Projeto terapêutico singular em saúde mental: perspectiva das pessoas usuárias e familiares

Abstract

The Singular Therapeutic Project (Projeto Terapêutico Singular – PTS), conceived within the fields of mental health and collective health, is currently a widely implemented device in mental health services in Brazil. It is understood of an articulated set of strategies that recognizes and values the knowledge, experiences, and life histories of service users, their families, and the professionals involved, who collectively participate in the co-production of a project oriented toward social emancipation and the promotion of health and life. This qualitative study aimed to identify the perspectives of service users and family members regarding the PTS developed in Psychosocial Care Centers (Centros de Atenção Psicossocial – CAPS), as well as the challenges related to its construction and implementation and the aspects that characterize, from their standpoint, a PTS considered successful. Twelve participants took part in the study, seven family members and five service users, linked to four CAPS in a municipality in the interior of the state of São Paulo. The study included a preliminary pilot phase conducted in a municipality distinct from the primary data collection site. Data were produced using participant characterization forms, guiding question scripts, and field diaries. Data collection strategies differed across participant groups. For family members, individual semi-structured interviews were conducted in a single meeting lasting between 40 minutes and one hour. For service users, data collection occurred over two meetings involving a focus group and a photo-elicitation activity, each lasting two hours. All meetings were audio-recorded, transcribed, and subsequently analyzed. Data from the characterization forms were analyzed descriptively. Among family members, all were mothers aged 46 to 72 years, mostly self-identified as Black or Brown. Among service users, all were men aged 30 to 62 years, also predominantly self-identified as Brown or Black. Data derived from the interviews, the focus group, the photo-based activity, and field diaries were subjected to thematic analysis following Bardin, resulting in the emergence of the following thematic categories: Understanding and construction of the PTS; Stigma and violence; Everyday life; Work; Networks, intersectoriality, and social relations. The results indicate that although participants were not familiar with the formal concept of the PTS, they identified central elements for constructing a successful project that align with the principles of Psychosocial Care. Everyday life emerged as both a sustaining context for care and a space where vulnerabilities, multiple forms of violence, and stigma are reproduced, directly shaping care plans. Work was found to be scarcely accessed in formal terms, although recognized as a producer of health when endowed with personal meaning for service users. Health and intersectoral networks appeared poorly articulated, resulting in limited social participation and restricted social relationships. The study concludes that a gap persists between the premises of the PTS and their practical realization, particularly regarding the effective participation of service users and families, despite their perspectives aligning with the possibilities of Psychosocial Care. In this context, we hope that this study contributes to the strengthening of these practices by offering insights that help bring such premises closer to the everyday realities of mental health services.