El objetivo de este trabajo fue analizar la integración de las Estrategias de Salud de la Familia, uno de los pilares de la atención básica brasileña, con las políticas de salud mental en dos unidades de salud, una localizada en la ciudad de Porto Alegre, la otra en la ciudad de Natal. Para este fin fueron realizadas entrevistas y grupos focales con los integrantes de ambos equipos de salud y, posteriormente, se implementó un proceso de formación, articulado a la propuesta de Educación Permanente en Salud. En el análisis de la información obtenida, pudo observarse que entre los integrantes de los equipos de salud de ambas unidades prevalecen dos estrategias terapéuticas frente a casos entendidos como de salud mental: la prescripción de medicación psiquiátrica y la derivación a especialistas. Las formas de funcionamiento burocratizadas de los equipos de salud dificultan la implementación de otro tipo de estrategias e intervenciones.

The aim of this work was to analyze the integration of Family Health Strategies, one of the cornerstones of Brazil's basic healthcare system, with mental health policies in two healthcare units, one located in the city of Porto Alegre, and the other in Natal. In order to do this, both interviews and focus groups were conducted with members of the two healthcare teams and, subsequently, a formation process, articulated to the Permanent Health Education Proposal, was implemented. In the analysis of the obtained data, it could be observed that among the members of the healthcare teams of both units two therapeutic strategies prevail, in face of cases considered as mental health type: the prescription of psychiatric medication and the referral to specialists. The bureaucratic procedures of the healthcare teams hinder the implementation of other kinds of strategies and interventions.

Las figuras legales denominadas "medidas de seguridad" permiten la reclusión de infractores a la ley, considerados inimputables, en instituciones específicas, conocidas en Brasil, como Manicomios Judiciales. En este artículo se analizan las características de los discursos psiquiátricos y jurídicos que operan en estos casos, su funcionalidad institucional y social y sus consecuencias para los sujetos. Para esto, se toman como referencia las pericias psiquiátricas realizadas a los internos que cumplen estas medidas en el Ala de Tratamiento Psiquiátrico de una prisión de Brasilia, Brasil.

Individuals who infringe the law but are declared legally un-punishable are, in some cases, committed in specific institutions, known in Brazil as Judiciary Madhouses. This paper analyzes the characteristics of the psychiatric and judiciary discourses that operate in these cases, its consequences for the subjects and their institutional and social functionality. It takes the psychiatric verdicts of individuals housed in the Psychiatric Treatment Area of the Coméia Prison in Brasilia-Brazil and constitutes it as the main information upon which this analysis is based.

El régimen penal de prisión domiciliaria está destinado principalmente a aquellas personas que habiendo pasado por un período de prisión efectiva, progresan hacia este tipo de medida como paso previo a la finalización de su condena. En el Distrito Federal de Brasil este proceso de inserción social se ve dificultado por las condiciones de vulnerabilidades sociales, individuales e institucionales de esta población. Con el fin de profundizar el conocimiento acerca de estas cuestiones fueron entrevistados 175 sujetos en esta condición sociojurídica, por medio de entrevistas semi-estructuradas. Como resultado se puede afirmar que las dificultades de acceso a educación, salud y condiciones dignas de empleo en general se suman a factores relacionados con la salud mental de esta población, entre ellos el consumo de alcohol y otras drogas, lo que dificulta su inserción social y aumenta las probabilidades de reincidencia penal.

Domiciliary prison is an alternative for those inmates that having paid a fraction of their effective time term in prison are considered eligible to finish it off at their own homes. In the Federal District, Brazil, this process of social insertion is hindered by highly vulnerable conditions -social, spatial, individual and institutional- of this population. In order to reach a more in-depth knowledge of these questions, we interviewed, through a semi-structured format, 175 former inmates enjoying the aforementioned legal condition. We established that poor mental health, fueled by the consumption of alcohol and other drugs, aggravates the expected inequality of opportunities in education, health and decent employment suffered by this population, and hinder their social rehabilitation, increasing all along the probability of returning to a life of crime.

Los individuos que infringen la ley, considerados portadores de enfermedad mental y declarados legalmente inimputables, son recluidos en instituciones específicas. Para definir esa condición de inimputable es necesaria la realización de un laudo psiquiátrico que defina su patología y condición de peligroso. La relación que se produce aquí, entre el discurso psiquiátrico y el jurídico en asociación con determinadas prácticas institucionales, lleva al deterioro social e individual de estos sujetos y a su cronificación institucional. Esta investigación tuvo como objeto analizar las características de esos discursos y su funcionalidad institucional y social. Los laudos psiquiátricos de los reclusos del Ala de Tratamiento Psiquiátrico de la Prisión de Coméia, Brasil, constituyen la información sobre la cual se basó este análisis

Individuals who infringe laws, considered mentally ill and declared legally immune from prosecution, are in some cases secluded in specific institutions. To define the condition of immune from prosecution it is necessary to make a psychiatric verdict which may also define his pathology and his condition of danger. This way, the relation between psychiatric discourse and judiciary discourse in association with certain institutional practices leads to the individual and social deterioration of these people and this process produces an institutional chronification. This research aims to analyze the characteristics of these discourses and their institutional and social functionality. The psychiatric verdicts are of recluse individuals in the Psychiatric Treatment Area of the Colméia Prison of Brasilia and constitute the main information of which this analysis bases on.

Os sujeitos infratores à lei, considerados portadores de doença mental e declarados legalmente inimputáveis, são objeto das denominadas medidas de segurança. Estas sanções legais dispõem, em alguns casos, a reclusão desta população em instituições específicas. Para definir essa condição de inimputável é necessária a realização de um laudo psiquiátrico que define também sua patologia e grau de periculosidade. Essa associação do discurso psiquiátrico com o jurídico e as práticas institucionais relacionadas leva à deterioração individual e social desta população e, com freqüência, à sua cronificação institucional. O propósito desta pesquisa é analisar as características destes discursos e sua funcionalidade institucional e social. Os laudos pertencentes aos sujeitos que cumprem medida de segurança na Ala de Tratamento Psiquiátrico do Presídio da Colméia de Brasília constituem a informação principal sobre a qual se baseia a análise. A Análise de Discurso e a Análise Institucional são as ferramentas metodológicas utilizadas para esse fim.

Individuals who break the law, considered mentally ill and declared legally exempt from punishment are object to what is called security measures. These legal sanctions, in some cases, dispose of the incarceration of this population in specific institutions. To define the condition of exemption from punishment, it's necessary to carry out a psychiatric assessment that defines the pathology and level of danger to others. The association of psychiatric and judiciary discourse, and related institutional practices, conveys to individual e social deterioration and, frequently, to a chronic institutionalization. Analysis was based on the data taken from the medical records of subjects who are under security measures in the Psychiatric Treatment ward of the Presídio da Colméia in Brasília. Discourse analysis and Institutional analysis are methodological tools used for these objectives.

O modelo americano de tribunais para dependentes químicos está em tratativas de implantação pela justiça do Distrito Federal, Brasil. Neste modelo penal, os consumidores de drogas ilegais ficam obrigados a se tratar da sua suposta doença, diagnosticada por uma autoridade judiciária. A recusa em aceitar o tratamento implica uma punição legal. A metodologia empregada para analisar os documentos que descrevem e justificam essas políticas é a análise crítica do discurso que, com um critério hermenêutico, tenta mostrar as características ideológicas de textos e discursos e os relaciona com formações discursivas maiores.As políticas de tratamento compulsivo aos usuários de drogas provocam a penalização dos mesmos, ficando estes sob o duplo estigma de doentes e criminosos. Estas iniciativas estão relacionadas com as políticas denominadas de "Tolerância Zero" que procura incriminar grupos sociais e tipos subjetivos particulares. A crescente demanda da justiça aos profissionais da saúde mental para fazer parte deste circuito legal coloca aos mesmos perante uma eleição de caráter ético e político.

The justice department of the Distrito Federal, Brazil (the municipality of Brasilia, the capital of Brazil) is transacting the implementation of the american model of drug courts. In this penal model, consumers of illegal drugs are under the obligation of treating their supposed disease, diagnosed in magistrate's court by a judiciary authority. A refusal to the treatment implies in legal punishment. We used critical discourse analysis as the methodology to analyse the documents that describe and justify these policies. With hermeneutical criteria this methodology tries to point out the ideological characteristics of the texts and discourses and relates them with greater discourse formations. These policies of compulsive treatment of drug users results in penalizing the drug users themselves, placing them under the double stigma of being sick persons as well as criminals. These initiatives have a relationship with the denominated "zero tolerance" policy that tries to incriminate social groups and particular subjective types. The Justice's increasing demand of mental health professionals to become members of this legal circuit places them amid an ethical and political challenge.