Reabilitação psicossocial e atenção psicossocial: identificando concepções teóricas e práticas no contexto da assistência em saúde mental

Abstract

The Psychosocial Rehabilitation proposal presented by Benedetto Saraceno has influenced transformations in the field of mental health in Brazil, and discussions about this conception started in the late 1980s. In the country, the concept of rehabilitation has changed under the influence of the Psychiatric Reform movement, and the creation of substitute services to the hospital care services. Among the theoretical-practical formulations produced, we highlight the studies by Costa-Rosa and collaborators on Psychosocial Care. Psychosocial Care is registered in the field of mental health, constituting and seeking to respond to the guidelines of the Unified Health System (SUS), standing out as a public policy of the Ministry of Health in Brazil. The present study aimed at understanding and analyzing the theoretical and practical conceptions about Psychosocial Care and Psychosocial Rehabilitation that have been contributing to the current formation of the field of mental health care in Brazil. This is an exploratory research with a qualitative approach consisting of a deep theoretical - reflexive study and a field study. A total of 19 higher education professionals working in CAPS III (6 in total) that make up the mental health network of a municipality in the state of São Paulo participated in this research. For data collection we used Forms to characterize participants and CAPS III and two Roadmaps for conducting the Focus Groups, one Focus Group consisting only of Occupational Therapists and another consisting of distinguished professionals of higher level. Data from the forms were analyzed descriptively and those from the focus groups were submitted to the Thematic Analysis Technique. The time of existence of CAPS III ranged from 14 to 22 years, the territorial area covered by them ranged from 145,000 to 490,000 total population and the number of professionals in the teams ranged from 58 to 72 professionals. The results from the Focus Groups performed only with Occupational Therapists reveal that, although they differentiate Psychosocial Rehabilitation from Psychosocial Care, they claim that both are perspectives that complement each other in practice. Occupational therapists consider that there are specific contributions from Psychosocial Rehabilitation to Occupational Therapy, helping in the work developed at CAPS, however, this association with Psychosocial Care was not so clear and direct. Regarding the results from the Focus Groups with the other higher education professionals, it is verified that they assume such perspectives as distinct, despite the difficulty to sustain such differentiation. Psychosocial Care is sometimes conceived as a synonym for crisis care and, despite the greater familiarity with the notion of Psychosocial Rehabilitation, the speeches revealed difficulty in addressing it. The study revealed, in both groups, that the users' crisis, the financial and other crisis of resources represent important challenges for the practice of care based on the notions of Psychosocial Rehabilitation and Psychosocial Care. It is noteworthy that, besides understanding and analyzing the notions of Psychosocial Rehabilitation and Psychosocial Care from the reflections produced by the participants, the present study allowed us to assess how professionals who work directly in the care of users have operationalized the current “model” of mental health, as well as the way the transformations in the mental health field have been metabolized by these subjects and used as parameters for the construction of intervention strategies