Saúde Mental E Atenção Básica: Território, Violência E O Desafio Das Abordagens Psicossociais

Abstract

Re su mo Este artigo teve como objetivo discutir os desafios para a implementação das ações de saúde mental na Estratégia Saúde da Família na perspectiva da desinstitucionalização e territorialização do cuidado. Descrevemos, na visão de gestores e equipes de saúde da família, o contexto territorial, formas de identificação das demandas e práticas de acolhimento e cuidado em saúde mental. Avaliamos ainda os desafios para a construção de abordagens psicossociais potentes e o cuidado em rede. O campo da pesquisa constituiu-se de dois territórios da cidade (Manguinhos e Complexo do Alemão) com características emblemáti-cas do contexto urbano do Rio de Janeiro no período estudado (2009 a 2013). Os pesquisadores trabalharam com estratégias de metodologias qualitativas e colaborativas que incluíram entrevistas com gestores, grupos focais com trabalhadores e visitas sistemáticas ao campo. Os dados coletados apontaram tendências específicas como expansão acelerada da Estratégia Saúde da Família com impactos no processo de trabalho; discurso dos gestores com evidência de abertura para inclusão da saúde mental na Estratégia; narrativas dos trabalhadores explicitando sensação de despreparo e baixa percepção do potencial terapêutico da atenção básica; violência nos territórios causando tensões e ambivalências em relação aos poderes locais; associação direta entre saúde mental e cotidiano violento. Pa la vras-cha ve saúde mental; atenção básica; abordagens psicossociais; território. Abs tractThis article aimed to discuss the challenges to the implementation of mental health actions in the Family Health Strategy in the context of deinstitutionalization and of the territorialization of care. We described, in the view of the family health managers and teams, the territorial context, forms of identification of the demands, and the mental health support and care practices. We also evaluated the challenges to building powerful psychosocial approaches and network care. The research field consisted of two territories in the municipality of Rio de Janeiro (Manguinhos and Complexo do Alemão), Brazil, with iconic features of the city's urban context, in the period studied (2009)(2010)(2011)(2012)(2013). The researchers worked with qualitative and collaborative methodology strategies that included interviews with managers, focus groups with workers, and systematic visits to the field. The data collected showed specific trends, such as the accelerated expansion of the Family Health Strategy with impact on the work process; the discourse of the managers with evidence of opening for the inclusion of mental health in the Strategy; workers' narratives explaining their sense of unpreparedness and a low perception of the therapeutic potential of primary care; violence in the territories causing tension and ambivalence in relation to local authorities; direct association between mental health and violence in daily life.

Clinical stability, diagnosis and catchment area: the patients of a university-based psychiatric outpatient clinic

“…Data from the research conducted by Prata et al 31 in the city of Rio de Janeiro between 2009 and 2013 show trends that help us reflect on the current assistance model, such as: the expansion of the Family Health Strategy (ESF) in the city; reports made by managers providing evidence that the ESF has been opening itself to mental health and that there are difficulties in the cases' longitudinal followup due to work overload; narratives of workers in family health teams manifesting the sensation of lack of training and low perception of the therapeutic potential of primary care; violence in the territories, among others. Among the described narratives, we highlight the managers' different points of view about the assistance model, depending on their involvement in mental health or in the ESF.…”

O conflito armado e os impactos na saúde dos trabalhadores que atuam na Estratégia de Saúde da Família na cidade do Rio de Janeiro

“…The World Health Organization (WHO, 2008) warns of the high prevalence of psychosocial risks to which health workers in Europe are exposed, responsible for increasing problems such as work-related stress, violence, harassment and bullying in the workplace. Regarding violence, a survey conducted in two vulnerable territories in the municipality of Rio de Janeiro identified, in the participants' statements, urban violence as a permanent challenge that interferes in the management, in the professionals' work, and in the care of health system users (Prata et al, 2017).…”

Healthcare professionals’ perception of mental health in primary care

“…This new model can help the transformation of the work processes, in the direction of sharing care between the teams (16) . Matrix support can also provide greater safety in the work of primary care professionals, since they do not always feel secure when dealing with cases that involve mental health (17) .…”