Centro de Atenção Psicossocial álcool e outras drogas e regionalização

Abstract

Inspired by the Italian psychiatric reform, led by Franco Basaglia, in Brazil the movement gained strength in the late 1970s, under the leadership of psychiatrists and other professionals that worked in mental hospitals in that period, later added to the fight, family and deinstitutionalized patients joined. The movement gains strength, given that in the country there were two other major fronts taking place: the health reform and the approval of the new federal constitution. The culmination occurred in 2001 with the approval of the law 10.216 / 2001 known as the Psychiatric Reform Law which aimed to reformulate the care of people with mental disorders ensuring their citizenship and to gradually close the psychiatric hospitals and direct the care for the territory. To this end, the Psychosocial Care Centers (CAPS - Ordinance 336/2002) were created with the purpose of ordering care in the territory, which also includes forms of treatment for people with mental and behavioral disorders derived from the use of alcohol and other drugs. Since then, many advances have been made in the last 4 decades. In addition to studies on the theme and knowledge development, the law has advanced with the approval of ordinances, technical notes, manuals, among others, in order to legitimize psychiatric reform, including the closing of psychiatric hospitals deinstitutionalizing hundreds of people. However what can be seen nowadays is the disbelief of the principles and goals of the movement in the spheres of government, as it was possible to realize in the last technical note approved in the first semester of 2019, which legitimizes the return to the psychosocial care network of the extinct psychiatric hospitals and mental health outpatient clinics, besides include therapeutic communities as a form of treatment, all with public funding. In this scenario it is necessary to strengthen the specialized services (CAPS) and bring to reflection their relevance in the care in the territory. In a context that currently exists in the country more than two thousand enabled devices, in Rio Grande do Sul, 189 and of these 29 in the regional configuration. This study becomes pertinent when it brings to reflection the regionalization of a territorial service from the perspective of non-asylum care. The aim of the present study was to evaluate the regional Psychosocial Care Center Alcohol and other Drugs (CAPS AD) from the potentialities and obstacles identified by the different interest groups. It is a qualitative study using the Fourth Generation Evaluation. The period of collection was between May and November 2018 through documentary research, semi-structured interviews and focus groups. The selection by interest groups was performed to define the participants: managers, workers and users. Emerged to evaluation the thematic nuclei: the regional configuration; intersectoriality and matrixing. The conclusion was that regionalization, used as a management strategy, needs regular renegotiations between municipal managers and other spheres of government, in order to ensure its operation and quality assistance to the users' treatment; intersectoriality and matrixing are facilitators of expanded care, but it has in the distance one of the biggest obstacles for not guaranteeing transportation and the challenge of defining roles between the services of the Psychosocial Care Network (RAPS) and despite the relevance of providing the service in the region there is still a need to broaden the discussion and demystify the drug issue.