Atenção à crise na contemporaneidade: desafios à Reforma Psiquiátrica Brasileira

Abstract

RESUMO Neste ensaio, são abordados os modos de viver e de acolher a experiência de crise no âmbito da saúde mental brasileira, considerando que esse acontecimento se impõe como um dos desafios estratégicos da fase atual da atenção psicossocial. Essa demanda heterogênea evidencia os efeitos coletivos e individuais decorrentes das transformações da vida contemporânea no mundo ocidental, cenário que, no contexto brasileiro, envolve, com frequência, crescentes situações associadas a rupturas e violências. Além disso, o acolhimento à crise e a clínica da urgência ainda se apresentam fortemente marcados pelo discurso psiquiátrico, que mantém legitimidade exclusiva nesse âmbito ao fornecer uma interpretação para a crise como evidência de uma psicopatologia. Em contrapartida, propõe-se uma noção de crise referida a um momento específico da existência, o qual condensa e atualiza uma série de afetos e impasses próprios à heterogeneidade que faz parte da vida. Nesse sentido, recupera-se a dimensão simbólica que intervém nesse acontecimento, privilegiando-a como recurso de subjetivação e tratamento para as modalidades de cuidado que se contrapõem à lógica discursiva psiquiátrica.

The ability of Psychosocial Care Centers specialized in Alcohol and Drugs to handle crises

“…Comprehensive admission is a fundamental tool to allow users to experience and go through the crisis moment with safety and freedom, without further harm. The gateway for this care is considered a strategic path in the network to accommodate the demand since, with 24-hour assistance, users can benefit from all the resources offered by the services ( 1 ) . In addition to that, the presence of Nursing teams, including weekends, and the support of peers in the community services, can contribute to the good result of management in crises, with a significant improvement in the biopsychosocial aspects ( 8 ) .…”

“…A strategy that opens up conditions for the exchange, speaking and listening to the subjects, and consequent resumption of possibilities. It represents an opportunity for users to take care of the distress caused by problematic AOD use and social exclusion ( 1 ) . In this sense, dialogue and establishing a relationship of trust offered in this device can ease approaches to users in crisis, allowing professionals and the person in care to access in more depth the relationship between consumption and care planning, in addition to medication support ( 4 ) .…”

“…For these cases, the services must remain open as a reference to be accessed based on the subjects’ desire; and 3. Different negotiations must be allowed in each situation ( 1 , 4 ) .…”

“…A mental health crisis can be defined as a critical moment characterized by disrupting a person’s organization in its psychological, social, biological, spiritual, or cultural dimensions ( 1 ) . A crisis can be triggered by various situations beyond a person’s limits.…”

“…Although not always qualified as urgent, crisis moments require immediate admission (1,4) . For more than a decade, the World Health Organization (WHO) has recommended that these services be preferentially carried out in the community context and by teams or specialized mental health services; however, these resources are still not sufficiently available or structured at the global level (3)(4)(5) .…”