Citation

Fulone I, Barreto JOM, Barberato-Filho S, Bergamaschi CDC, Silva MT, Lopes LC. Front. Psychiatry 2021; 12.

Copyright

(Copyright © 2021, Frontiers Media)

DOI

10.3389/fpsyt.2021.575108

PMID

unavailable

Abstract

BACKGROUND: The deinstitutionalization process is complex, long-term and many countries fail to achieve progress and consolidation. Informing decision-makers about appropriate strategies and changes in mental health policies can be a key factor for it. This study aimed to develop an evidence brief to summarize the best available evidence to improve care for deinstitutionalized patients with severe mental disorders in the community.

METHODS: We used the SUPPORT (Supporting Policy Relevant Reviews and Trials) tools to elaborate the evidence brief and to organize a policy dialogue with 24 stakeholders. A systematic search was performed in 10 electronic databases and the methodological quality of systematic reviews (SRs) was assessed by AMSTAR 2.

RESULTS: Fifteen SRs were included (comprising 378 studies and 69,736 participants), of varying methodological quality (3 high-quality SRs, 2 moderate-quality SRs, 7 low-quality SRs, 3 critically low SRs). Six strategies were identified: (i). Psychoeducation; (ii). Anti-stigma programs, (iii). Intensive case management; (iv). Community mental health teams; (v). Assisted living; and (vi). Interventions for acute psychiatric episodes. They were associated with improvements on a global status, satisfaction with the service, reduction on relapse, and hospitalization. Challenges to implementation of any of them included: stigma, the shortage of specialized human resources, limited political and budgetary support.

CONCLUSIONS: These strategies could guide future actions and policymaking to improve mental health outcomes. © Copyright © 2021 Fulone, Barreto, Barberato-Filho, Bergamaschi, Silva and Lopes.

Language: en

Keywords

adult; human; mental health; suicide; quality of life; schizophrenia; community mental health services; hospitalization; psychoeducation; politics; controlled study; patient care; mental health service; community mental health; cost effectiveness analysis; budget; relapse; satisfaction; schizoaffective psychosis; deinstitutionalization; case management; schizophreniform disorder; Article; harm reduction; psychosocial rehabilitation; schizotypal personality disorder; social stigma; assisted living facility; evidence-informed policy; knowledge translation; resource shortage