O cuidado em saúde mental na atenção básica: uma revisão de literatura sobre desafios e possibilidades na perspectiva dos trabalhadores das Unidades Básicas de Saúde

Abstract

During the Multiprofessional Residency in Collective Health, the constant articulation between the different devices of the Psychosocial Care Network in the debates on the cases of users in psychic suffering and in major vulnerability became a question. Such situations are discussed at different times and drew attention due to the high complexity involved, as well as the great difficulty that Primary Care devices presented in assuming the role of care coordinators, in its integral conception. The main prisms of analysis for the foundation of the present study are based on the trajectory of definition and institution of services of mental health care in Brazil, based on health policies as conceptual theoretical frameworks throughout history. This path took place towards the focus of mental health care in Primary Care and what is currently set as a challenge in this instance from the last National Primary Care Policy (NPCP). The objective is to analyze the scientific production after the publication of the NPCP, in 2017, about the perceptions of health professionals on the current policy and the challenges posed in mental health care, as well as to assess whether there are any effects in everyday practices and possible association with the aforementioned framework. A narrative review of the literature on mental health care practices produced by workers at primary care units was carried out. This survey was carried out in the main repositories, seeking studies that have interviewed these professionals on this main subject in the period between January 2018 and February 2020. After the literature review, 16 studies were analyzed and presented these main topics: social determinants and psychosocial vulnerability; professional categories, their training and teamwork; the challenges for mental health care in primary care; to plan mental health strategies in small towns; child and youth care; medicalization. The themes that emerged from the survey were analyzed by four dimensions: the actions performed and impasses encountered by Primary Care workers on mental health care; matrix support and the effects on the care provided; intra and intersectoral articulation and coordination of care by Primary Care; the conjuncture of the basic health units: infrastructure and processes of the different levels of management. Despite the fact that it was not possible to directly correlate the difficulties encountered in this review to the changes in policy, it is necessary to highlight the aggravation in recent years of the challenges for sustaining a substitutive model of mental health care in Primary Care.