Tips for permanent education in mental health in primary care guided by the Institutional Socio-clinic*

Objective: to analyze a process of Permanent Education in Health about mental health with Family Health teams. Method: research-intervention performed with 20 workers from two teams of the Family Health Strategies. Semi-structured interviews and 12 reflection meetings were carried out with each team. The principles of Institutional Socio-clinic were used to guide the meetings and the analysis of the data. Results: seven beaconing tips were identified for the Process of Permanent Education in Health: effects produced from the choices of inclusion of the management in the planning of the meetings, revealing established ways of working; attention to non-control in training movements; use of restitution at meetings, reducing stiffness and tensions; attention to the institutions that cross us; analysis of the facilitator’s involvement in the training, redirecting behaviors and attitudes; problematization about the object, instrument and purpose, which favored the reflection about the mental health care and to learn to facilitate and experience the Permanent Education in Health in the act of making. Conclusions: socio-clinic assisted the experience of facilitating in-service training, pointing out tips for the collective construction of contextualized, reflexive and problematizing knowledge.


Introduction
The National Health Council (NHC) approved the

System (UHS): Pathways to Permanent Education in
Health, establishing the National Permanent Education Policy (NPEP) as a UHS strategy for training and work development, considering the constitutional responsibility of the Ministry of Health to order the formation of human resources for the health area (1) .
It is understood that the Permanent Education in Health (PEH) is a proposal of relevant learning to contemplate the worker as protagonist of the formation process. The latter -also focused on the problems and difficulties experienced in the daily production of care, management and participation and social control -makes it possible to construct collective spaces for reflection and evaluation of the daily actions of the health services, decentralizing and disseminating the pedagogical capacity between managers and workers, operating in the micro-politics of the work process. In this way, professional training is offered at the same time as the changes in health practices are produced (2)(3)(4) .
PEH is one of the strategies that can favor the expansion of mental health care in relation to health services and the care network, as well as highlighting various possibilities of work tools to be used in the psychosocial context, since new policies and guidelines guide the care network and, therefore, involve workers from different services and, necessarily, the Family Health Strategy (FHS), seeking the construction of autonomy and social reintegration of the subjects (5)(6) .
Despite this indicative of network care, studies indicate that the FHS teams report difficulties in providing care to people suffering from mental illness, referring to the fragility of this specific care and the need for training for it (7)(8)(9)(10)(11) .
In addition, it is relevant that Mental Health care is also understood in the context of general health, in which the worker acknowledges that the mental health demand can be present in several complaints reported by the users that reach the FHS. Thus, thinking about PEH as a strategy capable of generating reflective processes and covering mental health care can result in comprehensive care of the person and the family.
Given this context, there is a new demand for the training of workers at work, for work and for the work (12) . In order to expand understanding and look at mental health as a care integrated with practice and that takes into account the integrality of the subject, it is necessary that the training be based on the reflection of the work process and that it is a collective construction, not taxation and encompasses psychosocial attention as a guideline.
Although there is this need for training, most of the international studies point to a formative logic still focused on the traditional training and capacities, with measurements of their impacts in the daily work (13)(14)(15)(16)(17) .
Another relevant point refers to the fact that Mental Health training is often based on the biomedical / psychiatric model, emphasizing the diagnosis of mental disorders and drug treatments, besides happening in a decontextualized way of the daily work of health (18) .
Brazil has stood out in terms of training that takes place from the context of health work, dialoguing with it, in a permanent perspective, seeking to propitiate  (19)(20) .
Given this context, it is understood that the training is not effective to enable the change of practice and the incorporation of new concepts, by de-contextualization and based only on the transmission of knowledge in a unidirectional perspective (3) .
Like PEH, one of the structuring axes of Institutional Socio-clinic is also work. For this, the professional practice includes ways of relating to the collective of work, of thinking about these relations and of assigning values, being constituted by a set of updates of the relations that the subjects establish with the professional institution, that is, its professional implications (21) .
The institution, in turn, would be the rules and rules established and socially constructed, such as family, education, health, work, among others (22) . In this sense, the individual and / or collective subject can problematize his daily work, recognizing himself involved with the aspects and institutions that he questions.
It is believed, therefore, that the Institutional Socio-clinic can act in the perspective of generating PEH processes. It does not consist in a technical modality or protocol of practice and analysis, but in a way to question the object and intentions of analysis, seeking to understand the social dynamics (21) .
Its principles consist of characteristics to be observed in the beaconing of institutional interventions. analysis of order and demands; analyzer work; application of refund arrangements; analysis of the transformations that occur as the work progresses; intention of knowledge production; attention to contexts and institutional interference, and the analysis of the implications (21) .
The devices are elements such as writing, speech, videos, among others, created for / in situations of intervention, that can destabilize the instituted ways of functioning of the institutions, and can also become an analyzer if they can put some situation under analysis, revealing the structure of the institution, provoking it and forcing it to speak (21,(23)(24) .
The order refers to an official request for imaginary solutions or actions to restore order and allows the intervention to begin. It involves not only who asks for the intervention, but also what is asked for (23) . The demands are conscious, manifest, deliberate aspects and also unconscious and unsaid aspects, and may be in tune with the order or not. Thus, the order also has individual demands (23,25) .
During the analytical process, transformations occur that, for Socio-clinic, deserve attention and attention.
In the same way, there are institutional interferences, processes of intersection and noise produced when institutional logics enter into contradiction.
In order for this process to take place, it is necessary to analyze the implications of the researcher and the other participants in the development of socioclinical research. Analyzing the implications is to analyze the relationships that the subjects establish with the institutions that pass through them (26) .
Using the principles of Institutional Socio-clinic to mark PEH in Mental Health in the FHS can be a potentiator of learning processes and cause workers to think and reflect on their respective work processes. In this way, the researcher is the subject and object of knowledge (27) .
The data presented comprised part of a doctoral thesis whose field of intervention was composed by two These training meetings were also configured as data production space.

The PEH was guided by the principles of Institutional
Socio-clinic with the workers who accepted to participate, totaling 12 meetings, with an average of two hours. The meetings were recorded and transcribed for analysis, protecting the identity of participants.
One also used the researcher's field diary on the intervention research. In this diary, there were reports of group movements, resistances, advances; content discussed, that is, the narrative of the historical-social context reflected in the research activity (28) .
As this is an intervention research, the results were discussed with the participants as they were produced.
For the organization of the empirical material, the work of transcription was carried out, followed by the transposition, by means of a more attentive and reflexive reading, considering the speeches and the acts / gestures in the different encounters and returning them to the teams. Finally, the work of reconstitution was carried out, in which the construction of a narrative argued around the analysis of the categories (29) .
At the reconstitution stage, we sought to identify

Results
The experience in the process of PEH for the formation in Mental Health points to some beaconing tips guided by the Institutional Socio-clinic. for the other and co-responsibility in this process.
The second clue to PEH is to lose the illusion that there is control and that this is part of the movement to learn concepts, practices and to think collectively.
Allowing not to control the learning process is also an important clue to self-management-based training for the collective.

Discussion
It is a challenge to construct and think about effective ways of training workers from their health work context so that decision-making processes are based on the collective so that workers and users actively participate (31) . Not recognizing that the organization of the health work process is a result of the inclusion and interaction of workers and users can produce bureaucratic forms of work, with the subjective impoverishment of the worker and, consequently, of the care (32) . Thus, the worker may lose his desire for work as he fails to recognize himself in the final product of his work process.
Heterogeneous management can increase the exploitation of labor, alienation, reproduction of the instituted and the naturalization of daily life, and in response to this context, self-managed proposals may arise as an institutional movement (33) .
The training process (undergraduate, graduate, The restitution, as an opportunity to deepen or question the analyzes (21) , was another Socio-clinic principle used to experience PEH in the training in service in Mental Health, which also could favor the movement of the collective and the notion of lack of control.
In doing the restitution and sharing of the PEH process in Mental Health, the workers also occupied a place of actors of the learning movement, being able to speak of institutional attitudes and interferences as: to rethink and to talk about the obligation to participate and its relation with behaviors of resistance, stiffness and tension in the encounters.
Looking beyond the behaviors and speeches presented, comprising, therefore, the institutions that cross the professionals, could favor the understanding and resolution of conflicts in the process of formation.
In this case, resistance as a barrier to the development of PEH should not be taken as a negative sense, but an opportunity or a way to preserve a certain way of www.eerp.usp.br/rlae 6 Rev. Latino-Am. Enfermagem 2019;27:e3204.
working / life in the face of a change of course, as well as possibilities of facing some imposed determinations by management (34) .
The principles of Institutional Socio-clinic favored that the facilitator of PEH (and researcher) could interpret this stiffening in the group as a possibility of growth and involvement with in-service training, stimulating instituting processes of self-management.
Being aware of these institutional interferences, such as the fact that municipal management includes services in a taxing way, has opened the possibility for a more powerful meeting. Otherwise, disputes, disagreements and conflicts could be established (35)(36) .
During the restitution, there was no recrimination or accusations charged with impotent denunciations, but it was used as a space for the enunciation of things, being constructive and respectful (22) .
Through the restitution, it was possible to review the demand of the group, understanding that it is changing and does not necessarily happen explicitly. The overlap also experienced is the result of strong ideological engagements (21) -in this context, the militancy and specialization in Mental Health. The objective is not to make the overlap disappear, but to perceive it, to make it visible and analyzable, consequently, no longer acting in the field of overlapping, but of implication, producing a new knowledge (38) .
Making PEH for Mental Health training and being concomitantly guided by the principles of Socio-clinic favor spaces and opportunities to re-discuss and revise the needs of the group, revisit the initial proposal and understand that the PEH is a field of dialogue that should also consider the institutional interferences , the diverse implications and desires of all involved.
Another point consisted in using the concepts of object, instrument and purpose, to review the work process. The work process is a means of constructing subjectivities where the subject establishes relationships and (re)produces their existence, having as elements the object, in which the work will be applied, through the use of instruments, which are material or non-material forms (such as knowledge, individual consultation, medicine, among others) in order to achieve a specific purpose (30) .
Perceiving these aspects of the work process is also a clue so that one can progress in the transformation of professional practices from the reflective look to the daily life of these.
In this way of learning from the collective, many That is, the transformation of the look into the work object leads to the creation of new instruments based on inter-sectoral actions that seek the social reinsertion and the autonomy of the users (39) . Facing this, it is noticed that the meetings of PEH favored moments of learning to learn, deconstructing and reconstructing new knowledge.
This critical capacity to look at everyday practice and activities with a willing eye to identify fragilities, but also inventions / creations, permeates the process of perceiving reality as being dynamic and fruit of a social and historical construction, which can be transformed (40) .
In this sense, PEH participants began to unveil reality in a movement to look at themselves and practice. Therefore, it consisted in thinking of the movements of PEH as a capacity for outreach, that is, of discovering / producing / welcoming others within ourselves; a multiple singularity, stimulating the capacity of creation, of unfolding, of curiosity before the world, activating the power before the life (41) .
As limit of the study, it is pointed out the nondiscussion of results with municipal management. It is considered that the qualitative research does not have the ambition of generalization of results but of the reflections. In this way, it is possible that PEH takes place from the reality of each day-to-day life, so it is not proposed (and should not be), with this research, to construct a training manual based on the principles and guidelines of the PEH, but point out tips that facilitate its development in the act.

Conclusion
PEH can be a practice that mobilizes deterritorializations in health work teams as it produces reflection and self-analysis. But it can also be captured