILATORO J, DE LA ROSA B, FLEIZ C, GALVÁN F, ROJAS E, KURI P, TAPIA-CONYER P: Estudios en Población general: encuestas de hogares. Población entre 18 y 65 años. Observatorio Epidemiológico en Drogas, 19-24, 2001.

  31. MEDINA-MORA M: La mujer y el abuso de bebidas alcohólicas en México. En: A. Lara y N. Salgado (comp.) Cálmese son sus nervios, tómese un tecito.. .La salud mental de las mujeres mexicanas. Pax, 71-84, México, 2002.

  32. MEDINA-MORA M, FLEIZ C: La salud mental y las adicciones: retos, barreras y perspectivas. Cuadernos de Nutrición 26(2):69-76, 2003.

  33. MEDINA-MORA ME, BORGES G, LARA C, BENJET C, BLANCO J, FLEIZ C, VILLATORO J, ROJAS E, ZAMBRANO J. Prevalencia de trastornos mentales y uso de servicios: Resultado de la Encuesta Nacional de Epidemiología Psiquiátrica en México. En prensa.

  34. NATERA G, MORA J, TIBURCIO M: Barreras en la búsqueda de apoyo social para las familias con un problema de adicciones. Salud Mental, 22 (número especial):114-120, 1999.

  35. NATERA G, VALENCIA E: Centro de Atención al Alcohólico y sus Familiares (CAFF). Una experiencia de atención al alcoholismo en México. En: H. Ayala y L. Echeverria (comp). Tratamiento de Conductas Adictivas. UNAM, 93-107, México, 2001.

  36. ORGANIZACIÓN MUNDIAL DE LA SALUD: Informe sobre la salud en el mundo 2001. Salud mental: nuevos conocimientos, nuevas esperanzas. Organización Mundial de La Salud. Ginebra, 2001.

  37. ORTIZ A, SORIANO A, GALVÁN J, RODRÍGUEZ E, GONZÁLEZ L, UNIKEL C: Características de los usuarios de cocaína, su percepción y actitud hacia los servicios de tratamiento. Salud Mental, 20(Suplemento julio):8-14, 1997.

  38. ORTIZ A, SORIANO R, GALVÁN J: El sistema de Información en Drogas, SRID. Observatorio Epidemiológico en Drogas, 44-50, 2001.

  39. ORTIZ A, SORIANO A, GALVÁN J: Sistema de Reporte de Información en Drogas. Tendencias en el Área Metropolitana No.8- 9. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, 1990.40. ORTIZ, A. SORIANO A., GALVÁN, J: Sistema de Reporte de Información en Drogas. Tendencias en el Área Metropolitana No.20- 21. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, 1995.

  40. ORTIZ A, SORIANO A, GALVÁN J: Sistema de Reporte de Información en Drogas. Tendencias en el Area Metropolitana No. 30-31. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, 2001.

  41. PADILLA, P; MAS, C; EZBÁN, M; MEDINA_MORA, ME; PELAÉZ, O: Frecuencia de trastornos mentales en pacientes que asisten a la consulta general de un centro de salud. Salud Mental 7(3):72-78, 1984.

  42. PADILLA P, PELAÉZ O: Detección de trastornos mentales en el primer nivel de atención médica. Salud Mental 8(3):66-72, 1985.

  43. PÉREZ C, GONZÁLEZ L, ROSOVSKY H, CASANOVA L: La mujer en los grupos de alcohólicos anónimos. Reseña de la VII Reunión de investigación, Instituto Nacional de Psiquiatría, 125-129, 1992.

  44. ROMERO M, GÓMEZ C, RAMIRO M, DÍAZ A. Necesidades de atención a la salud mental de la mujer adicta. Salud Mental, 20(2):38-47, 1997.

  45. ROMERO M: Estudio de las adicciones en mujeres y su relación con otros problemas de salud mental. Tesis de doctorado en Antropología, Instituto de Investigaciones Antropológicas , UNAM, 1998.

  46. ROMERO M, RODRÍGUEZ E: (2000) Proyecto 4292 Proyecto 4292 Adicciones en mujeres y su relación con otros problemas de salud mental. Propuesta de un programa de reducción del daño.

  47. ROMERO-MENDOZA M, DÍAZ-MARTÍNEZ A: Ciclo vital femenino y abuso de sustancias psicoactivas. En: A. Lara y N. Salgado (comp.) Cálmese son sus nervios, tómese un tecito.. .La salud mental de las mujeres mexicanas. Pax, 85-104, México, 2002.

  48. ROSOVSKY H. La mujer en el tratamiento de las adicciones. Trabajo presentado en el tercer Congreso Nacional de Salud Pública, México, 1992a.

  49. ROSOVSKY H, GARCÍA G, GUTIÉRREZ R, CASANOVA L: Al-Anon groups in Mexico. Contemporary Drug Problems, 19(4):587-603, 1992b.

  50. ROSOVSKY H. Alcohólicos Anónimos. En ME. Medina- Mora (coord). Beber de Tierra Generosa. FISAC, 218-233, México, 1998.

  51. RYAN P, VALENCIA M, MARTÍNEZ R, OTERO R: Patrones de uso de los servicios de un hospital psiquiátrico (Fray Bernardino Álvarez). Reporte Interno, 1980.

  52. SALGADO N, DÍAZ_PÉREZ M, MALDONADO M: Los nervios de las mujeres mexicanas de origen rural como motivo para buscar ayuda. Salud Mental 18(1):50-55, 1995.

  53. SALGADO N. La prevalencia de algunos trastornos mentales, su interpretación sociocultural y la utilización de servicios de salud mental en poblaciones rurales: el impacto de la migración México-Estados Unidos, reporte técnico CONACYT, proyecto núm. 4257H, 1998.

  54. SALGADO N, DÍAZ-PÉREZ M: (2002). Salud Mental de las mujeres rurales: problemas, necesidades y alternativas. En: A. Lara y N. Salgado (comp.) Cálmese son sus nervios, tómese un tecito.. .La salud mental de las mujeres mexicanas. Pax, 151- 172, México, 2002.

  55. SECRETARÍA DE SALUD, DIRECCIÓN GENERAL DE EPIDEMIOLOGÍA, INSTITUTO MEXICANO DE PSIQUIATRÍA Encuesta Nacional de Adicciones. México, 1990.

  56. SECRETARÍA DE SALUD, DIRECCIÓN GENERAL DE EPIDEMIOLOGÍA, INSTITUTO MEXICANO DE PSIQUIATRÍA Encuesta Nacional de Adicciones. México, 1998.

  57. SECRETARÍA DE SALUD. Programa de Acción en Salud Mental. Secretaria de Salud, México, 2001.

  58. SOLÍS L, MEDINA-MORA ME: La utilización de los servicios de atención para la salud mental por mujeres mexicanas. Resultados de dos encuestas nacionales. Salud Mental, 17(1):7- 10, 1994.

  59. SOLÍS, L. Las tendencias de la investigación sobre las necesidades y recursos de atención primaria en salud mental en México. Anales de la X Reunión de Investigación y Enseñanza. Instituto Nacional de Psiquiatría, 176-183, 1995.

  60. TURULL F: Aspectos socioculturales de la demanda de la atención en un servicio de alcoholismo de la ciudad de México: el Centro de Ayuda al Alcohólico y sus Familiares. Salud Mental, 5(2):66-73, 1982.

  61. TURULL F: El tratamiento de las incapacidades relacionadas con el consumo de alcohol. Características de la demanda y uso de servicios. Salud Mental, 7(1), 82-94, 1984.

  62. VEGA L, GUTIÉRREZ R, RODRÍGUEZ E, GALVÁN J: Factores de riesgo para la salud mental de las niñas que subsisten en la calle. En: A. Lara y N. Salgado (comp.) Cálmese son sus nervios, tómese un tecito.. .La salud mental de las mujeres mexicanas. Pax, 25-54, México, 2002.

  63. ZIMERMAN M, MORALES C, BUENDÍA A, SAAD E: Los servicios de salud mental para niños y adolescentes en el valle de México. Salud Mental 4(2):4-7, 1981.




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