Satisfaction of users of Psychosocial Care Centers*

Objective: evaluate the satisfaction of users with the care provided at the Psychosocial Care Centers and its association with clinical and sociodemographic factors. Method: this cross-sectional study was conducted with 55 users from 5 Psychosocial Care Centers. The sociodemographic and clinical characteristics were obtained through an individual structured interview. The abbreviated version of the Mental Health Services Satisfaction Scale (SATIS-BR) was used for data collection. Results: were descriptively analyzed and simple and multiple logistic regression models were adjusted for analysis of associations, estimating the gross and adjusted odds ratio, with the respective confidence intervals of 95%. Results: the age average of the sample was 40.1 (±12.4) years and the degree of satisfaction average was 4.56 (±0.45). Users with less education (primary school) had 5 times more chance of having less satisfaction (p<0.05). Users with frequency of intensive monitoring were 5 times more likely to have less satisfaction than users who receive monthly monitoring (p<0.05). Conclusion: the majority of users are satisfied with the service and factors such as low education and higher frequency of monitoring influenced the satisfaction.


Introduction
Over the history of Brazil, the mental hospital model based on the cure and elimination of symptoms of psychic disorder had as its main institution the psychiatric hospitals with treatments based on hospitalization, hydrotherapy techniques, excessive administration of medication, even the application of electrical stimuli or the use of surgical procedures (1) .
With the Psychiatric Reform movement, there was a reordering of the care model in order to provide greater autonomy to people who suffer with mental disorders (2) .
Thus, after the Law 10.216, April 6, 2011, mental health has assumed new models of care for people with psychic suffering that go beyond the sphere of isolation and segregation (3) . This represents a change of perspective about mental health with the focus of the treatment on the patient and not on the disease, and the main work tool is the Singular Therapeutic Project formulated by the team together with the user in order to meet their clinical and psychosocial needs (4) .

The design of the Brazilian mental health network
is configured based on the emergence of the Centers for Psychosocial Attention (CAPS) that provide the subject with extra-hospital support, reducing future hospitalizations, seeking the social reintegration of the patient and providing the dignity and autonomy of him using activities and therapeutic practices (5) . These devices have an open and communitarian character and are composed of multiprofessional and transdisciplinary teams that provide care to users with severe and persistent mental disorders and to people with suffering and/or mental disorders in general, not excluding those resulting from the use of crack, alcohol or other drugs (6) .
CAPS are organized in different modalities according to the public served and the population demand (7) .
In these terms, with the expansion of the concern to improve mental health services and improve their efficiency, studies reveal the importance of studying the satisfaction of users, family members and workers of mental health services (8)(9)(10) and the profile of service users enabling to know the sociodemographic and clinical characteristics of the researched users (11)(12)(13) .
Researches carried out in the coastal plain region of Piauí had the purpose of knowing the reality of Piaui's psychiatric reform, highlighting the main challenges (14)(15) , in addition to the experiences lived in the constitution of the Psychosocial Care Network in Piaui's capital (16) showing the process of regionalization of mental health in the coastal plain of Piauí (17) .
The evaluation of mental health services in the view of users is an important resource, because it allows detecting the efficiency of the services and the ability to meet the perspectives of users, considering them as protagonists in the production of knowledge about the theme of mental health (18) . Thus, this study aimed to assess user satisfaction with CAPS care and the association with clinical and sociodemographic factors.

Method
This is a cross-sectional study, developed in 2017, in the coastal plain in the extreme north of Piauí, which has an estimated population of 265 thousand inhabitants (19) .
The study was developed in the 05 reference CAPS of the region: CAPS II and CAPS AD located in the municipality  (20) . We excluded those under 18 years old and those who presented some kind of impediment that could hinder the understanding and answering of the questions in the proposed questionnaire. The user profile was evaluated considering issues related to sociodemographic characteristics: sex, age, education, occupation and income (20) . The questions about the clinical characteristics involved the use of medication, history of hospitalization and participation in therapeutic activities.
The evaluation of the degree of user satisfaction was evaluated by the Mental Health Services Satisfaction Scale (21) validated in Brazil (22) . The scale has 12 quantitative

Results
Of the 150 users selected, 13 were excluded because they were under 18 years old, 64 because they had difficulty to understand the questionnaire, and 18 because,  Table 1.  Table 3 shows that the degree of overall satisfaction ranged from 3.30 to 5.00, with an average of 4.56.
When analyzing the results considering the subscales, the evaluation ranged from 3.00 to 5.00, with average

Discussion
The results revealed, as a priority, that the patients are satisfied with the mental health service, reflecting a positive view that these users have about the service they use. This result is similar to that found in other studies that assessed patient satisfaction using the SATIS-BR questionnaire (20)(21)(22).
Regarding the profile of the users evaluated, the majority are young adults, male, with a low level of education, income from 1 to 2 minimum wages and single. Although the sample in this study was a convenience one, this profile was also found in other studies involving users of CAPS in Brazil (11,(13)(14)(15)(16)(17)(18)(19)(20)(23)(24)(25)(26) .
Regarding the profile of the users evaluated, the majority are young adults, male, with a low level of education, income from 1 to 2 minimum wages and single. Although the sample in this study was a convenience one, this profile was also found in other studies involving users of CAPS in Brazil (11,(13)(14)(15)(16)(17)(18)(19)(20)(23)(24)(25)(26) .
This difference observed in relation to sex may be related to the particular characteristics of the service evaluated in this study, since although only 1 of the CAPS is registered for the care of alcohol and drug dependent patients, the others also offer care to the public undergoing treatment for the use of alcohol and other drugs, mostly male (3) .
Young adults represented the majority in the study (13.20) and despite the average age of users being in the range of economically active people who should be inserted in the labor market, the lack of job opportunity associated with low education that hinders the insertion in the market, has as a consequence their dependence on family and government aid to meet their basic needs (27) what makes the majority public of the service made of an economically less favored population (28) .
In addition, mental disorder often brings to the individual's life difficulties of social, affective and interpersonal relationships (29) which leads to the understanding of the fact that most users are single (30) bringing up the reflection about how these individuals are seen by society and by their families impairing their social reintegration, the resumption of work and their dignity as citizens.
A key factor for the integrality of health care is the guarantee that the user will have their needs met within a Network of Psychosocial Care (Rede de Atenção Psicossocial -RAPS) (7) , enabling access and articulation of actions and health services at different levels of complexity. When it was assessed how users arrived at Rev. Latino-Am. Enfermagem 2019;27:e3223.
the service, it was observed that, in general, the search was spontaneous or intermediated by family members.
The gateway to any public health service should be the primary care (23) that in this study referred a small percentage of users, which may indicate a possible difficulty of the primary care services in actively seeking these patients for referral to the reference services.  (31) . Thus, these are effective spaces in the assistance to patients with psychic suffering (32) and in health care (33) since most users perform the intensive treatment in the CAPS mainly by the availability of therapeutic activities appropriate to them (15) .
Although most users perform therapeutic activities in the CAPS as part of the treatment offered, a high rate of people using medications and with previous history of hospitalizations was found. There are previous reports of coexistence of care practices that corroborate the principles of Psychiatric Reform and others that still reproduce the asylum logic in Psychosocial Care Centers (33) . The reformulation of the entire health care system for patients with mental health problems is a complex and continuous process that should seek the implementation of actions and strategies that overlap with institutionalization (34) . However, the therapeutic actions of mental health services still point to an emphasis on pathology and medication (5) in spaces that do not even have the minimum structure necessary for the development of services (35) .
Thus, it is essential to understand the patients' own perception of the results of treatment as a predictor of their satisfaction with the services (8) . Studies relate user satisfaction to several issues, including: adherence to treatment, characteristics of the service, sociodemographic and clinical variables of patients, reduction of symptoms, team competence, quality of professional and patient relationship, accessibility to service, quality of facilities, continuity of care and the information received (8)(9) .
In general, the patients in this study were satisfied with the services offered. The best evaluation was in relation to the help received and the welcome of the team, being in agreement with other national studies (3,(20)(21)(22)(23)(24)(25) . The criticisms observed were basically in relation to the environment condition, with regard to comfort, appearance and general facilities of bathrooms, kitchens and dining room, a characteristic also observed in other studies in which this sub-item of the evaluation scale obtained the lowest average (20)(21)(22)(23)(24)(25)36) .
In this study, the individuals with lower education, in semi-intensive treatment, had more chance of having less satisfaction with the service. Unlike other studies in which the satisfaction among illiterate users was higher (4,18,29) . This result raises the reflection that because of their hospitalization or attending by the service semiintensively, it makes them more critical, in addition to perceiving more easily the existing problems and failures.
The level of discontent may also be related to the nature of mental disorders since, according to the diagnosed disorder, users may have different levels of satisfaction (20) .
Another recognizing that they are able to live a productive life even while manifesting the symptoms of the disease besides the recognition that many of them will recover of their mental disorder (18) .
In relation to the associations of user satisfaction and profile, we observed that the patients of CAPS in plan, which reflects the characteristics of the psychosocial model adopted in Brazil as a guideline for the priority focus of the Psychosocial Care Network (37) .
Some research experiments have demonstrated the potential of effective user participation in intervention evaluation studies. This is a relevant challenge, not only for the current stage of Brazilian psychiatric reform, but also for the expansion of analytical perspectives and for the social reach of research in psychiatry and mental health in the country (27,38) .
Studies about the evaluation of mental health services, especially those that describe user satisfaction, are still limited even with the change in the paradigm of the view about mental health, which places the individual in a position of autonomy and empowerment observed after the psychiatric reform (10,20,(22)(23) . From the study, we