O cuidado em saúde mental infantojuvenil em municípios interioranos e sem Centro de Atenção Psicossocial Infantojuvenil (CAPSij): desafios, experiências e caminhos para a atenção psicossocial infantojuvenil brasileira
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| Autor principal: | |
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| Data de publicació: | 2025 |
| Format: | Doctoral thesis |
| Idioma: | por |
| Font: | Repositório Comum do Brasil - Deposita |
| Download full: | https://deposita.ibict.br/handle/deposita/816 https://psicologia.ufes.br/ https://isni.org/isni/0000000121674168 https://ror.org/05sxf4h28 https://psicologia.ufes.br/pt-br/pos-graduacao/PPGP/detalhes-da-tese?id=22403 https://www.wikidata.org/wiki/Q10387830 |
Sumari: | The thesis aimed to critically analyze child and adolescent psychosocial care in Brazil, with a focus on mental health care for children and adolescents (CAMH) in small or medium-sized municipalities in rural areas, lacking Child and Adolescent Psychosocial Care Centers (CAPSij). It includes five articles, comprising three literature reviews (narrative, integrative, and scoping) and two qualitative field studies. The combination of reviews and field studies aimed to provide an analysis that transitions from a broader context (multiple realities) to a more specific one (a specific municipality). The first article shows that Brazilian challenges, such as the lack of mental health services, regional disparities, low public investment, and medicalizing practices that diverge from regulatory frameworks and guiding policies, are shared by other Latin American and Caribbean countries. SMIJ services are scarce or nonexistent in many countries in the region, especially in rural and inland municipalities, forcing families to seek care in urban centers. Brazil stood out as the only analyzed country with a strategic service specifically for SMIJ, the CAPSij, a pioneering and unparalleled policy. However, despite its relevance, its implementation remains limited. The second article revealed that, in municipalities without CAPSij, care tends to occur through “personalization of care,” where a single professional takes on most of the demands, working in an overburdened and isolated manner. The main challenges in care include high staff turnover, complaint-conduct-centered approaches, and a lack of intersectorality and effective regionalization. The third article investigated SMIJ care in a specific rural municipality without CAPSij. It found a local agreement establishing a “Multidisciplinary Mental Health Team” as the reference for SMIJ demands. However, the service has operated in an outpatient and precarious manner, without fulfilling its role as a network coordinator. Additionally, Primary Care showed limited involvement, with Basic Health Units (UBS) primarily used as referral points. High staff turnover and fragile employment contracts also emerged as major barriers. The fourth article highlighted that the therapeutic itineraries of children and adolescents with mental health needs are fragmented, with CAPSij being perceived by users and families as the most reliable service within the Psychosocial Care Network (RAPS). Barriers such as a lack of human resources, an overload of referrals, and dehumanized approaches in emergency and hospital systems were emphasized. The review highlighted the absence of studies on SMIJ itineraries in cities without CAPSij. This gap is significant, as more than 60% of Brazilian municipalities meeting the population criteria for this service still do not have it. The fifth article analyzed the therapeutic itineraries of children and adolescents served by the “Multidisciplinary Mental Health Team” in the same municipality discussed in the third article. It identified schools as the primary point for the initial detection of CAMH demands, while the “Multidisciplinary Mental Health Team” operated as the main local resource but faced limitations related to high staff turnover and predominantly outpatient activities. The thesis emphasizes that, although the psychosocial paradigm is normative in CAMH policy, its implementation still faces challenges, which may be even more pronounced in municipalities lacking the main strategic devices of psychosocial care for children and adolescents. It argues that the effectiveness of the CAMH network in municipalities without CAPSij requires a local device with a clear public mandate that goes beyond merely absorbing cases. The history of CAMH in Brazil is marked by nonlinear progress, frequently interrupted. Without agents to articulate this agenda, it loses momentum. Thus, it is essential that this mandate drives networked actions, particularly within Primary Care or in synergy with it, overcoming the outpatient model and promoting practices aligned with expanded clinical care and psychosocial care for children and adolescents. |