Matrix Support In Mental Health Research Articles

MATRICIATION IN MENTAL HEALTH: Conceptions, changes and difficulties of primary care professionals

The objective was to analyze the conceptions of professionals from Primary Care teams in a municipality in southeastern Brazil, regarding matrix support in mental health. This is a qualitative research study. Data were collected through semi-structured interviews and subjected to the content analysis technique. In total, six professionals from different categories participated in the research. The results demonstrated that matrix support is presented by some reference teams as a favorable strategy for improving mental health care and by others as a proposal with low resolution, which ended up being converted into an inspection apparatus and expansion of the power of experts. The need to promote the regularity of productive matrix support meetings is highlighted, encouraging this strategy towards health promotion and deinstitutionalization, due to its ability to cover Primary Care in discussions and actions around Psychiatric Reform.

A narrative review of matrix support in mental health among the CAPS-ESF teams in Brazil

Resumo A pesquisa teve como objetivo identificar como acontece o Apoio Matricial realizado entre o Centro de Atenção Psicossocial (CAPS) e as equipes de Saúde da Família. Ocorreu a partir de uma revisão narrativa da literatura feita através de uma busca utilizando como descritores “apoio matricial AND saúde mental”, nas bases da SciELO e PubMed, entre 2016 e 2020, com 12 estudos selecionados. Após a leitura do conjunto do material, dois eixos temáticos foram construídos: apoio CAPS-ESF na prática e seus alcances e elementos facilitadores e desafiadores. O Apoio Matricial é ferramenta essencial à Reforma Psiquiátrica; recurso de fortalecimento entre os serviços de saúde mental especializada e Atenção Básica. Os desafios envolvem o campo das relações entre os sujeitos implicados nos serviços de saúde mental, incluindo a gestão, nas limitações do próprio trabalho em equipe, e nas fragilidades estruturais da rede de saúde mental. Por fim, os estudos convergem em destacar que o cuidado compartilhado entre apoiadores só é possível por meio de encontros e desencontros entre as equipes, sendo trabalho complexo por seu caráter de construção.

Theory of change for implementing matrix support in mental health

Objective: To describe the process of development of the theory of change for the implementation of Matrix Support in a medium-sized municipality in São Paulo and to reflect on the contributions of this approach to the planning and evaluation of this intervention, considering the potentialities and challenges from its execution remotely. Methods Qualitative study performed through participatory workshops and construction of narratives with workers and managers of the Psychosocial Care Network following the recommendations of a guide for the development of the theory of change in complex interventions. Results: The implementation of Matrix Support configures one of the three distal results that culminate in the possibility of establishing the logic of shared care related to the activation of intersectoral network and the implementation of a Continuing Education Committee. External components that should be guaranteed by the organizational context for the effective achievement of some intermediate and long-term results were also recognized. Conclusion: The development of the theory of change was effective in delimiting objectives and implementation components from the perspective of the actors involved, establishing indicators for its monitoring and evaluation based on context conditions, and enabling the direction of workers’ efforts towards its consolidation.

Avaliação das estratégias de promoção da saúde e prevenção ao uso de drogas na rede psicossocial

Abstract Objective to assess health promotion and drug use prevention strategies in the Psychosocial Care Network. Method this is a qualitative study based on empowerment evaluation, developed in 2017 in the Psychosocial Care Network of a municipality in Rio Grande do Sul, Brazil. The interest groups were 42 workers and managers representing the municipal RAPS components. Participant observation techniques, interviews and Open Forum were used. Results it was assessed that health promotion and drug use prevention actions are precarious and require investments, constituting the mission of workers and managers. Primary care was identified as a difficulty due to weaknesses in public policies and lack of support from specialized services. As a potentiality, matrix support in mental health was listed. Investment in Primary Care is suggested through training and support for these teams. Conclusion and implications for practice health promotion and drug abuse prevention agenda are urgent and must be included in the structuring of public policies and practices within the networks.

Matrix support in Mental Health: narrative revision of the concepts horizontality and supervision and their practical implications.

The Matrix Support (MS) is one of the cornerstones of the integration between Primary Health Care (PHC) professionals and Mental Health professionals (MH). A narrative review was conducted on the articles on MS in MH published in national databases from 1998 to 2017, considering a brief history of the PHC reorganization processes that led to the creation of the MS proposal. The aim was to understand the meanings attributed to the terms "horizontality" and "supervision" as well as the descriptions of the "matrix support" itself. We sought to identify factors contributing to the difficulties that have been described in the practices and literature, based on the assumption that these concepts are polysemous and it is possible to generate ambiguities that operate to the detriment of interprofessional practices. Based on the analysis of the selected articles, we were able to conclude that, in addition to polysemy, the obstacles' force lies in the hegemonic model of professional Health training, as it is traditional, hierarchical and uni-professional, and hinders the development of dialogic relations that favor the integration of the matrix support teams and PHC and consequent resolubility and quality of care.

A educação permanente como instrumento para o matriciamento em saúde mental

Através de uma revisão integrativa da literatura foi realizada a análise reflexiva sobre como a política nacional de educação permanente é reconhecida pelas equipes de saúde e como os profissionais utilizam esta ferramenta no processo de matriciamento em saúde mental. O levantamento foi realizado nas bases de dados Scientific Electronic Library Online (SciELO), Scopus, PubMed e MEDLINE, sendo encontrados 117 estudos. Após aplicação dos critérios de inclusão e exclusão foram selecionados seis artigos. Com a análise dos estudos, foram identificados os temas mais abordados, sendo elencados em três categorias: Desafios e ganhos da educação permanente no matriciamento em saúde mental, Educação permanente como estratégia do matriciamento em saúde mental e Estratégias de educação permanente e matriciamento na rotina dos serviços de saúde. Os dados apresentados pelos estudos, apontam que a educação permanente para o matriciamento em saúde mental é reconhecida pelos profissionais como uma importante ferramenta de trabalho, que proporciona o diálogo e o encontro entre os pares, fortalecendo o cuidado em rede. Contudo, há relatos de que é comum esses espaços esfriarem ou perderem a horizontalidade, que é intrínseco a essas organizações institucionais. Neste sentido, é importante que os encontros sejam avaliados regularmente, para que as equipes reflitam se os espaços continuam sendo pulsantes, pois sem o desejo, não há educação permanente, nem matriciamento em saúde mental.

Matrix support in mental health in primary care: the vision of supporters and nurses.

To understand the view of supporters and nurses on matrix support mental health actions in Primary Health Care. A qualitative and phenomenological study, with Alfred Schutz's framework of phenomenological sociology. The study was conducted with five supporters and 22 nurses from Basic Health Care Units in the city of Porto Alegre. The participants' intentions and expectations, captured through a phenomenological interview, made up the corpus of analysis. The supporters have the intention, given the actions of the matrix support, to improve mental health care for the user. On the other hand, the nurses expect support to the health units, which reveals nonconformities in the mental health practices instituted in the basic network. Knowing the motivations of supporters and nurses can be a powerful strategy for consolidating public policies with a view to the psychosocial way in the territory.

Matrix support in mental health: practices and concepts brought by reference teams, matrix teams and managers

The scope of this study was to analyze matrix support in mental health from the practices and conceptions brought by reference teams, matrix teams and managers on the topic. To achieve this, semi structured interviews were conducted with 41 participants, among whom there were 11 managers, 12 reference team professionals from Health Units and 18 matrix team professionals from Psychosocial Care Centers, in addition to 110 hours of observations of matrix practices based on field journal records. The data were then submitted to content analysis. From the information gathered by the participants, two lines of thought were highlighted about the concept of Matrix Support, namely as a forum for productive meetings between health teams on the one hand, and as a strategy of training-on-the-job on the other. These concepts were discussed in juxtaposition with the data brought from the observations of the daily work in practice. Because of this contradiction, it was possible to perceive the need to create, systematize and strengthen spaces for dialog between reference teams, matrix teams and managers, such that the consolidation of matrix support may occur.

Apoio Matricial em saúde mental: a perspectiva dos especialistas sobre o processo de trabalho

RESUMO O artigo aborda a descentralização em saúde mental por meio do Apoio Matricial na Atenção Primária à Saúde (APS). A pesquisa teve como objetivo geral investigar o Apoio Matricial em saúde mental na APS na perspectiva dos especialistas, levando em conta as diretrizes do Sistema Único de Saúde (SUS) e da Reforma Psiquiátrica. Trata-se de uma pesquisa qualitativa, realizada mediante entrevistas semiestruturadas e grupo focal com apoiadores matriciais em saúde mental. Os resultados evidenciam o aspecto processual da construção conjunta de intervenções sustentadas pela corresponsabilização e pela cogestão; os arranjos organizacionais e operacionais fundamentados em ações de supervisão, discussão de casos clínicos e atendimento conjunto. As relações personalizadas com as equipes de referência, o viés de saúde pública dos especialistas e o investimento em sensibilizar os profissionais generalistas e especialistas foram identificados na pesquisa. Conclui-se que o Apoio Matricial se sustenta por meio de tecnologias relacionais, na sistematicidade dos encontros e na longitudinalidade, devendo ser tais questões consideradas no cuidado interprofissional.

APOIO MATRICIAL NA ATENÇÃO À SAÚDE MENTAL EM UMA REGIONAL DE SAÚDE, PARANÁ, BRASIL

Este estudo objetivou analisar os limites e possibilidades do apoio matricial em saúde mental na Atenção Básica, segundo a percepção de gestores e profissionais de saúde em uma regional de saúde, Paraná, Brasil. Trata-se de um recorte da pesquisa intitulada Componentes da Rede de Atenção à Saúde Mental: realidade da 4ª e 5ª Regional de Saúde do Estado do Paraná. Os dados foram coletados por grupo focal e submetido à análise de conteúdo, da qual emergiram duas categorias. Na primeira categoria discute-se a não realização do matriciamento por parte do NASF e CAPS e as contradições entre as políticas de saúde e sua efetivação. Na segunda, pontua-se a realização e as potencialidades do matriciamento em saúde mental. Ficou evidente que as equipes de apoio matricial precisam assumir a responsabilidade de suporte técnico à atenção básica principalmente no acolhimento às necessidades de saúde mental.

Matrix support in mental health in Primary Health Care: Barriers and facilitating factors

Abstract O artigo discute as barreiras e os fatores facilitadores à descentralização em saúde mental por meio do apoio matricial. Trata-se de uma pesquisa qualitativa, realizada com apoiadores matriciais ‒ psicólogos e psiquiatras da região metropolitana de Porto Alegre, Rio Grande do Sul, Brasil. Os resultados evidenciam como obstáculos ao apoio matricial a não validação plena da gestão; a sobreposição das questões políticas em detrimento das técnicas; a incongruência entre os valores institucionais e os profissionais; as diferentes configurações da rede em Unidades de Saúde tradicionais e Unidades de Saúde da Família, que demandam arranjos organizacionais diferentes. Dentre os fatores facilitadores, evidenciam-se as relações personalizadas entre os apoiadores e os profissionais de referência, a disponibilidade, o comprometimento, a comunicação fluida, a corresponsabilização e a sistematicidade dos encontros. Conclui-se que, apesar dos diferentes obstáculos, a manutenção do apoio matricial decorre essencialmente da motivação dos apoiadores à descentralização em saúde mental.

ARTICULAÇÃO ENTRE APOIO MATRICIAL EM SAÚDE MENTAL E REDES DE ATENÇÃO À SAÚDE

Esta pesquisa teve como objetivo investigar o apoio matricial em saúde mental na Atenção Primária à Saúde e a articulação às Redes de Atenção à Saúde. Trata-se de uma pesquisa qualitativa realizada com apoiadores matriciais, tais como psicólogos e psiquiatras. Os instrumentos utilizados foram entrevistas semiestruturadas e grupo focal. Para o tratamento dos dados utilizou-se a análise de conteúdo na modalidade temática. Os resultados evidenciam as relações personalizadas e o estilo de trabalho das equipes como recursos imateriais que sustentam o trabalho; a potência do apoio matricial em Unidades de Saúde da Família; a necessidade de apoio sistemático longitudinal; a coordenação como um fator facilitador à descentralização em saúde mental. Os resultados mostram, também, a existência de três tipos de redes - centralizada, descentralizada e distribuída. Conclui-se que as redes imateriais construídas nas comunidades, por meio das relações e interações estabelecidas entre profissionais e usuários, sobrepõem-se às redes formais instituídas e apresentam potência de produção de vida.

Matrix Support in mental health: The experience in Vitória, Espírito Santo.

This study discusses the implementation of Matrix Support in Vitória, Espírito Santo, Brazil, through analysis of documents and semi-structured interviews. Results indicate that Matrix Support evolved over time to provide community services that reflect local reality, enabling the integration of mental health into primary care practices as well as boosting reduction in the number of psychiatric hospital admissions. Results suggest that the use of collaborative spaces to evaluate Matrix Support network and the services it provides helps to ensure that this strategy is not lost in hierarchies and specialisms.

The perspective of professionals in primary health care on matrix support in mental health

The research investigates the matrix support in mental health in Primary Health Care in order to identify the guidelines, professional principles and values that permeate the process. The study used a qualitative approach with triangulation of techniques, and was performed with professionals from the Family Health Strategy. The results reveal a work process which is based on personalized relations, guided by the broadening of clinical practice and mediated by principles, such as inter-disciplinarity, bonding, comprehensiveness, accessibility, co-responsibilization and longitudinality. The values that underpin the relationship with the specialist are organized around the bond, trust and honesty. Difficulties in taking patients to Psychosocial Care Centers arise as obstacles to networking. The bond with the specialist, the structure of Family Health teams and the exchange of experiences and knowledge are identified as facilitating factors. The conclusions drawn are that the networking and the systematic and longitudinal support by specialists are key to decentralization in mental health.

The maze and the minotaur: mental health in primary health care.

The article aims to discuss the issue of integration of mental health in primary care by matrix support in mental health. We point out the main barriers in the use of this work method, as well as the facilitating factors of the matrix support of mental health in primary care. The first are within the scope of epistemological specificities, professional issues and management in the political and ideological dimensions. Among the second, we highlight: the care for people with mental disorders in the territory; the reduction of stigma and discrimination; the development of new skills for professionals in primary care; reduction of costs; simultaneous treatment of physical and mental illness, which often overlap; the possibility of incorporating mental health care in a perspective of extended clinical service using an inter/transdisciplinary approach.

Matrix Support: a bibliographical study

This article presents a bibliographical review of matrix support in mental health. A search was conducted in the Virtual Health Library and the LILACS, SciELO and Google Scholar databases using the key words: "matrix support in mental health." Fourteen articles were located with the desired characteristics, which indicates that only a restricted number of publications are in circulation. The articles were analyzed with respect to their structural and methodological aspects, which revealed the absolute predominance of the use of qualitative methods and health professionals as the target research population. The same articles were then analyzed for their theoretical discussions. Among other issues, the importance of matrix support to enhance the primary health care teams provided to people suffering from psychic distress is highlighted. However, there is still considerable confusion regarding the proposal of the matrix support and shared responsibilities between teams of reference and mental health professionals, which emphasizes the need for training of these professionals, as well as better coordination and organization of the mental health care network.

Atenção a usuários de álcool e outras drogas e os limites da composição de redes

The objective of this qualitative study was to understand the connections between the care services for mental health and users of alcohol and other drugs, considering the view of health care professionals. A focal group was developed with 10 Family Health Strategy workers in 2011. Thematic content analysis revealed that the disconnection between mental health care services is a limiting factor to the arrangement of the network, as well as to clients’ access to services. Accessibility barriers are established by the difficulty that health care services have to embrace patients and their reproduction of the hegemonic model, which prioritizes referrals to specialist services. The insufficient qualification to work as a network reveals the workers’ limitations, pointing at a need for matrix support in mental health. The urgency to rethink practices is highlighted as a way to (re)organize service structure, aiming at building a network for care in mental health.Descriptors: Mental Health; Primary Health Care; Delivery of Health Care; Nursing Care; Substance-Related Disorders.

Apoio matricial em saúde mental: fortalecendo a saúde da família na clínica da crise

O objetivo consiste em abordar o apoio matricial em saúde mental às equipes de Saúde da Família (SF) e a sua relação com as situações de crise em saúde mental. Trata-se de uma pesquisa--ação realizada com equipes de SF e com um CAPS III, na Rocinha, Rio de Janeiro. Participaram profissionais de diferentes categorias em grupos operativos de reflexão e os dados foram examinados pela análise de conteúdo. É destacada a importância de envolver a SF no que se refere à clínica da crise.

<b>Family in the matrix support in mental health: concepts and practices in national scientific output</b> - DOI: 10.3395/reciis.v6i3.512en

Scientific output that addresses family relationships and health has reached new dimensions with the shift of care strategies based on the individual to those based on the family as instigated by the Family Health Program. The objective of this study was to analyze the concepts of family and care practices in the scientific output on matrix support in mental health in primary care available in the Virtual Health Library database from 1998 to 2010. Therefore, an integrative review was conducted that used natural language as a search strategy. The data were analyzed using an adapted content analysis technique that designated the following categories as the core meanings: the family as the focus of the direction of assistance for matrix support, the family as a housing territory, the family as having singularities and the family as co-responsible for health care. The results demonstrated a low recurrence of the term “family” and the still strong persistence of the idea of the family as a household unit and the locus of intervention for health care professionals. This study discusses the changes in the approaches to thinking about and working with families based on a paradigm that considers the individual and his/her family as participating subjects.

<b>A família no apoio matricial em saúde mental: concepções e práticas na produção científica nacional</b> - DOI: 10.3395/reciis.v6i3.512pt

Scientific output that addresses family relationships and health has reached new dimensions with the shift of care strategies based on the individual to those based on the family as instigated by the Family Health Program. The objective of this study was to analyze the concepts of family and care practices in the scientific output on matrix support in mental health in primary care available in the Virtual Health Library database from 1998 to 2010. Therefore, an integrative review was conducted that used natural language as a search strategy. The data were analyzed using an adapted content analysis technique that designated the following categories as the core meanings: the family as the focus of the direction of assistance for matrix support, the family as a housing territory, the family as having singularities and the family as co-responsible for health care. The results demonstrated a low recurrence of the term “family” and the still strong persistence of the idea of the family as a household unit and the locus of intervention for health care professionals. This study discusses the changes in the approaches to thinking about and working with families based on a paradigm that considers the individual and his/her family as participating subjects.