A saúde mental brasileira sob o olhar decolonial: contribuições para o debate da saúde mental global a partir de uma experiência de cooperação internacional com a Itália

Abstract

Global Mental Health aims to understand the impact of mental disorders on different populations of the globe, and to fill the gap of access to diagnosis and effective treatments for people in distress, especially in low and middle income countries. However, these initiatives have meant the spread of hegemonic ways of understanding and dealing with the suffering that indicate a relationship with coloniality. Regarding the current dilemmas that permeate Global Mental Health, there is a need for research and practices that consider the local context and the daily lives of its actors. This research proposes to identify similarities, particularities and paradoxes around mental health care that emerge from the process of exchanging of knowledge, and from practices of an experience of international cooperation between Brazil and Italy; and to identify, through the decolonial perspective, possible relationships between the Global Mental Health movement and mental health care practices in the Brazilian locations that were surveyed. It was a qualitative collaborative research, based on an ethnographic approach proposed within a Virtual Community of Practices (CoP), which included the participation of family members, users, professionals and service managers, volunteers from associations, and researchers, from Brazil and Italy. The research field was constituted by health services and other territories in the cities of Araraquara, São Carlos, Perugia and Gubbio, and by the CoP's face-to-face and virtual spaces. The data produced was based on: online forms of characterization of participants; narrative and audiovisual materials produced by the participants in order to present their respective care practices; collective reports of face-to-face meetings; and the researcher's field diary. The data was analyzed with the use of the NVIVO software, following the prerogatives of Bardin's Content Analysis for coding the findings. The results were about: 1) the imaginary of the Brazilians about Italy, and of the Italians about Brazil; 2) the paradoxes of mental health care in both locations, namely a) the underfunding of the public health system, the privatization process and the implication of political elections for mental health; b) the centrality of psychiatry in the practice of care and its representation by the hero-villain binomial; c) the relationship between the absence of social support networks and asylum practices d) the lack of connectivity between the networks (intra-team, inter-team, and between teams and communities): technologies, time and collective suffering; e) the challenge of building territorial care with focus on promoting mental health. As a third point, it was possible to identify the resonances of Global Mental Health in Brazil, visualizing aspects of coloniality, as well as the possibilities of creating deviations and ruptures in the hegemonic approaches from local actors, and their context and daily life, with a focus on minor knowledges. The third space appears as a possibility to face the challenges related to international cooperation, practice and research. We concluded that the research enabled the establishemt of dialogue between Brazil and Global Mental Health, based on an experience of exchange with Italy, and that it opened perspectives for the construction of decolonial practices in mental health.