Mental health care: how can Family Health teams integrate it into Primary Healthcare?

Gryschek, Guilherme; Pinto, Adriana Avanzi Marques

doi:10.1590/1413-812320152010.13572014

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review • Ciênc. saúde colet. 20 (10) • Oct 2015 • https://doi.org/10.1590/1413-812320152010.13572014 copy

Mental health care: how can Family Health teams integrate it into Primary Healthcare?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Mental health is one of the responsibilities of Brazil's Family Health system. This review of literature sought to understand what position Mental Health occupies in the practice of the Family Health Strategy. A search was made of the scientific literature in the database of the Virtual Health Library (Biblioteca Virtual de Saúde), for the keywords: ‘Mental Health’; ‘Family Health’; ‘Primary Healthcare’. The criteria for inclusion were: Brazilian studies from 2009 through 2012 that contributed to understanding of the following question: "How to insert Mental health care into the routine of the Family Health Strategy?" A total of 11 articles were found, which identified difficulties and strategies of the professionals in Primary Healthcare in relation to mental health. Referral, and medicalization, were common practices. Matrix Support is the strategy of training and skill acquisition for teams that enables new approaches in mental health in the context of Primary healthcare. It is necessary for Management of the Health System to take an active role in the construction of healthcare networks in mental health.

Key words
Primary healthcare; Mental health; Family Health

Title	Authors	Year	Study	Principal results
Common mental disorders in Petrópolis, Rio de Janeiro State: a challenge for integration between mental health care and the Family Health Strategy³3. Fortes S, Lopes CS, Villano LAB, Campos MR, Gonçalves DA, Mari JJ. Transtornos mentais comuns em Petrópolis-RJ: um desafio para a integração da saúde mental com a estratégia de saúde da família. Rev Bras Psiquiatria 2011; 33(2):150-156..	Fortes S, Lopes CS, Villano LAB, Campos MR, Gonçalves DA, Mari JJ	2011	Quantitative	There is a group especially at risk for mental disorders in primary healthcare: poor women with little social support. In other countries, special interventions have been developed for them to be assisted by primary healthcare.
Challenges facing mental health care in the Family Health Strategy¹⁰10. Cavalcante CM, Pinto DM, Carvalho AZT, Jorge MSB, Freitas CHA. Desafios do cuidado em saúde mental na estratégia saúde da família. Rev Brasileira em Promoção da Saúde 2011; 24(2):102-108..	Cavalcante CM, Pinto DM, Carvalho AZT, Jorge MSB, Freitas CHA	2011	Qualitative	Mental Health actions are carried out by some health workers in the Family Health Strategy: matrix support, relationship technologies, home visits, and community therapy. It was found that there is a deficiency in the training and skills acquisition of basic healthcare professionals, due to the persistence of the pathological/curative model of health care.
Work processes in healthcare: practices for care of mental health in the Family Health Strategy¹²12. Camuri D, Dimenstein M. Processos de trabalho em saúde: práticas de cuidado em saúde mental na estratégia saúde da família. Saúde Soc 2010; 19(4):803-813..	Camuri D, Dimenstein M	2010	Qualitative	Work processes in health care are organized in a bureaucratic and hierarchical manner, and healthcare practices perpetuate the knowledge/ practices of each professional involved. The logic of specialty-based care persists; and teams do not welcome nor accept responsibility for the demand – referring cases to other services.
Conceptions of mental health care as perceived by a Family Health team, in a historical and cultural perspective¹³13. Dalla Vecchia MD, Martins STF. Concepções dos cuidados em saúde mental por uma equipe de saúde da família, em perspectiva histórico-cultural. Cien Saude Colet 2009; 14(1):183-193..	Dalla Vecchia MD, Martins STF	2009	Qualitative	The team finds the following important: determination of life conditions in the health/illness process of the population served; the need to use diversified strategies in care beyond the consultation; the importance of the team taking care of its own mental health; the difficulties in the approach to the family.
The praxis of Mental Health in the ambit of the Family Health strategy: contributions to construction of fully integrated care¹⁴14. Arce VAR, Sousa MF de, Lima MG. A práxis da Saúde Mental no Âmbito da Estratégia Saúde da Família: contribuições para a construção de um cuidado integrado. Physis Revista de Saúde Coletiva 2011; 21(2):541-560..	Arce VAR, Sousa MF de, Lima MG	2011	Qualitative-quantitative	Population with difficulty of access to mental health care, due to the lack of a structured support network. It was found that there was a low capacity to resolve problems in practice in the Family Health Program, since the response that was provided primarily consisted of out-patient medical consultations and referrals for hospitalizations, thus showing both the hegemony enjoyed by the biomedical model and also the healthcare network's lack of a coordinated structure for ensuring fully integrated care.
Mental health in primary healthcare: evaluation study in a major Brazilian city¹⁵15. Campos RO, Gama CA, Ferrer AL, Santos DVD, Stefanello S, Trapé TL, Porto K. Saúde mental na atenção primária à saúde: estudo avaliativo em uma grande cidade brasileira. Cien Saude Colet 2011; 16(12):46434652..	Campos RO, Gama CA, Ferrer AL, Santos DVD, Stefanello S, Trapé TL, Porto K.	2011	Qualitative	Matrix Support showed potential for defining flows, training of teams and creating joint and shared care. Strategic role of the Community Healthcare Agent for identifying potential offers and providing a listening role from a position closer to the population. Health promotion practices not yet consolidated. When professional staff are employed outside the health units, actions that are more removed from the "treat them and move them on" approach are possible.
Matrix Support in units of the Family Health Program: trying out innovations in mental health¹⁶16. Dimenstein M, Severo AK, Brito M, Pimenta AL, Medeiros V, Bezerra E. O apoio matricial em unidades de saúde da família: experimentando inovações em saúde mental. Saúde Soc. 2009; 18(1):63-74..	Dimenstein M, Severo AK, Brito M, Pimenta AL, Medeiros V, Bezerra E.	2009	Qualitative	Proposal for Matrix Support is not clear to the team, and a great deal of demand for mental health care is not met.
Mental health and basic healthcare: analysis of an experience at local level¹⁷17. Silveira D P, Vieira ALS. Saúde mental e atenção básica em saúde: análise de uma experiência no nível local. Cien Saude Colet 2009; 14(1):139-148..	Silveira DP, Vieira ALS.	2009	Qualitative	Actions in mental health at local level show the biomedical model of organization of healthcare still dominant – with psychiatry being the standard approach, the work process bureaucratized, and action centralized action within the health units.
Mental health in primary care: the need to build competencies¹⁸18. Neves HG, Lucchese R, Munari DB. Saúde mental na atenção primária: necessária constituição de competências. Rev Bras Enferm 2010; 63(4):666-670..	Neves HG, Lucchese R, Munari DB.	2010	Essay	To achieve real improvement in health care there is a need to establish synchronization of knowledge and actions with the psycho-social care and guidelines of the SUS.
Partnership between CAPs and the Family Health Program: the challenge of construction of a new knowledge¹⁹19. Delfini PSS, Sato MT, Antoneli PP, Guimarães POS. Parceria entre CAPS e PSF: o desafio da construção de um novo saber. Cien Saude Colet 2009; 14(Supl. 1):1483-1492..	Delfini PSS, Sato MT, Antoneli PP, Guimarães POS.	2009	Qualitative	The strategies used are team meetings, in which there is training, discussion of cases, acceptance and preparation of therapeutic projects, and joint home visits. Difficulties found: high demand for health services and absence of institutional guidelines for the actual making of the partnership. A vision and approach that take in the family and the social context has results that are positive in comparison to the approaches in which the vision is centered only on the illness. Joint work enriches practice and makes possible a wider network of care in the territory.
Building the mental health care chain with the Matrix tool²⁰20. Sousa FSP, Jorge MSB, Vasconcelos MGF, Barros MMM, Quinderé PHD, Gondim LGF. Tecendo a rede assistencial em saúde mental com a ferramenta matricial. Physis Revista de Saúde Coletiva 2011; 21(4):1579-1599..	Sousa FSP, Jorge MSB, Vasconcelos MGF, Barros MMM, Quinderé PHD, Gondim LGF.	2011	Qualitative	Matrix Support is a potent structure for making it possible to build an articulated network system in the SUS, not limited to the frontiers of any one given service.

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Colaboration

G Gryschek worked in conception, research, discussion and final review; A Avanzi worded in research, discussion and final review.