Mental health in primary care under the perspective of workers and users of the services : a hermeneutic-narrative study of the processes of welcoming, liaison and accountability

Author(s)

Ana Luiza Ferrer

• Document type: Doctoral Thesis
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Ciências Médicas
• Defense date: 2012-00-00

Examining board members

Ana Maria Fernandes Pitta; Walter Ferreira de Oliveira; Erotildes Maria Leal; Nelson Filice de Barros

• Advisor: Rosana Teresa Onocko Campos

Abstract

This research investigates mental health actions in primary health care in relation to the processes of welcoming, liaison and the act of making responsible for the cases, from the workers' point of view and the users of health care services. It is a qualitative study aiming to investigate how the primary care teams define the criteria to prioritize the health mental demands; to investigate the understanding of the teams in relation to the concept of welcoming and how they organize themselves to accomplish it in relation to mental health; identify which criteria the teams use to refer mental health cases to other services in the network, and describe how the users of mental health services are linked to the basic units and territory resources. The instrument used to collect data was the focus groups technique. Nine groups were conducted: three with employees of different professions, three with Health Community Agents and three with the users of the Basic Health Units involved in this study. The groups were audio recorded and transcriptions were made. The construction of narratives, as per the theoretical framework of Ricoeur (1990, 1994), was used to interpret the material produced. Results point to a difficulty of the primary care teams to identify and define demands on mental health, mainly unspecific demands related to social vulnerability. The process of welcoming is understood and operated as a procedure - which shows a distance from its initial proposal, which aims to reform work practices - and is understood by the users as another obstacle to get a medical appointment. There are no criteria to referrals of the mental health cases and a tendency to isolation of mental health teams working in the Basic Health Units was observed. The Matrix Support takes place in a distorted manner in most of the services surveyed. For the users, referrals happen due to lack of professionals in the basic health net or due to the complexity of the situation. The link between health service and community ends up being under the responsibility of the Health Community Agents, who inhabit the territory, and therefore understand their dynamics and needs better. Users complain about the high turnover of professionals and value a lot the relationship established with them, especially with the physicians. It is noticeable that there is an investment in creating public policies that can improve the quality in the assistance of mental health in primary care. However, for the consolidation of these guidelines it is necessary to rethink the model of care currently in place, invest in changes in the training of new professionals, as well as ensure training for workers that are already in the practice in order to provide better and expanded understanding over the health-disease process and promote actions that are less fragmented and more dialogued over with the service network (AU)