Psychosocial Care Center Research Articles

Perceptions of nurses from Psychosocial Care Centers (CAPS) about practices performed during home visits

OBJECTIVE: Investigate perceptions about the practices performed by nurses during home visits carried out with patients treated at Psychosocial Care Centers (CAPS). METHOD: This exploratory research with a qualitative approach was carried out with six nurses at CAPS in a countryside city of Southern Brazil. Sociodemographic questionnaires and a semi-structured interview were applied, and the data were analyzed through Content Analysis. RESULTS: Results were organized into three categories: 1) Insufficient training of nursing professionals to work in CAPS; 2) Challenges faced by the nursing team during home visits; and 3) Impacts of the support network on the recovery process of patients. FINAL CONSIDERATIONS: The nurses participating in the study reported not having received adequate training during their undergraduate studies, making it necessary to seek knowledge by their own means. In addition, several challenges were noted during visits, such as patients' resistance to receiving the multidisciplinary team, incomplete or incorrect addresses, patients' absence during home visits, and the difficulty in reaching patients' families. Finally, the importance of family assistance as a support network for users with mental disorders was noted.

Key features and current challenges of the Brazilian Psychosocial Care Centers for alcohol and other drugs (CAPS-AD)

Key features and current challenges of the Brazilian Psychosocial Care Centers for alcohol and other drugs (CAPS-AD)

A ATUAÇÃO DO PSICÓLOGO NAS PRÁTICAS MULTIPROFISSIONAIS DA GESTÃO DA SAÚDE PÚBLICA

The psychologist’s role in public health management has become essential in providing comprehensive care to users of the Brazilian Unified Health System (SUS). Through a multidisciplinary approach, psychology contributes to understanding the psychological and social demands of individuals, while promoting mental health care strategies that complement medical and social practices. This chapter explores the role of the psychologist in public health, emphasizing their integration into multidisciplinary teams, especially in Psychosocial Care Centers (CAPS) and Primary Health Care. The challenges and potentialities of psychological practice in a context of shared management focused on promoting biopsychosocial well-being will be discussed.

A mindfulness-based intervention for Substance Use Disorder in a Brazilian vulnerable population: a feasibility mixed method study.

Substance Use Disorder (SUD) is a chronic condition that impacts various facets of an individual's life, and society as a whole. The Mindfulness-Based Relapse Prevention (MBRP) protocol is an innovative intervention that can help to prevent relapse, particularly when used as a post-treatment approach. However, although there is significant evidence of its effectiveness in studies from high-income countries (HICs), there is a dearth of studies examining its feasibility and efficacy in low- and middle-income countries (LMICs). Thus, this study investigates the feasibility of MBRP as an adjunct to outpatient treatment for SUD in a socially vulnerable Brazilian population. The study employed a mixed-methods design in eight Psychosocial Care Centers for Alcohol and Drugs (CAPS-ad) in the city of São Paulo, and involved 140 participants, 24 healthcare professionals and 7 CAPS-ad managers. In total, 17 MBRP intervention groups were conducted. The study assessed qualitative indicators of acceptability, demand, implementation, adaptation, integration, and limited efficacy testing through group interviews, in-depth interviews and field diary records. It also included limited efficacy testing of the protocol using a quantitative pre-post pilot study to investigate consumption behavior, using the Timeline Followback (TLFB) assessment method; depression, using the Center for Epidemiologic Studies Depression (CES-D) scale; anxiety, using the state trait anxiety index (STAXI-2); craving, using the Penn Alcohol Craving Scale (PACS); readiness to change, using the Readiness-to-Change Ruler (RCR); and severity of dependence, using the Severity of Dependence Scale (SDS). The qualitative data were triangulated with the quantitative data to comprehensively evaluate the feasibility of the intervention. The sample comprised socially vulnerable participants with a high dropout rate, primarily due to social factors. Despite facing challenges in respect of regular engagement and initial cultural misperceptions of meditation, the intervention showed positive acceptance and mental health benefits, including impacts on consumption behavior. The study emphasizes the importance of adapting the format of the protocol to better suit vulnerable populations, and to ensure its effective integration into the public healthcare system. Future research should explore protocol modifications, assess its effectiveness in different contexts, and conduct cost-benefit analyses for broader implementation.

Perfil Epidemiológico Dos Pacientes Com Diabetes Mellitus (Dm) E Hipertensão Arterial Sistêmica (Has) No Centro De Atenção Psicossocial II De Santa Inês – MA Em 2024

This observational, cross-sectional, descriptive methodological study, with a quantitative approach, based on the database on patients with Arterial Hypertension and Diabetes Mellitus followed by the Psychosocial Care Center (CAPS) II of the Municipality of Santa Inês, in Maranhão, presents the epidemiological profile of patients served by the endorsed health center. This is a study with a population of 48 patients, of which 16 have Has, 27 have DM and 5 have comorbid health conditions, with both health complications. The general objective of this study was to delimit the epidemiological profile of patients at CAPS II in Santa Inês MA-Brazil, with Has and DM, the results point to a female majority who present the health problems mentioned and alert to the fact that these two conditions of Health causes considerable deaths in Brazil and needs to be treated properly.

Territorial-based mental health in Brazil: a systematic review of the literature

The research aims to investigate the actions of territorial and community-based services focused on mental health, with the participation of the Psychosocial Care Network, focusing on the family health strategy team. The Systematic Review methodology is used. The analysis of the key characteristics listed in the RAPS and the synthesis of the data were carried out according to the availability of data from the 10 eligible studies, covering topics such as Psychosocial Care Center, referral and matrix support, medicalization, care strategies in the territory, public policies, stigma/prejudice, training and social reintegration. Through the analyzed studies, it could be concluded that this service network is still under development, pointing out the importance of territorial-based care, and the need for expansion and implementation of extra-hospital infrastructure closer to the daily lives of mental health users, to that does not overload the insufficient substitutive services of assistance that are characteristically community, inadequate assistance approaches to the point of lack of assistance in some cases.

Psicanálise e saúde mental infanto-juvenil: uma reflexão sobre o lugar da subjetividade nos CAPSi

The aim of this article is to discuss the work of the mental health teams in the Child and Adolescent Psychosocial Care Centers (CAPSi), in order to consider subjectivity as a factor of inclusion. The methodology used was based on applied psychoanalysis. Franco Basaglia's contributions were revisited in order to understand his influence on the Psychiatric Reform in Brazil and to elucidate the current practice of CAPSi. The current impasses in the field of subjectivity in the Psychiatric Reform are discussed and it is proposed to locate transversal surfaces that articulate the presence of a psychoanalytic approach to subjectivity in psychosocial care. The conclusion is that it is important to discuss a psychoanalytic approach to subjectivation in public mental health services, so that treatment in these services is not polarized between biological reductionism and psychosocial care.

PERCEPÇÃO DE ENFERMEIROS DO CAPS DURANTE A PANDEMIA DA COVID-19

Introduction: The current pandemic becomes a concern for the mental health of the population, because in addition to the fear of contracting the disease, COVID-19 has caused a feeling of insecurity in all aspects of life, from the collective to the individual perspective, the daily functioning of the society to changes in interpersonal relationships. One of the services that has been challenged are the Psychosocial Care Centers, which offer care to people in mental suffering. Objective: to describe the experience of CAPS nurses during the covid-19 pandemic and how much this can interfere with care in the sector Method: An interview was conducted with nurses who work at the Psychosocial Care Center in the municipality of São Sebastião do Paraíso. Thematic content analysis was used for data analysis. Results and discussion: According to the nurses, the perception of the pandemic in the sector was revealed with feelings of apprehension, fear, lack of security and preparation; professional performance in this period has been a challenge and involved changes in the routine of the place and changes in the physical and mental health of the interviewees and, at the same time, an appreciation of the professional and an improvement in human relations and the difficulties and challenges facing the pandemic in the CAPS are centered on physical and social distance, lack of PPE, fear of contamination, difficulty in socializing, sleep problems and the worsening of the mental health of patients in general, which is in line with most of the studies referring to this topic. Final Considerations: The COVID-19 pandemic is part of the crisis conditions that the population is experiencing, including CAPS users, family members and users, conditions that, despite the circumstances, require solid bonds and the creation of care strategies that can guarantee safe assistance at a time of extreme insecurity for everyone, it being important to promote important changes for the continuation of assistance in demand, as far as possible, bringing the need for work by sectors, emphasizing communication in partnership with other health services and of other public policies. It was evident that professionals feel the need for training, material, physical resources and also to overcome difficulties and challenges, mainly related to the pandemic and reflection on the subject to recreate ways in order to continue carrying out their work in the best possible way.

MENTAL HEALTH HEROES: Skills desired by professionals for person-centered psychosocial care

The paradigm of psychosocial care in mental health is guided by the assistance provided in the territory to facilitate the identification and meeting of people's needs, as well as favoring psychosocial reintegration. The objective was to describe the competencies desired by mental health professionals for person-centered psychosocial care. This is an intervention research with a qualitative approach carried out with 30 professionals from two Psychosocial Care Centers in the central region of Brazil from October to December 2022. Four group meetings were held in the format of experiential workshops recorded in audio format. For data collection, the “My superpower” technique was used, in which professionals expressed which skills they would like to have in their care practice. The data was subjected to thematic content analysis. The skills desired by professionals were: usable and useful intelligence, time control, reading minds, reading thoughts, erasing minds, healing, eliminating pain, adjusting family relationships, forgetting the past, clearing hurts, welcoming with quality and in a short time develop coping strategies and instill hope. Some competencies are linked to the psychosocial and person-centered care model, while others are associated with the biomedical model based on curative practices.

Therapeutic relationship in nurses’ work process at Psychosocial Care Centers

Objetivo: conocer de qué manera los enfermeros perciben la relación terapéutica en su proceso de trabajo en los Centros de Atención Psicosocial. Metodología: estudio cualitativo, descriptivo y exploratorio, basado en el enfoque del materialismo histórico dialéctico. Los datos se recolectaron través de entrevistas semiestructuradas, basadas en análisis de contenido en conjunto con análisis temático y se los discutió por medio de la dialéctica entre trabajo muerto y trabajo vivo en acción. Resultados: participaron diez enfermeros. La relación terapéutica surgió de la tensión dialéctica entre el trabajo muerto, considerado como trabajo anterior y enajenado, y el trabajo vivo en acción, que es el lugar de la relación terapéutica. Conclusión: el trabajo muerto se evidenció en la reproducción del modelo de atención en el que el trabajo burocrático es asumido por los enfermeros y se deslegitima el rol de los pacientes. El trabajo vivo en acción se identificó por el establecimiento de la relación terapéutica, desarrollada a través de la convivencia, en los intercambios de confianza, a través de talleres, en el rol de referencia y a través de la relación como experiencia definitoria de la trayectoria profesional. La tensión dialéctica se convierte en un proceso rico en consumo de tecnologías ligeras, que ayuda al enfermero a reconocer su rol en el nuevo modelo de atención a la salud mental, en el que la praxis se convierte en un camino posible en el contexto de su trabajo.

Expressive workshops in mental health

Studies development by the World Health Organization on schizophrenia and other psychoses have demonstrated, since the 1970s, that different social contexts represent important variables in the course and prognosis of the disorder. If the evolution of each psychopathological disorder is strongly impacted by socio-environmental variables, in addition to specific medical care interventions for psychosis must include management strategies that impact the complex constellation of variables related to micro social contexts. In order to develop strategies that help the psychosocial reintegration of these individuals and their perception about themselves, we developed expressive workshops in Psychosocial Care Centres in a large city in the interior of the state of São Paulo, as part of internship and university extension projects. Based on psychosocial and psychoanalytic references, and on the works of Augusto Boal and Nise da Silveira, expressive workshops on scenic improvisation and artistic expression aimed to provide to the users, especially those who express themselves verbally in a restricted way, materials and space to express psychic contents in a way to organize them according to their own personal elaboration rhythm. Offered to anyone who wanted to participate, 12 workshops were held per semester, with a weekly participation of 8 to 12 users in the improvisation workshops and 4 to 8 users in the artistic expression workshops. The constant frequency and active participation of users in the workshops indicate they are able to represent a valid instrument as an aid to other treatments offered to this population, as it promotes the expressiveness of psychic contents that remain outside the field of language, in addition to encouraging communication, the autonomy and social reintegration of the users.

Qualified Listening to Relatives of Users at a Psychosocial Care Center

Introduction. The Psychiatric Reform introduced a new people-centered care model to replace psychiatric hospitals: the Psychosocial Care Center. Qualified listening can be used to achieve the integrality and humanization of the health care provided. It allows for the appreciation of content, the respect of its uniqueness, empathy, and the promotion of a space in which freedom of expression is provided. Objective. To identify the understanding of qualified listening from the perspective of the relative of a person with a mental disorder at a Psychosocial Care Center. Method. Qualitative, descriptive, exploratory study. Ten relatives over the age of 18 participated, contributing to the production of information. Data was obtained through the triangulation method, through semi-structured individual and collective interviews, observation, and field diary records. Results. For relatives, qualified listening translates into clarifying the illness, understanding the family’s painful situation and providing help and support during the psychosocial rehabilitation process. Discussion and conclusion. Listening constitutes a means of consolidating care networks, through the strengthening of bonds and co-responsibility, in a centered and expanded family-user logic model.

CARTOGRAPHIC WRITING: Institutional analysis in the context of a psychosocial care center (CAPS) II

This experience report is an institutional analysis based on the experiences of two interns at a Psychosocial Care Center (CAPS) II. Our intention is to raise some questions and reflections about Institutional Psychology and the institutionalities that permeate the service, the tension between the instituted and the instituting, focusing on the language that operates as an institution. The objectives are: to investigate the possible logic of subversion in such a scenario, still permeated by the asylum model; to examine how Institutional Psychology can assist in this subversion; to determine if language, as an institution, can free bodies from such a model. We used the cartography method, where the procedures involved observation, field diary recording, sharing in supervisions, and literature review. Five examples of language observed in the service are used: invalidation of suffering, infantilization, LGBTI+phobia, stereotypes against psychoactive substance users, and re-signification of the language of madness. A discussion is conducted on these five examples based on the results obtained, which point to the importance of Institutional Psychology and the need for training professionals and emancipating users as political subjects. We understand that, with the raised reflections and discussions, room can be opened for transformations. In the final considerations, it is concluded that language has the potential to contribute to reinforcing or liberating the abjection of certain bodies produced by the asylum model. This liberation occurs when there is analysis, redesign, and collaboration with CAPS users.

TERAPEUTIC WORKSHOPS IN PSYCHOSOCIAL CARE CENTERS: What public policies and users say

Therapeutic workshops are commonly used resourse in a large mental health establishments, including in Psychosocial Care Centers. There is no absolute consensus about its definition, but, in general, are developed in groups and offer of some activity that contributes to the reduction of mental suffering and more autonomous daily life. The objective of this study is to understand how service’s users participates in therapeutic workshops and whether this is in line with what the public policies that regulate this strategy recommend. The research was developed in two stages. The first stage was theoretical in virtual place with government documents; the second stage was virtual too, with 8 collaborators who answered to a form in Google forms with questions about sociodemographic data and their own preferences about terapeutic workshops in your treatments. It was noticed that the resource under discussion is important for assistance in mental health to occur in accordance with the determined in government documents and this can be seen in the employees’s reports of their mood, social skills, experiences and expressive capacity were positively modified from engagement in terapeutic workshops.

Factors associated with the hospitalization of users referred from primary health care to follow-up in Psychosocial Care Centers in the city of São Paulo, Brazil.

This study evaluated factors associated with hospitalization related to the mental health of people undergoing follow-up in Psychosocial Care Centers (CAPS, in Portuguese) in the city of São Paulo, Brazil, referred from Primary Health Care (PHC). This was an evaluative study conducted with 297 individuals in 24 adult CAPS. This study analyzed the prevalence ratios (PR) and their respective 95% confidence intervals (95% CI), obtained through Poisson Regression with robust variance. A statistically significant association was found with hospitalization during follow-ups in CAPS: having health insurance and/or medical plan; waiting time between the diagnosis and the first consultation with a non-medical professional of more than seven days; not having received medical advice regarding how long to use medication; not having received a psychopharmaceutical prescription at PHC; and having a medical history of the hospitalization due to mental health. The results warn of the need to expand access to the more socially vulnerable population, in addition to a restructuring of the services in order to provide more interactive and inclusive practices geared toward the singularities of the users.

Decrease in alcohol use disorder hospitalizations in Brazil: what does it mean?

To analyze the trend of hospitalizations for alcohol use disorder (AUD) in Brazil, by region, and establish its relationship with mental health care facilities. Data were collected through the Brazilian Unified Health System's (SIH/SUS) Hospital Information System (Sistema de Informação Hospitalar) and the National Register of Health Establishments of Brazil (Cadastro Nacional de Estabelecimentos de Saúde [CNES]). We used linear regression models to estimate the effect of SUS psychiatric beds and Center for Psychosocial Care (Centro de Atenção Psicossocial [CAPS]) numbers on AUD hospitalizations. From 2015 to 2020, 298,735 hospitalizations for AUD were recorded. Most of the patients admitted for AUD were male (88.8%). Individuals aged 60 years and older accounted for 11.7% of our cohort. The highest concentration of hospitalizations occurred in the South region (40.1%). The rate of hospitalizations per hospital bed remained relatively constant. The number of CAPS has a negative effect on SUS psychiatric beds in Brazil (average effect -22.31 [95% confidence interval {95%CI} -26.92, -17.70]). Psychiatric beds have a positive effect on AUD hospitalizations in the country (average effect 1.82 [95%CI 0.91, 2.74]). Prioritization guidelines for other forms of care are associated with a decrease in hospitalizations for AUD, so we highlight the importance of adequate training of health care professionals for proper referral of these patients to hospital admission when necessary.

Fatores associados à internação de usuários encaminhados pela atenção primária para acompanhamento em Centros de Atenção Psicossociais do município de São Paulo, Brasil

Abstract This study evaluated factors associated with hospitalization related to the mental health of people undergoing follow-up in Psychosocial Care Centers (CAPS, in Portuguese) in the city of São Paulo, Brazil, referred from Primary Health Care (PHC). This was an evaluative study conducted with 297 individuals in 24 adult CAPS. This study analyzed the prevalence ratios (PR) and their respective 95% confidence intervals (95% CI), obtained through Poisson Regression with robust variance. A statistically significant association was found with hospitalization during follow-ups in CAPS: having health insurance and/or medical plan; waiting time between the diagnosis and the first consultation with a non-medical professional of more than seven days; not having received medical advice regarding how long to use medication; not having received a psychopharmaceutical prescription at PHC; and having a medical history of the hospitalization due to mental health. The results warn of the need to expand access to the more socially vulnerable population, in addition to a restructuring of the services in order to provide more interactive and inclusive practices geared toward the singularities of the users.

Psychosocial care centers and professional training for the provision of integrative and complementary practices: a study with professionals offering these services

Estudos sobre a formação em Práticas Integrativas e Complementares têm se concentrado na análise curricular dos cursos da Saúde e as pesquisas abrangendo as percepções dos profissionais a respeito dos processos formativos devem ser mais elucidadas. O estudo objetiva identificar os processos de formação e capacitação dos profissionais ofertantes de Práticas Integrativas e Complementares nos Centros de Atenção Psicossocial de uma região metropolitana. Trata-se de um estudo descritivo, exploratório, de abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 45 profissionais, as quais foram posteriormente analisadas segundo a Análise de Conteúdo Temática. As pós-graduações, graduação, formações em serviço e o ensino privado foram as trajetórias adotadas pelos profissionais, revelando a existência de uma formação difusa para a oferta no cenário investigado. Esses resultados podem subsidiar o planejamento de estratégias educacionais para a ordenação dos recursos humanos em Práticas Integrativas e Complementares.

“Existe o espaço, mas ao mesmo tempo não existe”: análise do processo de cuidado no tratamento psicofarmacológico na saúde mental

Considering the challenges to psychosocial rehabilitation, this study was aimed at understanding the perspective of users and workers regarding psychopharmacological treatment. This is a qualitative study, which interviewed six providers and ten users of the Psychosocial Care Center of a municipality in the north of Minas Gerais. The transcripts were treated in Coding Cycles and examined by Discourse Analysis. Three categories related to the micropolitical dimension of care were defined: the institutional flowchart; the intercessory spaces; and the subjective production of the agents. Dissonances were revealed between statements alluding to the psychosocial care policy, with the competition of emancipatory and restrictive conceptions and technologies of care. The importance of the micropolitical analysis of care in psychopharmacological treatment was verified, favoring the processes of contractuality, protagonism, and user autonomy.

O percurso pela atenção à crise em saúde mental na cidade do Rio de Janeiro

Abstract The concept of crisis in mental health involves a complex multidimensional formulation, forged in the context of the Brazilian Psychiatric Reform, which is not always taken unequivocally by those involved. However, it is necessary to consider a network capable of providing adequate answers on how to provide care in this situation; thus, networking is an essential condition of this approach. This article discusses the management of the mental health crisis in Psychosocial Care Centers III (CAPS III) in the municipality of Rio de Janeiro, Brazil, from the perspective of central and local health care managers, via semi-structured interviews and analysis based on Giddens’ Theory of Structuring. This study found that the municipality of Rio de Janeiro adopts a crisis care model structured into a centralized care network and integrated network, with an emergency network highly integrated with the Psychosocial Attention Network (RAPS), especially with the CAPS III, and the crisis situations are cared for preferably in specific services. Still, from Giddens’ perspective, CAPS III have the legitimacy to provide care toward mental health crisis.