Cuidado em saúde mental infantojuvenil na atenção básica à saúde: práticas, desafios e perspectivas

Abstract

In recent years, a growing global investment in health guidelines has been identified, so that all professionals, especially those working in the field of Primary Health Care (ABS), have been invited to intervene in suffering. Thus, a sustainable relationship between mental health and ABS actions has been fundamental for advancing health reform proposals and psychiatric reform in Brazil, although the few studies focused on this level of care show a number of weaknesses. To this end, the objectives of this research were to: - Identify the implications of child and adolescent mental health care developed in ABS and conceptions of child and adolescent mental health from the perspective of the managers of the Health Units team of seven municipalities in the State of São Paulo; and to understand in depth the reality of mental health in ABS in order to reveal the challenges, perspectives and potentials in this level of health care. Regarding the specific objectives, we sought to identify a) the practices of care in the field of child and adolescent mental health offered by the Health Units, b) with the network and intersectoral care has been proposed and developed, c) how the access has been given of children and adolescents in psychic suffering in ABS, and d) whether the Health Unit responds to public policies for children and adolescents and mental health. This is a quantitative qualitative study based on two studies. In the first study, two forms and a questionnaire were applied with 53 managers of ABS Health Units from seven municipalities in the State of São Paulo - Brazil. Study II, is an ethnography, developed in a periphery of evident vulnerability, in one of the Health Units involved in the first Study. In this Study II, the insertion of the researcher in the field involved the observation and participation in the activities carried out by the Health Unit, the mapping and recognition of the territory attached to the Unit, as well as the dialogue with technicians, users and other actors involved with childhood and adolescence. The results of study I pointed out that the conception of most ABS professionals about child and adolescent mental health is close to the precepts present in psychosocial care, however, this understanding is not related to the recognition of children and adolescents in psychic suffering, with the care actions proposed by the services, and also in practices that involve network and intersectoral care, which is based on the specialty and referrals. The results from Study II have shown that when there is some form of care, it occurs under the perspective of health problems, being predominantly biomedical and curative, and there are no actions that aim to reach children and adolescents in psychic suffering, even in the face of the obvious demand in a territory of extreme vulnerability, marked by drug trafficking, violence, exclusion and social inequality. It is also identified in the results of Study II that, in the absence or insufficiency of the State, drug trafficking is present in the mediation and management of the daily relations of the population, including their relationship with health equipment. Moreover, much of the specificity and field of child and adolescent mental health was being re-dimensioned during the course of ethnography, as well as the role of ABS, as a territorial equipment, fundamental in the process of deinstitutionalization, and was re-signified. Beyond the limits of the current reality, the extreme need for attention to this population and also the powers in the possibilities of expansion of care in the territory have been revealed, which reaffirms the fundamental role of ABS in child-minded mental health care.