Evaluation of psychosocial healthcare services in the city of São Paulo, Southeastern Brazil

Abstract

OBJECTIVE: To describe infrastructure, human resources, and care approaches in psychosocial healthcare services. METHODS: Descriptive study including 21 psychossocial healthcare services for adults affiliated to the local health department in the city of São Paulo, Southeastern Brazil, conducted between 2007 and 2008. Information about infrastructure of facilities, human resources available and patient care was collected using a standardized instrument. There were performed descriptive data analysis and chi-square test to test the association between care activities and service source and location. RESULTS: Ten services were first created as outpatient clinics and later adapted, eight were day hospitals and only three were created as psychosocial healthcare services. None of them was open 24 hours a day. Half of them were located in rented buildings with inadequate infrastructure especially for group activities. Staff composition was very different among services, with emphasis on on-site group activities and little integration to other health services. All services provided mostly arts and cultural activities. Earlier outpatient services provided mainly craft activities and former day-hospitals offered mostly psychophysical integration activities. The profile of activities varied according to the geographical distribution of services. CONCLUSIONS: Current heterogeneous character of psychosocial healthcare services seems associated to the history of mental health care programs that have been implemented in São Paulo since 1980s and to social, economic and cultural differences in different areas of the city. Different psychosocial care approaches were found ranging from on-site care with little integration with other health services to services that refer their users to other services after symptoms become stable in an attempt to create a network of mental health care.