Modos de apreensão das propostas da reforma psiquiátrica: um estudo qualitativo interpretativo junto à equipe de um CAPS

Abstract

The Brazilian Psychiatric Reform (RP) is a movement that provided the questioning of current ways of dealing with insanity, allowing criticism and therefore, the transformation of care practices in mental health. Questioning the exclusive nature of psychiatric institutions, Brazilian RP's movement is guided on proposals involving political and legit studies as well as clinical, epistemological and sociocultural researches. Over the past 20 years there has been numerous achievements this movement has accomplished by promoting very important structural changes to the development of other forms of care for mental insanity and psychological suffering in general. Among some of the equipment designed to enable a new model of care, the Centers for Psychosocial Care (CAPS) have become the main substitute devices for mental health treatment, setting up a community that has a nature of service, policy guidelines and social clinic purporting to being anti the madness asylums. We believe, however, that the changes on a micro-political level depend directly on how the proposals presented are affecting and being dealt with by mental health care agents. Considering this, on this specific thesis we aimed to understand the modes of apprehension of policy proposals, ideological and clinical studies of the Psychiatric Reform by professionals of CAPS. The theoretical framework adopted involves authors who discuss the Brazilian Psychiatric Reform and the expanded clinic or clinical psychosocial care. The research method was a qualitative-interpretative module, supporting the theory of Gadamer's hermeneutics. We conducted participation and observation of weekly team meetings during the five-month period, with a concomitant construction diary. Also, focus groups with workers that were chosen from different professional categories, CAPS, as well as an interview with the coordinator of the services. The empirical material was worked from a basis of a construction of narratives, which eventually expressed the formation of three units of meaning: 1. The weakening of the clinics; 2. Interaction with the network; 3. The place of the doctor. The first nucleus presented us with certain fragility in the construction and discussion of individual therapeutic projects, suggesting a weakening of the clinic inside CAPS. The lack of communication with intersectional network support group of CAPS was discussed as well. We Also discussed the place that the medical profession has occupied within CAPS and its relationship with the team and the ideals of RP. We emphasize that many of the practices that are currently being carried out within CAPS that are in question, are in line with the proposals of the RP, especially those related to rehabilitation / reintegration. However, little is discussed about the principles of the reform movement. Care practices were not well analyzed as well or questioned for this matter. The clinic seems to lack a great deal of vitality and also very critical examination that should be performed by its team.Consequently, this showed some signs of chronicity, highlighting the need for available spaces for collective reflection, such as, institutional clinical supervision. Still this study showed that the principles of RP learned / built by the professionals need to be integrated into the service history in a process of meaningful construction work.