A implantação do modelo de hospital - dia da UISM nos hospitais e policlínicas navais distritais : elevação do nível da assistência em saúde mental e redução de custos

Abstract

The COVID-19 pandemic has significantly impacted global mental health. Diagnoses of mental and behavioral disorders have multiplied around the world, expanding the number of patients with mental and behavioral disorders, mainly involving cases of anxiety, depression, alcohol and substance abuse. Suicidal ideation as a complication in the progression of diseases and the number of suicides with the arrival of the pandemic have seen increased rates, including among adolescents. In parallel, since the beginning of the 21st century, new concepts have emerged in psychiatric therapeutic approaches, advocating for psychiatric deinstitutionalization, relegating full psychiatric hospitalization as a last resort. At this time, the humanized therapeutic model of Day Hospital gains strength, promoting multidisciplinary care in a holistic environment integrated with the patient's family, in order to promote early reintegration with considerably lower costs than full psychiatric hospitalization. Considering the increase in mental and behavioral disorders in the Naval Family's Health System and consequently the costs associated with psychiatric hospitalization, and also, that the Brazilian Navy has implemented a series of measures to address the scenario involving mental and behavioral disorders, the first stage of the research aimed to describe the structure and actions implemented within the Force and compare them with other coping programs, in order to seek similarities and singularities. Programs from the Psychiatry Institute of the Federal University of Rio de Janeiro, the Psychiatry Institute of the Clinical Hospital of the University of São Paulo, the Health Plan for Public Servants of the State of Bahia, and the Petrobras Health Program were chosen. From this comparison, it was concluded that the mental health structure in the Brazilian Navy, in Rio de Janeiro, equals the best in Psychiatry in the country, due to the excellence of the most complex activities developed in the Integrated Mental Health Unit, which include Psychiatric Emergency, the newly inaugurated Labor Mental Health Unit, and the Daily Care Center, which operates in the Hospital-Day model. The second part, and the core of the research, focuses on the analysis of the increase in cases that required referral for treatment in a Day Hospital and full psychiatric hospitalization regime, in the Hospital Units accredited to the district Naval Hospitals and Polyclinics, outside the Headquarters (Rio Area) and their respective costs. By concluding that the presence of a Day Hospital model in the district Hospital Organizations would improve8 the quality of mental health care and reduce costs associated with hospitalization in Non-Navy Health Organizations, a pilot project was proposed for the implementation of the Integrated Mental Health Unit's Day Hospital model in the district Naval Hospitals and Polyclinics. If deemed relevant, it is suggested that the project be studied within the Navy Health Directorate.