Banca de DEFESA: THAIS BRASIL DE OLIVEIRA RODRIGUES

Mental Health and Primary Health Care: dialogue to build care for people with mental suffering

mental suffering; mental disorder; Primary Health Care; Mental Health.

The prevalence of people in situations of mental suffering has been growing progressively throughout the world, causing suffering to the individual, family and community, which places a high burden on society. The relevance of investment in the area is due to the fact that mental suffering and its effects are a matter of public health, human rights and socioeconomic development. With the advancement of Mental Health (MH) and Primary Health Care (PHC) Policies in Brazil, this research sought to understand how the two are linked in the country, in particular to analyze the MH practices carried out by PHC professionals. It took as its object of study a small municipality in the interior of Rio de Janeiro state. The methodology consists of a descriptive study, with a quantitative and qualitative approach, integrative review and case study. In the integrative review, articles, dissertations and theses published in the last 20 years in the country were investigated and which discussed MH care practices carried out by PHC professionals, seeking to narrow down their contributions, difficulties and challenges. The case study of the small town was carried out through context analysis and a family health unit (FHU) aiming to investigate how PHC provides care to users in mental distress. Two levels of data production were observed, those made available by the PHC Coordination and related to SM care throughout the municipality, and those produced at the FHU studied. In this unit, medical records were analyzed, made available in E-SUS, of SM users monitored by APS. When examining the medical records, the attributed diagnoses, medication prescriptions, how users were received and care practices were listed. Results: the set of problems presented in the integrative review demonstrates that the experiences underway in the country contradict the guidelines of the Ministry of Health (MH) regarding the articulation between SM and PHC, characterized by medical, individual and medication care. Collective activities are scarce and territorial work is minimal, generally restricted to home visits. There is a significant lack of training on the part of PHC professionals and matrix support has many limits to its implementation. With regard to the case study, it is noted that the municipality's PHC cares for numerous MS cases, but that data production is limited, as is the planning of actions based on them. There are disparities in the performance of PHC network units and, contrary to expectations, community mental health service often has more MH users per territory than the Family Health Strategy (FHS). Regarding the care provided at the investigated FHU, it was identified that just over half of the cases are related to mild to moderate conditions, most of them anxiety and depression, converging with the findings in the literature. The data reveal that 80% of the sample uses psychotropic drugs and that the majority of cases (75%) are treated with at least two classes of medication. We can see the local reproduction of literature findings, with a predominance of individualized care and the absence of collective, group and family care activities, denoting the hegemony of the individual clinic and also the centrality of drug treatment. No case discussions were recorded in 98% of the records and 100% of them are silent on articulation with the intersectoral network to conduct care. Regarding co-responsibility for care, it appears in 41.7% of cases, in the remaining 58.3% there is no mention of the process. Regarding the follow-up of cases by community mental health service, 65% of the records state that they follow up with the case in psychiatric and psychological consultations, however it is not possible to verify whether they carry out other collective or coexistence activities at community mental health service. Even though there may have been underreporting of the actions carried out at the FHU studied, the information obtained expresses the difficulties in putting the MH's normative guidelines into practice. It is believed that the results can contribute to improving care for SM users in the city's PHC, in addition to adding to the national production on the topic in the country.