Questions/Answers

Custody and Psychiatric Treatment Hospital (HCT) is a space for custody, shelter, hosting and treatment of people, to ensure compliance of the Safety Measure – these people, due to mental disturbs, are unable to recognize the action’s illegality. The intervention at HCT-BA is based on the principles of Deinstitutionalization, Inclusion, Ability and Psychosocial Rehabilitation of Programs of Individualized Assistance. The work is done by following a multidisciplinary approach, especially with the sectors of Psychology, Social Assistance, Occupational Therapy, Education and Safety. Under this context, the role of health professionals is to establish a differentiated bond with the patient, this way enhancing the psychological action and aiming to fulfill the needs of the individual in their different dimensions. The work of the team of Psychology at HCT follows a multidisciplinary perspective in the interface of the discourse and practices of Law, Psychiatry, Safety and Social Assistance and that reflect on the psychologist’s ethics and social function, which come from the tensions and conflicts that the work in an institution imposes. Interventions occur in three axis: Deinstitutionalization, Socio-educational and Therapeutic Activities that unfold in innumerable activities, objectives and aims to be fulfilled by professionals and interns. Many interns that arrive in the institution attest the condition of excluded of the basic rights of citizenship, once they had not gone through any attending in the health public network and did not have civil documentation. Under this context, the building of spaces for attention to the person as workshops, social-educational and therapeutic activities, gained relevance insofar as the teams deconstructed the hospital as a place to restrain madness and criminality, internalized the principles of Deinstitutionalization and broadened the actions to comply with Objective 16 of Agenda 2030 for the sustainable development.

Develop actions in mental health for prisioners in process of deinstitutionalization should be articulated with a service network in the region, involving intersectional actions with education, work and leisure. Build spaces for attention to the person who is in compliance with a security measure, as workshops, social-educational and therapeutic activities, among other resources. Deconstruct the hospital as a place to restrain madness and criminality, internalized the principles of Deinstitutionalization and broadened the actions to comply with Objective 16 of Agenda 2030 for the sustainable development that aims peace, justice and efficient institutions to change the world (UN , 2016).

Work based on the principles of alterity and peace, even in conditions of deprivation of freedom, is necessary. Brazilian Constitution (BRASIL, 1988) and the Law 10216/2001 (BRASIL, 2001) guarantee that individuals like the ones who are attended at HCT have their rights and dignity protected; the precariousness of custody institutions and the lack of adequate treatment for the illness they show, corroborate so that these individuals return to life in society with few perspectives of inclusion and, then, condemned to isolation. Then, even with the right to prison, they are imprisoned and watched by a society that is contaminated by the stereotype that associates madness to violence and criminality. So psychosocial attention in a context of deprivation of freedom creates conditions of reception and inclusion. Many interns that arrive in the institution attest the condition of excluded of the basic rights of citizenship, once they had not gone through any attending in the health public network and did not have civil documentation.

The HCT is a place of deprivation of liberty, but unlike the other prisons it is a place to live in peace. There were planned and held workshops and educational actions: eight workshops in each cycle/semester (Expressive, Manufacturing of masks, Informative, Sexual Health, Poetry, Writing and Stories of Life, among others), and they were held with the presence of que corrections officers. In the third phase, there were workshops on Arts and Music, Reading, Writing and Stories of Life, Circular Dance, Wheel of Life, among others, and they resulted in the organization and presentation of a soiree. In the workshops, the interns told stories about their childhood, their feelings about being imprisoned, existential conflicts, the absence of the family and expectations to return to social life. Lack of affection, absence of family support and the importance of the contact with young students were constant topics in all the narratives. Aspects such as self –care, relationship with their community of origin, citizenship, music and arts, were more highlighted in the workshops, much more than health/illness or stability in clinical pictures. The workshops highlighted the importance of multidisciplinary cases (but more emphasized in the actions by the psychologist) and created spaces to think about the person, know his/her story and the difficulties in the building of a project of life.

The provision of public services for persons deprived of their freedom is carried out on the basis of security, discipline, punishment. In HCT the biopsychosocial team works with the suffering human being that needs to be socially included. In the workshops, the interns experimented with a new attitude that showed a different attitude towards life with more cooperative and solidary forms of relationship.

Regarding the profile of the population that was admitted at HCT in 2015, the unit had 136 interns ( 10 women and 126 men) , 43 of them in a compliance of Security Measure , 2 under treatment , 9 with a Letter of Non- admittance and the other ones waiting for a judicial decision. In 2016, the unit had 168 interns, 49 of them in a compliance of Safety Measure, 4 under psychiatric treatment, 16 with a Letter of Non- admittance, and the other ones were in the unit waiting their return to their hometown, after the sending of the Report of Mental Sanity. In 2017, during the period of holding of the research, there were 154 interns and 52 of them were undergoing Security Measurement. Regarding the mental disturbance that6 had been diagnosed in the exams, more than 60% of the interns that undergo security measurement, show paranoid schizophrenia. It was verified that the interns who participated in the workshops adhered more to the treatment and the insertion in the CAPS (Psychosocial Attention Network) after discharge. Of the 72 patients who participated in the educational activities (three stages), only 8 had difficulty or did not adhere to the satisfactory treatment after discharge, presenting difficulties in resumption of family life.

Deconstruct the hospital as a place to restrain madness and criminality, internalized the principles of Deinstitutionalization and broadened the actions to comply with Objective 16 of Agenda 2030 for the sustainable development that aims peace, justice and efficient institutions to change the world (UN , 2016) is a different and important work because it is in a context of deprivation of liberty and focus on Agenda 2030 which provides for universal respect for human rights and human dignity with respect to race, ethnicity, cultural diversity and equal opportunities.

I am not aware of work in the prison system with the perspective of inclusion and what Propose Agenda 2030. The intervention at HCT-BA is based on the principles of Deinstitutionalization, Inclusion, Ability and Psychosocial Rehabilitation.

The words, the affection and the respect added in pencil, paper and music. Under this context, the role of health professionals is to establish a differentiated bond with the patient, this way enhancing the psychological action and aiming to fulfill the needs of the individual in their different dimensions.

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The production of these experiences in the prison system or in other contexts as people with mental disturb , can happen as long as we provide conditions for so, deconstruct the stereotypes about the mad person ( and the person who commits crimes) and we open the possibility for the encounter , dialogue , welcoming and the care with the other and him/herself. The initiative must be adaptable to other contexts. It is necessary dialogue, welcoming and the care with the other and him/herself.

In the state of Bahia, the place for the holding of exam of mental sanity and applying of safety measure is the Custody and Treatment Hospital (HCT), a unit of the Secretariat of Prison Administration and Resocialization, which is located in Salvador-Bahia and attends the 417 cities in the State.

Deconstruct the hospital as a place to restrain madness and criminality, internalized the principles of Deinstitutionalization and broadened the actions to comply with Objective 16 of Agenda 2030 for the sustainable development that aims peace, justice and efficient institutions to change the world. It is necessary to train teams to understand the Agenda 2030 that involves the economic, social and environmental dimensions of sustainable development. Sustainability explores the dynamic interconnections among social and economic systems in order to meet the needs of the present.

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For the psychologists, interns and students, as well, during the evaluation of the work that had been done, observations highlighted the learning and experience. In these meetings, it was highlighted that social – educational and therapeutic actions should be focused in the interns’ interest and with attention to time. Long activities of more than one hour, produced the dispersion in the group and music was Always welcomed. It was also considered that the actions in mental health for interns under the process of deinstitutionalization should be articulated with the service network in the region, by involving intersectional actions with education, work and leisure.

The actions should follow the model of care networks of territorial basis and aim the establishment of bonds and welcoming, according to the reasoning of the principles of the Unified Health System and Psychiatric Reform notion of territory, intersectional activities, psychosocial rehabilitation, deinstitutionalization, building of the autonomy of users and families, etc.).

Interest in participating, assiduity, approachable behavior, adherence to treatment.

It was always considered that actions in mental health for interns in process of deinstitutionalization should be articulated with a service network in the region, involving intersectional actions with education, work and leisure. Actions should follow the model of care network of territorial basis and aim for the creation of bonds and welcoming, according to the reasoning of the principles of the Unified Health System and Psychiatric Reform (notion of territory, intersectional activities, psychosocial rehabilitation, deinstitutionalization, building of the autonomy of users and families, etc.). The acting as a psychologist in the unit and the work developed with graduate students of Psychology, who use the space as a scenario of practices, learnings and researches, made it possible the arising of reflections on the interventions done with people with mental disturb at HCT. Professionals, students, family members and interns participate in the HCT actions.

The action created spaces to think about the person, know his/her story and the difficulties in the building of a project of life. The encounter, the dialogue, the reception and the care with the other and with you are the lessons learned in the context of deprivation of freedom