Intersectorial Actions For Mental Health
Intersectorial Actions For Mental Health
Intersectorial Actions For Mental Health
763-770
ABSTRACT
Objective: The study’s purpose has been to identify in scientific literature the intersectoral actions developed
in the mental health field. Methods: It is an integrative review that was performed by searching in both
LILACS and MEDLINE databases for publications between January 2005 and August 2015. There were found
1,027 publications, 28 of which met the inclusion criteria. We evidenced some intersectoral actions that were
categorized as follows: interventions in school/educational institutions; educational activities; partnerships
with NGOs; discussion forums; social benefits; inclusive actions at work; interventions in the community;
home interaction; religious care institutions; and leisure. Results: Through data analysis, it was possible to
observe the importance of intersectoral actions in social inclusion, and also the decentralization of care to other
services, places and sectors. Nonetheless, it is still necessary to discuss this process, once it is not only to include
other spaces, rather to stimulate and to develop the communication between health, social assistance, work,
and education. Conclusion: The challenge of consolidating intersectoriality lies on building an articulation
between different sectors and shared responsibilities for mental health cases.
1
Nursing Graduate by the UFRGS, Residency student enrolled in the Integrated Health Residency Program by the Escola de Saúde
Pública do Rio Grande do Sul. Escola de Saúde Pública do Rio Grande do Sul, Brazil.
2
Nursing Graduate by the Universidade do Vale do Rio dos Sinos (UNISINOS), MSc and PhD in Psychiatric Nursing by the Universidade
de São Paulo (USP), Full Professor of the Nursing School at UFRGS. Universidade Federal do Rio Grande do Sul (UFRGS), Brazil.
3
Nursing Graduate by the Universidade Federal do Pampa (UNIPAMPA), Specialist’s Degree in Nursing by the Universidade Federal de
Pelotas (UFPel), MSc in Nursing by the UFRGS, PhD student enrolled in the Nursing Postgraduate Program at UFRGS. Universidade
Federal do Rio Grande do Sul (UFRGS), Brazil
4
Nursing Graduate by the Universidade Federal de Pelotas (UFPEL), MSc student enrolled in the Nursing Postgraduate Program at
UFRGS. Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
5
Nursing Graduate by the UFPel, Specialist’s Degree in Psychiatric Nursing by the UFRGS and Associação Encarnación Blaya, MSc and
PhD in Psychiatric Nursing by the USP, Associate Professor of the Nursing School at UFRGS. Universidade Federal do Rio Grande do Sul
(UFRGS), Brazil
DOI: 10.9789/2175-5361.2019.v11i3.763-770 | Silva LM, Olschowsky A, Silva AB, et al. | Intersectoral Actions for Mental...
During the second stage, the Medical Literature Analy- professionals (39.29%) occurred in ten of these psychiatrists,
sis and Retrieval System Online databases (MEDLINE) and followed by psychologists (28.57%) and nurses (14.29%).
Literatura Latino-Americana e do Caribe em Ciências da According to the Synoptic Frame (Figure 1), it is obser-
Saúde (LILACS) [Latin-American and Caribbean Litera- ved that the highest concentration of publications was in the
ture in Health Sciences] were used. The following criteria years 2008 and 2009, totaling (46.43%) of the publications.
were used to guide the search, selection and inclusion of The distribution of publications according to the countries
articles for review: a) studies that fit into the proposed where the studies took place, it was observed that the majority
theme: intersectoral actions in mental health; b) theses and of the studies were conducted in the United States of Ame-
dissertations with full text available online; c) articles publi- rica (53.57%), followed by Brazil and the United Kingdom
shed in Portuguese, English, and Spanish, in national and (14.29%); Australia (7.14%); South Africa, Russia and Canada
international journals, covering the period from January (3.57%), totaling 28 publications selected for this study.
2005 to August 2015; d) articles with full text indexed in
the bases previously mentioned; e) combinations of the des-
criptors included in the list of Health Sciences Descriptors
(DeCS), Intersectoral Action, and Mental Health were used
in LILACS. In MEDLINE, the Medical Subject Headings
(MeSH) combinations were used: Mental Health, Mental
Health Services and Community-Institutional Relations.
The criteria for exclusion of articles used were the fol-
lowing: a) not answer the guiding question; b) publica-
tions of the type reflection, bibliographical and integrative
review, summaries, comments, books, interviews, editorials,
government publications, project and study protocol. The
descriptors were combined in pairs, totaling three combi-
nations of DeCS and three combinations of MeSH.
After the crossings of descriptors, there were 925 publi-
cations in MEDLINE and 102 in LILACS. In this stage,
46 publications were selected, 37 of which were indexed
in the MEDLINE database in the English language and
nine indexed in LILACS in the Portuguese language. The
searches occurred over the period from August 9th to Sep-
tember 30th, 2015. In the data evaluation stage, a detailed
reading of the 46 chosen publications was made. During
this stage, 11 publications indexed in MEDLINE and nine
indexed in LILACS did not respond to the guiding question
and were excluded from the study. We thus totaled 28
publications, 26 of MEDLINE and two of LILACS.
In order to analyze the data, we developed a collection
tool to guide what should be observed in the article as
the identification data, objectives, methodology, results
and conclusions, in order to organize and categorize the
information found in the articles. The presentation of
the data was organized through a synoptic table with the
publications selected for the study with the title, authors,
country and year. The ethical aspects were observed pre-
serving the idea of the referenced authors and giving the
due credits in order to maintain the intellectual property *P.C. Publication Code.
rights of the same ones. Figure 1 – Synoptic frame.
Table 1 - Distribution of the publications by the category of identified The studies P1, P3 and P24 show examples of intersectoral
intersectoral actions. actions carried out within the scope of teaching. Among
them is a health education program, carried out during the
period of P1, the implementation of health centers within
schools, intersectoral actions in P3; and the behavioral and
cognitive-behavioral approaches provided by home and
school services for the care of children with trauma related
to emotional/behavioral problems reported in P24.
When considering intersectoral actions in higher educa-
tion institutions, study P9 presents the experience of a service
that offers psychotherapy and emergency care for undergra-
duate and graduate students of a university in São Paulo.
Most of the articles come from the MEDLINE database, According to the study, the students attending the Psycho-
which may be from journals in more than 70 countries on logical and Psychiatric Assistance to the Student (SAPPE)
different continents, while LILACS only covers journals from are mostly low-income students who have presented Mental
Latin America and the Caribbean. This characteristic leads Health issues, requiring university looks.
us to think that intersectoriality in mental health has been It is noted that professionals use these spaces to create/
explored and described worldwide. However, despite the propose health care, this can provide the ease of access and
current debates, it has been little worked in studies, since adherence by the users. Nevertheless, it is important to con-
the analysis of the articles allowed to identify that there is sider that these strategies in the creation of intersectoral
a concentration of publications on this subject between the networks should expand beyond centers or practices within
years 2008 and 2009, being still necessary the incentive to schools and universities, or simply interventions in some
its study. periods of time in these places. In expanding the intersec-
In relation to the hegemony of publications and studies toriality debate, its actions should be shared among health
conducted in developed countries, emphasizing the United professionals, teachers, families, and social actors, making
States of America, it is understood that there is a culture of the school and university a partner in a health and service
research strongly consolidated in these countries, a fact that network that goes beyond a traditional clinic.
justifies the expressive number of articles found. In Brazil,
it is believed that the researches were given greater visibility Intersectoral actions of educational interventions
and fomented, as the policies of incentive were built the
networks resulting from the Health Reform and the need The studies P1 and P25 bring the importance of the figure
to build intersectoral policies. of the promoters of spaces of discussion and learning. In P1
The networks of health care that focus on preventive and the teacher is the driver of the emotional health prevention
curative actions, integration of a diversity of services and programs of schoolchildren, thus making their training a
intersectoral work, are necessary and discussed models from cost-effective way of promoting mental health in schoolchil-
the 90’s, questioning the bureaucratic and hegemonic model, dren. Instead, study P25 presents actions in which nurses
based on hierarchical pyramids and models of health that and human resources employees are responsible for the
are focused only on the solution of signs and symptoms.7 action since they have the characteristic of going to schools
Hence, observing a context of social complexities, it was to develop young people’s awareness and understanding of
necessary to think of networks of flexible structures open to mental health issues, and in addition they present the services
the work of different levels of attention, professionals, and available in the network, which was also saw in P10.
decentralization of care. Considering the actions carried out, we highlight in P23
Given this context, the intersectoriality is constructed the experience of workshops on body image and the iden-
by intersectoral actions by which they are presented in the tification of students at risk of eating disorders, in order to
selected articles (Figure 1). The intersectoral actions identified refer them to specialized services in the community. On the
in the integrative review were gathered according to Table other hand, the educational actions as professional training
1, and are discussed below: studies P4, P20 and P27 presented the logic of the training
of professionals as a form of intersectoral actions. In P4, it
Intersectoral actions of interventions in the school/edu- is demonstrated that the specialized training program has
cational institution helped to promote lasting changes in practice by creating a
critical mass of professionals capable of providing multidis-
It is observed the importance of the school environment ciplinary evaluation and treatment. This idea is also worked
and also of the university in the prevention and promotion on in P27 that addresses the strategies of training and qua-
of health, being these local spaces necessary for carrying out lification of professionals in partnership with a university.
actions in health and mental health.
In this same line of thought, P20 describes the develop- Services (SAPS), the Department of Justice and the Depart-
ment of a training program for Community Health Agents ment of Correctional Services. According to the authors, such
(CHAs), whose purpose is to enable CHAs in the active search intersectoral collaborations are the exception rather than the
as a complement to collaborative care for depression. The rule in the country in question. In P6 a forum is described to
main goal of the action is to reduce the disparities in access discuss questions about the use of football in mental health.
and quality of services for depression and posttraumatic The author argues that it is necessary to develop deep and
stress disorder in the population of New Orleans following sustained partnerships between the world of football and the
the 2005 Hurricane Katrina disaster. During the implemen- world of mental health care as a potent activity for leisure,
tation of the program, the CHAs revealed lack of services inclusion, and demystification of madness.
for the vulnerable population, frustration with the lack of The studies demonstrate that forums have the potential
capacity to meet the financial needs of the population, con- to raise awareness of mental health issues in different gover-
cern with capacity, resources, and infrastructure for mental nmental spheres and sectors of society, are important tools
health services. for intersectoral actions to be established and strengthened,
Given this context, it is important to consider that aiming at integrality in health.
intersectoral actions should be considered beyond chan-
ging spaces, that is, taking care of the health service and Intersectoral actions of social subsidy interventions
letting the school and community be responsible for Mental
Health activities. This process should be more complex, it is P2, P4, P11 and P27 mention the establishment of hou-
important to think about how to strengthen communication sing, such as the creation of shelters, social housing, and
between services and devices, so that both are not isolated Therapeutic Homes, which favor and support the process of
in the responsibility for health care, but rather that there is deinstitutionalization of patients with mental health issues.
a sharing of experiences, cases, the creation of projects and Among these, only P2 pointed out that sectors such as work,
co-responsibility for care. housing, and transportation have not been involved with
mental health issues.
Intersectoral actions of partnership Interventions with Considering the studies that involve some action between
Nongovernmental Organizations (NGOs) two services/agencies providing social subsidies are: study
P5, which presents a partnership between university and
Nowadays, a NGO is understood as a group of non-profit community, providing school, family and social reintegration
voluntary citizens, organized locally, nationally or interna- agencies and, when necessary, maintaining links active with
tionally. NGOs carry out a variety of humanitarian services Juvenile Court; and study P9, which presents a partnership
and functions, bring citizens’ concerns to governments, between university agencies that help students meet their
monitor policies and encourage political participation at financial and academic needs. This strategy has contributed
the community level. They provide analysis and expertise, to the reduction in the abandonment of the course since the
serving as an early warning mechanism, and help monitor profile of the students served is of low income.
and implement international agreements.8,9 In this sense, P16 reports the action of an active search
In the P2 study, early childhood intervention services, team and case management with high-risk adolescents and
the provision of social subsidies, the development of poverty difficult adherence to mental health treatments. The team
reduction programs, and the rehabilitation of drug use are is linked to the mental health service for children and ado-
said to be easy to access when partnering and funding NGOs lescents and funded by the Department of social work in
“In P4 the study presents actions that cover projects beyond Melbourne, Australia.
the health issue, such as housing and employment projects Socio-cultural factors have an effect on the course of the
in a region of Russia. disease and the outcome of the treatments; so, it is not possible
We can see in the studies presented that NGOs bring to restrict mental health to a narrow model of mental disor-
integration with social assistance, as they assume a role of ders by focusing only on psychiatric symptoms since health
mediators between the population and different sectors of care requires thinking social benefits and living conditions.1
government and society, and thus are important in the cons-
truction of intersectoral actions. However, it is necessary to Intersectoral actions of inclusive interventions at work
point out that the state needs to be frequently called upon to
assume its responsibilities in the creation, strengthening and Among the intersectoral actions focused on work is the
expansion of Public Policies of intersectoriality and integrality. study P4, which defends the need to define the roles and
responsibilities of the Department of Labor in the develop-
Intersectoral actions of forums and discussions ment of skills, vocational training opportunities and career
planning for people with intellectual and mental disabilities.
In the P2 study, a national forum on forensic psychiatry On the other hand, studies P22 and P25 report social
was reported in South Africa with the South African Police inclusion programs for patients in a psychiatric hospital;
and employment and volunteer programs as a way to engage mon people to identify and refer “acquaintances, friends, and
the local community in mental health issues. Already in P28 people of the community with health risks.
mentions the courses of professional qualification. Programs On the other hand, P11 and P24 address interventions
can help to rebuild patients’ self-esteem and confidence, at home, where they bring programs that aim to change the
helping to reduce hospital admissions and improve their behavior and emotional problems of children, the improve-
quality of life.10 P25 advocates the engagement of different ment in the father and son relationship and the instrumen-
sectors of society as essential for the success of integrality talisation of parents to care for their children. The presented
in mental health. strategies range from jokes, observations of behaviors different
Intersectoral actions in this field strengthen integral health from the common, and techniques of children approaching. It
care, as they provide resources for individuals to achieve social was observed that these programs aided in the professional’s
and economic integration in the environment in which they relationship with the family, placing the family as an essential
live. Thus, the work brings a sense of belonging, autonomy, member in the progress of the children.
and appreciation to people facing mental health problems. Professional, family and community training and instru-
Being that the articulation with this sector is an important tool mentation through courses and training has been a form of
to qualify attention in mental health since work in the pre- intersectoral approach, with the importance of environments
sent time is considered as a value for inclusion in society.11,12 for reflection and construction of a collective work, however,
it is necessary to point out that intersectoral actions must
Intersectoral actions of community interventions be reflected intersectoral network, formed of diverse sec-
tors, services and places of care, in a way to articulate these
P5, P12, P13, P15 and P26 presented a university-commu- places, and the great challenge is still to create integrated
nity partnership through community-based, sustainable and not only isolated actions, such as, new techniques, little
programs, prevention and intervention programs that helped contextualizing and knowing these sectors.
find new ways to include the family in the health-disease-care
process. In relation to other ways presented that promoted Intersectoral actions of welcoming interventions towards
intersectoral actions in the community were through research, religious care institutions
such as: the creation of a research project in partnership
between researchers, academics and a group of people diag- Study P7 investigates the perceptions and practices of
nosed with psychiatric disorders in P17; community-based pastors with regards to the mental health within their chur-
participatory research and cultural exchange theory to create ches. Among the actions undertaken by the pastors were
a research partnership between the Mental Health service counseling, recognition of behavioral and emotional changes
at P18. in church members, and referral of a member to an external
Other actions that do not include the university-research source of mental health services. It was noted that for effective
axis were also identified as the development of an action collaboration between the church and mental health services,
model for collaborative care for depression performed by there should be a working relationship between clergy and
community health agents in P20; a mental health education mental health professionals based on mutual trust and respect.
work in partnership between schools and community with a In P8, a community intervention is presented to sen-
community recruitment team at P19; a program that provides sitize the elderly to mental health issues and the available
home and school treatment services to address trauma-rela- resources. In the study, members of a community church
ted emotional and behavioral problems in children in P24; received a didactic presentation and answered a questionnaire
a program whose purpose is to bring together individuals regarding their preferences for seeking help before and after
and groups who wish to help people facing mental illness the intervention. The results suggest that the intervention
in a relationship of friendship and fellowship in P26; weekly successfully increased knowledge about mental health and
meetings for older men with mild to moderate mental health adequate resources by the elderly.
needs in a specially built shed in P21; the use of football In P28 there is the observation that faith is an important
stadiums as a space for P6 mental health interventions and aspect in the therapeutic trajectory of the interlocutors. The
ultimately actions to facilitate mental health reform in a region approach of the life trajectories of the interviewees shows that
of Russia using systematic approaches to policy design and social networks have an active participation in the definition,
implementation presented in the P4 study. management, and creation of strategies of interaction with
the disease.
Intersectoral actions of home interventions There are three different approaches involving religious
institutions: (1) the involvement of pastors who confers a
P14 brings a program aimed at working in the community, close eye on the individual in psychological distress; (2)
including social actors such as restaurant employees acting The intervention within the institution for the purpose of
like drivers, as well as health professionals. This program educating its members on mental health issues, and (3) The
aimed at working with seniors giving the possibility of com- importance of religious institutions and faith as something
capable of strengthening and supporting the user in mental point resolution of signs and symptoms, it covers the quality
health. In different ways, the welcoming of religious institu- of life and the broad need of the subject, in other words, it
tions shows itself capable of involving and sensitizing leaders, involves work, food, care, leisure, religion, dwelling.
members, and users in mental health issues. Understanding Hence, this work aimed to bring a review of what we
that mental health is not restricted to the “health sector” or have in the context of intersectoral actions in the world,
the formal networks of public policies, and can also count subsidizing the need for investment in research on the sub-
on networks that reinforce spirituality and religiosity. ject. It is important that our public policies involve different
services/spaces of society collaborating beyond the health
Intersectoral actions of leisure interventions sector, so we can envisage in the future the consolidation of
comprehensive networks of mental health care.
Intersectoral actions of leisure interventions go across
sports, cultural and entrepreneurship activities. For instance,
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Throughout the text, we seek to present and problematize 21.
intersectoral actions and the concept of intersectoriality,
understanding that this process is not only to include other
spaces for care but to stimulate and develop communica-
tion between health places, social assistance, work, leisure,
education.
We believe that the greatest challenge of consolidating
intersectorality is that there is such articulation between
different sectors, broad communication and shared respon-
sibility for mental health cases. For this, it is important the
professional and social formation aiming to comprehend that
health and integrality go beyond the absence of illnesses and
*Corresponding Author:
Luzia Michelon Silva
Rua São Manoel, 936
Rio Branco, Rio Grande do Sul, Brasil
E-mail address: luzia.michelon@gmail.com
Telephone number:+55 51 3308-5226
Zip Code: 90.620-110