Abstract
This article analyzes mental health care practices in primary health care (PHC) in the city of Florianópolis, which were based on proposals by Abilio Costa-Rosa regarding the asylum-psychiatric and psychosocial modes of care. The methods involved the following: a) the contextualization of the empirical field with documental analysis and interviews with managers; b) mapping interventions through interviews with professionals from nine selected Family Health Teams (ESF); c) deepening the understanding about these actions through observations and interviews with professionals and 20 case studies, which were systematized in accordance with the flowchart proposed by Merhy through interviews with service users and analysis of records. It was identified that the actions aimed at access and monitoring of the cases involved the whole team, and that medical and pharmacological treatment was centrally administered. Interventions based on words, socio-communitarian interventions and interventions based on the body were also present, and they showed the potential to operate from a perspective of valuing autonomy and singularity, aspects which are often underused when psycho-social approaches are absent. The need to improve care models and to bring together psychosocial care and PHC is suggested.
Highlights
Authors who have discussed the rapprochement between mental health and primary health care (PHC) have pointed out the epistemological and political compatibility of Health and Psychiatric Reforms in Brazil; they refer to the emerging challenges in this process, including the operation of care[1,2,3,4]
These studies have confirmed the shortage or absence of actions that use community resources5,6but they have emphasized that guidelines and concepts which are crucial to the operation of PHC, such as reception, humanization and quality of life, are gateways to the valuing and structuring of mental health care[8,9]
In the light of the aforementioned findings, the research summarized in this article aims to: a) describe the proposals, identified target group, and the operation of mental health care practices offered in the PHC network in the city of Florianópolis; b) to analyze how these care practices are articulated to comprise therapeutic projects as well as the care itineraries that are produced; c) to situate these practices in the theoretical-technical fields of mental health and PHC, as well as commenting on their inter-relationship
Summary
Authors who have discussed the rapprochement between mental health and primary health care (PHC) have pointed out the epistemological and political compatibility of Health and Psychiatric Reforms in Brazil; they refer to the emerging challenges in this process, including the operation of care[1,2,3,4].Previous studies about mental health care practices in PHC have identified the need to identify demand (in conjunction with Community Health Agents - ACS), reception and diagnosis[5,6,7]. There has been a tendency to view mental health as a specialized area of expertise, which is linked with the corresponding implementation of matrix support[5,6,8]; the prevalence of drug treatments or other biomedical interventions[6,8,9]; the use of listening and guidance, which are often not perceived as intervention even by professionals themselves,[7,8] or improvised actions[9]; attempts to develop therapeutic projects involving individual consultations and home visits with low levels of care cover[5]; and the referral of cases, which are often emergencies, due to crises[5,7,9] These studies have confirmed the shortage or absence of actions that use community resources5,6but they have emphasized that guidelines and concepts which are crucial to the operation of PHC, such as reception, humanization and quality of life, are gateways to the valuing and structuring of mental health care[8,9]. The “cure” is understood as a subjective repositioning, and the privileged therapies are psychotherapy, labor-based therapies and socio-cultural reintegration devices, depending on the situation, medicines may be used as major or minor auxiliaries
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