Community mental health network care: an evaluative approach in a Brazilian state

Abstract

In recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of the RAPS in Minas Gerais (MG), the second most populous state of Brazil, generating indicators that can enhance the strategic management of the SUS in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of ‘Family Health Strategy (ESF),’ ‘Expanded Family Health Center (NASF),’ and ‘Psychosocial Care Centers (CAPS)’ but a lack of ‘Beds in General Hospitals (LHG),’ ‘Unified Electronic Medical Records’ and ‘Mental Health Training Activities for Professionals’. In the process dimension, adequate implementation of actions such as ‘Multidisciplinary and Joint Care,’ ‘Assistance to Common Mental Disorders by Primary Health Care,’ ‘Management of Psychiatric Crises in CAPS,’ ‘Offer of Health Promotion Actions,’ and ‘Discussion of Cases by Mental Health Teams’ point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of ‘Psychosocial Rehabilitation Actions,’ ‘Productive Inclusion,’ ‘User Protagonism,’ ‘Network Integration,’ and practical activities for the effectiveness of collaborative care. We found a better implementation of RAPS in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of RAPS are scarce throughout the Brazilian territory, a fact also found in MG, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management.

Effect of an intervention for organizing mental health care in primary health care

“…It is noteworthy that the indicators of processes and outcomes of MH care in PHC used can be calculated from records available in information systems. The choice for existing sources of data instead of applying new tools considered the importance of proposing and evaluating metrics that can be incorporated into the work processes of PHC professionals and managers, considering the scarcity of evidence on monitoring and evaluating MH care in the Brazilian scenario [13,15]. [13] evaluated the implementation of PSCN in a Brazilian state, analyzing the structure and activities that constitute the complex range of actions necessary for the satisfactory provision of community psychosocial care.…”

“…The choice for existing sources of data instead of applying new tools considered the importance of proposing and evaluating metrics that can be incorporated into the work processes of PHC professionals and managers, considering the scarcity of evidence on monitoring and evaluating MH care in the Brazilian scenario [13,15]. [13] evaluated the implementation of PSCN in a Brazilian state, analyzing the structure and activities that constitute the complex range of actions necessary for the satisfactory provision of community psychosocial care. These authors identi ed low implementation of evaluative criterion 'Mental health care evaluation and monitoring actions at the municipal level'.…”

“…Considering the signi cance of monitoring and assessing program outcomes in real-world settings using data from service records [11][12][13] to inform decision-making, and to improve the quality of mental health care, and contribute to the ongoing discourse in the literature, this study aimed to evaluate the effect of SMAPS on mental health care indicators in PHC.…”

Evaluation of collaborative mental health services in Latin America: Theoretical and methodological basis

“…Evaluation is key to fostering ongoing processes and outcomes of collaborative care initiatives, enabling performance reporting across jurisdictions and over time, and assessing the attainment of goals established both for primary care and mental health, as well as for the broader health system renewal 13,14 . An appropriate and feasible evaluation framework is essential in: (1) strengthening mental health services in terms of access, quality of care and impact on population health status, including mental health; (2) enhancing management to better use local resources; and (3) fulfilling transparency and accountability requirements.…”