Projeto terapêutico singular como dispositivo de cuidado em saúde mental na atenção básica: um estudo com profissionais de estratégia de saúde da família

Abstract

Primary Healthcare is considered the organizer of the Healthcare Network. It develops its interventions based on the logic of longitudinal care. Besides, it works on the design of a specific area and population, which eases the access of such population to the healthcare service, as well as the access of both users and workers to that area. Thus, there is important the inclusion of Mental Health actions in the context of Primary Healthcare, since there are plenty of Mental Health demands in the daily routines of those centers of care. Thereafter, the research that based this thesis aimed to comprehend the perceptions of healthcare workers from Family Health Strategy regarding the Singular Therapeutic Project (STP), when working with Mental Health demands. The STP is a strategy of collective construction of intervention proposals among different healthcare workers, through the dialogue and the agreement of proposals with the necessities of the healthcare system user in psychological suffering and its family. Therefore, it was conducted a qualitative research, upon the epistemological perspective of hermeneutics and dialectics, with workers from two Family Health Strategy, located in the state of Rio Grande do Sul, Brazil. Participants were 17 workers from those healthcare teams. The instrument used was the semi-structured interview, which were audio recorded and, later, transcribed. Data analysis was performed through the content thematic analysis and all the ethical care involving human beings were followed. Hence, the results of the research are presented and discussed in two articles that are part of this thesis. In the first article, it was noticed that the STP is still distant from the reality of the healthcare teams and workers that participated in the study. However, there were perceived experiences that show a practice aligned with the postulations of the STP. On the other hand, the Brazilian National Humanization Policy seemed to be closer to the daily routines of the healthcare teams, though workers presented a lack of comprehension of the methodological assumptions of that policy. Besides that, there were discussed the different “clinics” developed in the production of care in mental health inside Family Health Strategy. In the second article, it was reflected upon the little comprehension of conceptual aspects regarding mental health and the feeling of lack of technical qualification towards mental health issues. There was also identified the importance of the assistance network on the integration of shared care, since reports from the workers showed extreme and complex situations. Nevertheless, there are some obstacles that weaken the shared care in the Family Health Strategy areas. Hence, the role of the Nucleio f Support to Family appeared to be relevant, as well as the care in cooperation with relatives of users in psychological suffering. Finally, there is emphasized that though the STP is not something wellestablished in the reality of the teams, there was identified that workers perform on a perspective of “live work”, using strategies of practice in mental health.