This paper presents a theoretical analysis on the integration of mental health within primary care from the perspective of the objectives and strategies of Global Mental Health (GMH). This task is divided into two parts. The first part is dedicated to international review studies on the subject and the second deals with Brazilian regulatory and scientific publications about the issue. The international studies corroborate the integration of mental health within primary health care (PHC) as a fundamental strategy for reaching the goals of GMH. In the Brazilian scenario, this topic is important for policies and research within mental health, but the objective of this integration and the ways in which it is put into operation require better definition. We conclude by pointing out some obstacles that prevent PHC from occupying a strategic role regarding mental health actions within the Brazilian National Health System (SUS).

Este artigo discute o que pensam os profissionais da gestão sobre os processos de educação permanente em saúde no município de Recife, Pernambuco, descrevendo as ações e relacionando-as com os conceitos de educação permanente ou continuada. Originou-se de um estudo de caso, que utilizou entrevista semiestruturada com sete gestores e gerentes. A análise de conteúdo foi o método escolhido para tratamento dos dados. A educação permanente em saúde tem sido utilizada como ferramenta para pôr em prática novos dispositivos de trabalho na atenção primária à saúde. Os resultados apontam para seu uso pela gestão como ferramenta de mudança do processo de trabalho. Alguns setores da Secretaria Municipal de Saúde de Recife se apropriaram mais adequadamente do conceito de educação permanente em saúde, enquanto outros ainda a entendem como sendo igual à educação continuada. As ações surgiram das dificuldades encontradas no trabalho, a partir do que a gestão definiu como importante para a qualificação dos trabalhadores e do que as universidades perceberam como demanda para qualificação profissional. Alguns dispositivos citados foram: o apoio matricial, o apoio institucional e o projeto terapêutico singular. As dificuldades para o aperfeiçoamento das ações foram a fragmentação das ações e a pouca priorização da educação permanente em saúde por alguns profissionais da gestão.

Since its emergence in 2007, Global Mental Health has been a growing and polemic area of study, research and practice in mental health worldwide. Despite having a significant endogenous academic production and innovative policy experiences, the Brazilian mental health field and its actors make few references to, and scarcely dialogue with, the Global Mental Health agenda. This article explores an aspect of this divergence between Global Mental Health initiatives and public mental health care in Brazil regarding the role of culture within mental health policies and practices. Our hypothesis is that part of this difficulty can be attributed to the low relevance of the cultural dimension for the Brazilian mental health field, here referred to as the “silencing of culture.” We examine the possible historical roots of this process with reference to theories of “anthropophagy” and “cultural uniformity” in the context of Brazilian cultural matrices. We then describe two recent experiences in public mental health care that incorporate cultural competence through the work of community health workers and the example of community therapy. We argue that the development of cultural competence can be decisive in enabling an improved dialogue between research and practice in Brazilian mental health and global mental health initiatives.

The aim of this study was to identify possible contributions from the work of the founder of anthroposophic medicine, Rudolf Steiner, to integrality in medical education. This was a hermeneutic study along the lines indicated by Gadamer, on the courses and lectures on medicine given by Steiner. Four main summarized proposals regarding his thinking are presented: (1) a critique of the model of materialistic science that can be expanded through Goethean phenomenology; (2) anthroposophic threefolding and fourfolding as interpretative keys for the health-illness process; (3) integration between human beings and nature as the foundation of research on new treatments; and (4) the link between moral development and scientific and technical training in medical education. The limits and potentials of these proposals were analyzed from the perspective of the viability of epistemological plurality within medical knowledge and practices.

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