Saúde mental infantojuvenil : identificando realidades de municípios que não contam com CAPS infantojuvenil, a partir da Atenção Básica em Saúde

Abstract

Public policies concerning mental health for children and teenagers in psychological distress have been discussed in a very disassociated way in comparision to the policies directed towards adults with mental disorders. The most recent public policyin this field, the Psychosocial Care Network (in Brazil, RAPS – Rede de Atenção Psicossocial), establishes the creation, expansion and articulation of health care structure for people in mental suffering or mental disorders, directing them to the Basic Health Units (UBS – Unidades Básicas de Saúde) and also the Centers for Psychosocial Child and Teenager Care (CAPSij – Centros de Atenção Psicossocial Infantojuvenis) the responsibility for developing the main articulation strategies for children and adolescents. However, the strategic equipment for mental health that provides care for the child and teenaging population is still scarce. The present study aims to understand, from the perspective of the professionals who work in the Family Health Strategy (ESF – Estratégia Saúde da Família) program, how the Basic Health Care services of municipalities which do not have constituted child and teenaging CAPS might deal with the demand related to Children and Teenagers Mental Health and, as specific objectives, it also aims to place the understanding of Primary Care professionals about Child and Teenagers Mental Health and the demands on this field that reach the ESF services, to identify, from the professionals in the Basic Care Services, the practices concerning the attention to the mental health of children and teenagers developed in the ESF services; and, finally, to understand the challenges and perspectives about the care delivered in Primary Health Care located in the municipalities which do not have child and teenaging CAPS, regarding the articulations with the Public Policies for Children and Teenagers Mental Health. In order to do so, three municipalities with different dimensions and resourceswere chosen and the studies were focused on them, which are located in the area covered by a Regional Department of Health in the State of São Paulo (DRS – Departamento Regional de Saúde). This is a descriptive-exploratory research, with a qualitative approach, using semi-structured interviews. Twenty-one professionals who are part of the Family Health Strategy program have participated in this study once they had been responsible for receiving children and teenagers in psychological distress who arrive at the Units. The interviews have been performed individually and live, and data analysis has been carried out using the Collective Subject Discourse – CSD (DSC – Discurso do Sujeito Coletivo) technique. The results obtained indicate that care in the unit itself, when it occurs, is performed mainly through physician-centered care and the Support Centers for Family Healthteams (NASF – Núcleos de Apoio à Saúde da Família), when it is a part of the municipal care network, both arising from individual care. When expressing their understanding of children and teenagers' mental health, participants have emphasized the influence concerning the importance of life contexts, with a special focus on the family context, which reflects directly in the identification of the demand that comes to the service. Related to the characterization of this population, they report that learning difficulties, social issues and use of alcohol and drugs are among the main problems and that, for the most part, they arrive by spontaneous demand. It has been identified that the actions in network and in the territory are practically absent and, among the difficulties reported by the professionals to carry out the attention to this population are listed the lack and the qualification of professionals, the high demand in the units, among others. It could be argued that the absence of network and territorial actions, shared care and parenting, are as harmful to children and teenagers mental health care as the absence of specialized mental health equipment and that investments for the implementation of these guidelines would qualify this kind of attention in the municipalities. Concerning the above, we present a conclusion that the care actions advocated in the guidelines and policies of psychosocial care for children and adolescents are not prioritized as care actions; That the professionals' understanding of the field of mental health is often limited or misleading, and that the shortcomings generated by the lack of strategic equipment are smaller, as long as the minimum of better resources available in the municipalities have been integrated.