The scientific production of Psychosocial Care Centers

Abstracts

Este estudo objetivou apresentar uma visão panorâmica da produção científica sobre os Centros de Atenção Psicossocial (CAPS). Trata-se de revisão bibliográfica a partir das bases de dados LILACS, MEDLINE e SciELO. Foram selecionadas 68 referências. Dessas, a maioria era de artigos de periódicos (88,24%) e de trabalhos relacionados à conclusão de cursos de pós-graduação (10,29%); 75% das referências foram incluídas a partir do ano de 2003. Dentre os objetivos mais frequentes, destacam-se: a análise e avaliação da nova proposta assistencial em saúde mental, representada pela Reforma Psiquiátrica e pelo CAPS, e a análise dos profissionais de saúde mental e suas expectativas quanto aos serviços. Espera-se que a presente revisão contribua para refletir caminhos e implicações que (re)configurem novos trabalhos científicos e práticas no cotidiano dos serviços.

Saúde mental; Serviços de Saúde Mental; Assistência em Saúde Mental

ORIGINAL ARTICLE

The scientific production of Psychosocial Care Centers

Producción científica sobre los Centros de Atención Psicosocial

Laura Regia Oliveira Cordeiro^I; Murilo Santos Oliveira^II; Rozemere Cardoso de Souza^III

^IMedicine undergraduate student, Universidade Estadual de Santa Cruz. Fellow of the Scientific Initiation Program, Fundação de Amparo à Pesquisa do Estado da Bahia. Ilhéus, BA, Brazil. [e-mail]

^IINursing undergraduate student, Universidade Estadual de Santa Cruz. Ilhéus, BA, Brazil. [e-mail]

^IIIPh.D. in Psychiatric Nursing, University of São Paulo at Ribeirão Preto College of Nursing. Adjunct Professor of the Department of Health Sciences, Universidade Estadual de Santa Cruz. Ilhéus, BA, Brazil. [e-mail]

^{Correspondence addressed to:}

ABSTRACT

The objective of this study was to present a panoramic view of the scientific production regarding Psychosocial Care Centers (CAPS). This literature review was performed using the LILACS, MEDLINE, and SciELO databases. Sixty-eight references were selected, most of which were journal articles (88.24%) and studies related to final graduate study essays (10.29%); 75% of the references found dating from 2003 were included. The following are highlighted among the most frequent objectives: the analysis and evaluation of the new proposal for mental health care, represented by Psychiatric Reform and by CAPS, and the analysis of mental health professionals and their expectations towards the services. The authors hope the present review will help find pathways and implications that lead to new studies and practices in the everyday work of health care services.

Descriptors: Mental health; Mental Health Services; Mental Health Assistance

RESUMEN

Este estudio objetivó presentar una vista panorámica de la producción científica sobre los Centros de Atención Psicosocial (CAPs). Se trata de una revisión bibliográfica a partir de las bases de datos LILACS, MEDLINE y SciELO. Fueron seleccionadas 68 referencias. De ellas, la mayoría correspondía a artículos de periódicos (88,24%) y de trabajos relacionados a finalizaciones de cursos de posgrado (10,29%); 75% de las referencias fueron incluidas a partir del año 2003. Entre los objetivos más frecuentes, se destacan: análisis y evaluación de la nueva propuesta de atención en salud mental, representada por la Reforma Psiquiátrica y por el CAPs, y análisis de los profesionales de salud mental y sus expectativas en cuanto a los servicios. Se espera que la presente revisión contribuya a reflexionar sobre caminos e implicancias que (re)configuren nuevos trabajos científicos y prácticas en el cotidiano de los servicios.

Descriptores: Salud Mental; Servicios de Salud Mental; Atención en Salud Mental

INTRODUCTION

The model of mental health care, based on the exclusion of the subject from the social life, with his/her hospitalization in psychiatric hospitals, has showed signs of breakdown since the 1970's. After the movements of criticism towards this model, official documents appeared concerning the Contemporaneous Psychiatric Reform⁽¹⁾. Among them, the Declaration of Caracas stands out, which is related to the protection of the human and citizenship rights of people with mental disorders and the need to develop networks of substitute services from psychiatric hospitals and, in Brazil, the law 10216, also known as Brazilian Psychiatric Reform Law, which gives continuity to the achievements of the Declaration of Caracas^(2-4).

This law has entered the senate in 1989 and was officially approved in the country only 12 years later, in April 2001. It defends the benefit to life, aimed at achieving recovery through the insertion of the family into the work and into the community and emphasizing the use of community services in mental health and treatment that aims at the social reinsertion of people with mental disorders⁽⁴⁾.

In agreement with the Psychiatric Reform, the Psychosocial Care Centers (CAPS), regulated through the regulation of Ministerial Decrees no. 336 from February 19 of 2002, are strategies of community services that work as organizational devices in mental health care with emphasis on psychosocial rehabilitation^(5-6). In this context, the CAPS were also recognized at the IV National Conference of Intersectorial Mental Health as substitutive care device, highlighting its strategic function as articulator of the network of services and the need to strengthen intersectorial partnerships⁽⁷⁾. The CAPS have showed effectiveness in the treatment allying clinical monitoring and the care for social insertion of the users through accessibility to work and leisure, as well as the exercise of civil rights and the (re)construction of family and community bonds^(1,8-9).

One of the inaugural milestones of the new paradigms in mental health is the CAPS Prof. Luiz Rocha Cerqueira, established in 1987, in the city of São Paulo^(6,10). It became a type of instigator of a care model for the Brazilian psychiatry⁽¹⁰⁾, a precursor of a technical proposal that is, practically, recent, innovative and ambitious. The numerous services implemented in the country is a result of the official-political reform of the government, the theoretical foundations that led to the creation of the CAPS and the success that their actions seem to have reached. Data from 2006 showed that the number of CAPS has increased from approximately 200 in 2002 to over 860 in 2006. This growth, according to the Ministry of Health, in December 2008, has reached a total of 1326⁽¹¹⁾.

In face of these considerations and, also, the experience at the Psychosocial Care Center of the city of Ilhéus, Bahia, the authors were interested to identify the scientific production related to this device, based on the following guiding questions: when and how does the scientific production approach the themes related to the CAPS? Which of the gaps existing in this production implicate in challenges for new studies regarding this service?

Therefore, this study presents a panoramic view of the scientific production regarding the Psychosocial Care Centers (CAPS), published in health databases in the period from 1989 to 2008, and may contribute to reflect pathways and implications that configure new practices in the routine of the services.

METHOD

This study consists of a literature review regarding the scientific production profile of the CAPS. The literature review was performed using the LILACS - Latin American and Caribbean Literature in Health Sciences, MEDLINE - Medical Literature Analysis and Retrieval System Online and SciELO - Scientific Electronic Library Online databases, using the descriptor Psychosocial Care Center, and including publications in Portuguese and in English.

LILACS provided 98 references. Among these, 39 were excluded, as they did not refer to Brazilian CAPS, resulting in 59 national references. In MEDLINE there were 300 references, however, only 10 addressed Brazilian CAPS. Four of these 10 references were excluded because they had already been catalogued in the LILACS database. Finally, SciELO presented 19 references, from which 16 were excluded because they had already been included in the list from the first surveyed databases. The 68 references collected for the sample consisted of articles, theses and book chapters. This material was organized according to the following items: references; addressed theme; types of study; objectives; context (study location); authors and main results. The information was obtained by analyzing the abstracts. Data were subjected to statistical analysis of numerical and percentage frequency.

RESULTS AND DISCUSSION

All 68 references were analyzed. Regarding the type of production, the most frequent were journal articles (88.24%) and master's theses (4.41%). It is observed that only seven (10.29%) references found are associated to studies of post graduation courses (specialization, master's and doctor's degree) and only one (1.47%) consisted of a book or book chapter.

In the analysis of the years of publication, five (7.35%) references were found in the period from 1989 to 1995, with the first publication in 1989 resulting in the mean of approximately 0.71 publications a year. In the seven following years, from 1996 to 2002, there was a production 220% higher than that from the previous period (1989 to 1995), in other words, a total of 11 (16.18%) of the analyzed references. From 2003 to 2008, the authors found 51 (75%) of the analyzed references, observing an increase of 463.64% in the production in relation to the previous period (1996 to 2002), resulting in a mean of approximately 8.5 productions a year (Figure 1).

This continuous increase in the production of studies regarding the CAPS may be associated with the changes in the model of treatment in mental health from the traditional model, based on the exclusion of the subject from his/her social life - almost exclusive until 1970 -, to the healthcare model, which aims at the inclusion of the subject into society⁽¹⁾. Based on this process, an increase is observed in the interest of researchers to assess and understand all aspects of the CAPS, namely, in the latest period from 2003 to 2008, which precedes the approval of law no. 10216⁽⁴⁾ in Brazil, with a more opened discussion about mental health.

Regarding the context of the studies analyzed, there is a concentration of 73.91% of the references in the south and southeast regions, with 29 (42.02%) references in the state of São Paulo and 10 (14.49%) in Rio Grande do Sul. Only 2.90% were found in the northeast region and 23.19% of the references did not present information regarding the study location, despite it being a field study (Table 1). This disparity and the highlight of the context in the south and southeast regions demonstrate the need for studies in order to understand the reason of this low production, the way the association of the implementation of mental health services at CAPS is made and the development of studies regarding this service in other regions of Brazil.

The number of contexts presented is higher than the number of references analyzed, because a study compared a CAPS from Rio de Janeiro to one from São Paulo. In general, the studies were developed in the CAPS facility (53) and some compared these areas to other environments such as: Psychiatric Hospitals, Family Health Units, Psychosocial Care Nucleus (NAPS), Day Hospitals, Therapeutic Residences and Damage Reduction Service.

Considering only the articles, according to the journal in which they were published, it was found that the 60 articles identified in the survey were published on 27 different journals. The category other journals included 18 journals that presented only one publication regarding the central theme of this study, CAPS, and one journal that presented two publications. Regarding the other journals, listed in Table 2, those with the most publications were: Revista Texto e Contexto (15%), Jornal Brasileiro de Psiquiatria (10%) and Revista da Escola de Enfermagem da USP (8.33%).

By distributing the authors according to their working area, it is observed that there is a prevalence of nursing professionals, 49.27%, followed by psychology (16.66%) and medicine (8.69%) professionals. The other professionals were distributed among the areas: occupational therapy; languages/anthropology; social sciences; social communication; physical education and physics, and there were no references identified regarding the areas of 20.28% of the authors. Among the authors identified, all of them presented at least an undergraduate degree in their area, observing, in this context, a gap regarding the participation of undergraduate students in the production of studies about CAPS.

According to the methodological approach used in the references, it was observed that 65 (95.59%) of the studies had qualitative character and only two (2.94%) were quantitative, but one of these studies presented both quantitative and qualitative aspects. Only in one reference (1.47%) the abstract was not available, therefore it was not possible to classify the type of study.

Table 3 presents the main objectives of the analyzed references, which were grouped according to the general theme they aimed to address in order to facilitate content investigation. Therefore, the most frequent objectives were: analysis and evaluation of the new proposal in mental health care represented by Psychiatric Reform and by CAPS (23.17%); analysis of mental health professionals and their expectations towards the services (17.07%); analysis of the CAPS practices (14.63%); identification of the relationships established among families, users and CAPS (13.41%) and identification of the user's view regarding the disease, treatment and CAPS (10.98%). The next table highlights publications with objectives that aimed at social networks in mental health, new perspectives of treatment in mental health and, also, the profile of the CAPS users, totalizing 20.74% of the explicit objectives.

The studies about the analysis and evaluation of the new proposal in mental health care, represented by Psychiatric Reform and CAPS, represented the objective that was most often addressed in the surveyed abstracts (23.17%). Eight of these abstracts (42.11%) pointed to a historical retrospective in the change of the paradigm for mental health care. Five (26.32%) referred both to the need for evaluative methodologies regarding the new CAPS service and the effective methodology type for a coherent evaluation of the work developed. Others addressed the theme through the analysis of the service transfer from a Hospital to a Psychosocial Care Center (21.05%). In the results of the studies, presented in the abstracts, it is observed that there is a need to work, regarding the Psychiatric Reform, both with the professionals involved in the process of change and with the society in general. Furthermore, two perceptions are observed regarding the influence of CAPS: one that evaluates the service as a facilitator of change in the users' life and as care device indicated for the new paradigms of mental health (99.95%), and another that evaluates it as effective only to assist patients stabilized at a poor clinical degree from the affective and ideational point of view (0.05%). It is worth highlighting that, in the evaluation developed, the conclusions of the abstracts did not point out only the quality of the services but also the failures; always searching for an alternative for improving, aimed at applying a process of action-reflection-action.

In the analysis of the abstracts of studies that addressed health professionals and their expectations towards the services (17.07%), it was observed that 12 (85.71%) studies were centered on understanding the professionals' view of the interdisciplinary work at CAPS and their preparation to assume their roles in the care strategy. One of the studies evaluated this theme not only with a health team but also with a focal group involving users, families and professionals. In 100% of the results of these studies it was possible to observe the need for investment in the qualification of professionals to work in the mental health care model and the view of the professionals regarding the services as an effective strategy, despite the fact that their knowledge is still associated with the traditional psychiatric care model. The other two studies (14.29%) evaluated the effectiveness of Brazilian scales elaborated by the WHO to measure satisfaction and the burden of mental health professionals; and found that these scales were effective.

The studies regarding the practices of CAPS, which represented 14.63% of the studied abstracts, always addressed the evaluation of new technologies and their perspectives for changing the mental health paradigm. Among these studies, it is important to highlight that two (16.66%) analyzed the effectiveness of the therapeutic group practice and two (16.66%) evaluated including practices involving families, aimed at better effectiveness. One of the studies (8.33%) analyzed mental health care regarding the practices, pointing out the need to know the service practices and aimed problematizing them so that they may actually support overcoming asylum practices.

Regarding the studies that addressed the theme of identifying the relationships established among families, users and CAPS (13.41%), four main lines of study were observed: work overload in the routine of caregivers and the psychological distress resulting from it - four studies (36.36%) -; the importance of the partnership between families and CAPS for the treatment - three studies (27.27%) - and family's knowledge regarding the treatment and the Psychiatric Reform - three studies (27.27%). One study (9.1%) addressed the family regarding the association of primary healthcare (Family Health Program) and mental health care. Among the results found, it is worth highlighting the confirmation of the great importance found in establishing bonds between families and CAPS for the improvement of both the treatment in users and the quality of life of caregivers. Two gaps are observed in the analysis of these abstracts: the analysis of the relationships between families and patients with mental disorders and the study of the socioeconomic condition of the families.

CONCLUSION

This study permitted to verify an increase in the number of publications regarding CAPS in the last years, mainly since 2001, after the approval of the Psychiatric Reform Law and the incentives of the government for the implementation of replacement services in mental health care.

It also allowed to characterize the development process of the current knowledge and to guide new study projects. It was observed that the studies evaluate the new model of mental health treatment and its practices.

It identified the need for studies regarding the social and socioeconomic characterization of the subjects involved in the mental health context; the relationship of bonding and familiarity existing between families and mental health patients, and the therapeutic itinerary of the service users, analyzing the community care practices in which they are inserted aside from CAPS.

It is also necessary to think about the orientation of studies in order to understand the centralization of the scientific production in the south and southeast regions of the country, analyzing the relationship between the implementation of the service and the development of studies.

Finally, the authors hope this review may act as an encouragement for new studies regarding Psychosocial Care Centers (CAPS), and contribute with reflections to establish the course and effects of the daily practices of health care services.

REFERENCES

Received: 11/23/2009

Approved: 08/20/2011

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Correspondence addressed to:

Rozemere Cardoso de Souza

Rua Maria Luiza, 603 - Bairro Iguape

CEP 45658350 - Ilhéus, BA, Brazil

Publication Dates

• Publication in this collection
  20 Mar 2012
• Date of issue
  Feb 2012

History

• Received
  23 Nov 2009
• Accepted
  20 Aug 2011