Manifestações de sofrimento: dilemas e desafios para a vigilância em saúde do trabalhador

Abstract

O artigo aborda as relações complexas e desafiadoras entre as manifestações de sofrimento dos trabalhadores e as práticas da vigilância em saúde. O objetivo deste ensaio é realizar uma análise crítica dos desafios e dilemas relativos à integração da saúde mental no escopo da vigilância em saúde do trabalhador no Sistema Único de Saúde. Percebemos processos de patologização dos trabalhadores em jogo nas práticas disponíveis na rede de saúde pública. Por isso, com base no pensamento de autores como Agamben, Guattari, Szasz e Rorty, discutem-se dilemas teóricos e práticos, técnicos e éticos do diagnóstico de transtornos mentais relacionados ao trabalho, destacam-se os riscos e perigos da tendência hegemônica centrada na abordagem epidemiológica e psicopatologizante, para lidar com as manifestações de sofrimento dos trabalhadores e, por fim, apontam-se alternativas para o desenvolvimento de estratégias institucionais que rompam com os dispositivos de patologização do sofrimento dos trabalhadores.

Vigilância em Saúde Mental e Trabalho no Brasil: características, dificuldades e desafios

“…Daldon and Lancman 23 confront the development of the VISAT, incorporating the acting, conscious worker with the current panorama of limitation of material and human resources, and of little investment in technical training, showing that the strategy of adding this actor to the Surveillance process is still a work in progress. However, it is worth stressing that the active participation of the workers as a crucial point for the development of the VISAT is an aspect highlighted by practically all the authors that produce research on this subject 17,21,24,25 .…”

“…Furthermore, tied to this diffuse tangle of actions, the predominant models of care in the VISAT actions in Mental Health are based on medical, outpatient perspectives, of a curative character and therefore reductionist [19][20][21][22][23][24][25] , clashing with the comprehensive conceptions of the psychosocial model defended in the Organic Health Law (Lei Orgânica de Saúde). Daldon and Lancman 23 stress the need for the decentralization of services as essential to the VISAT strategies, giving emphasis to the role of Primary Care and to the Community Health Agents as an alternative of first contact for the SUS service, in worker health as well as in mental health and work.…”

Theoretical-practical evidence in the prevention and promotion of workers’ mental health

“…On Table 4 , we descriptively analyze the percentage of articles per theoretical contribution; 35.7% (n = 5) approached “workers’ health surveillance”. 18 , 19 , 21 , 22 , 24 On the other hand, the less frequently observed theoretical contribution was “theoretical-methodological critical appraisal of work-related mental health”, 20 with only 7.1% of prevalence (n = 1); this was the only foreign study included in this review.…”

“…Table 5 shows a descriptive analysis of the percentage of methodological tools used in the investigation of research on occupational mental health. The result showed a bigger emphasis on the use of interviews, 14 , 18 , 23 , 25 - 27 all of which were semi-structured, with 42.9% (n = 6) of the studies, and document analysis of directives, legislation, medical records, and social security data, 16 , 17 , 19 , 20 , 21 , 24 with 35.7% of the studies (n = 5). The least frequently used methods were participant observation and focus group, 15 both in 7.1 % (n = 1).…”

“…The intersection between mental health and workers’ health is considered, in some of the analyzed studies, in view of the workers’ health surveillance approach, which was used by 35.7% (n = 5) of the retrieved studies, as shown in the previous section. Leão & Brant 19 state that the mission of workers’ health surveillance is to identify and intervene with determinants and conditioning factors of the mental health of workers” 20 (p. 1272). Workers’ health surveillance is defined by these authors as a collection of actions that influence the suffering of workers at distinct levels and as a key component of the National Health Surveillance System (Sistema Nacional de Vigilância em Saúde, SNVS), which is responsible for an articulate group of actions of health promotion and morbidity and mortality reduction among the worker population by Araújo et al 21 …”