O “manejo” da “desinstitucionalização”: da construção de um problema público à análise situacional das práticas de “desinstitucionalização” das profissionais nos serviços residenciais terapêuticos

Abstract

The aim of this research was to analyze the practical consequences of the psychiatric "deinstitutionalization" process in a public mental health service: Therapeutic Residential Services (TRS). The creation of these services results from the transformation of psychiatric hospitalization into a public issue, mobilizing mental health workers, family members, and civil society organizations in spaces for deliberating new psychiatric treatment proposals. The category "deinstitutionalization" appears in this context as a native category, specific to the field of mental health. Its meanings are constructed by these social actors in National Meetings, where proposals, legislative changes, and the development of new public policies for psychiatric care in the community emerge, replacing the treatment model based on compulsory hospitalization. Among the assistance services created in this context, the Therapeutic Residential Services emerge as a model of care for individuals discharged from long-term psychiatric hospitalizations, defined as a period exceeding two years of hospitalization, who have no family or housing ties. To analyze the consequences of "deinstitutionalization" in this specific service, I conducted a field study by attending the team meetings of two TRSs located in the Northern Zone of Rio de Janeiro. These meetings are moments in which the professionals – caregivers, coordinators, nursing technicians, and therapeutic companions – discuss their interactions with the residents of the TRSs and develop theories and practices of "management," a category used to define a set of actions and techniques aimed at the "deinstitutionalization" of the residents.The proposed analysis results from five months of fieldwork observing the weekly team meetings of professionals and two years of remote contact with coordinators and therapeutic companions of the service due to the COVID-19 pandemic. Throughout this period, I conducted semistructured interviews with both groups via an online meeting application. Another part of the work was conducted in the post-pandemic period when I returned to the field to interview caregivers and nursing technicians. The hypothesis raised is that "deinstitutionalization" is not a category with fixed and guaranteed meanings and practices, but one that is built daily by professionals through interactions with the residents and their "management" of life, relationships, emotions, the body, and the psyche, alongside psychiatric "crises" and other types of "crises" such as the pandemic, and their agency with the material, human, and emotional resources available.