Crianças e adolescentes na agenda política da saúde mental brasileira: inclusão tardia, desafios atuais

Abstract

Com base no argumento de que até o final do século XX não era possível afirmar a existência, no contexto brasileiro, de uma política de saúde mental para crianças e adolescentes (SMCA), o artigo analisa os possíveis determinantes da inclusão tardia deste tema na agenda política da saúde mental brasileira. Como parte desta análise, identifica e descreve as duas ações prioritárias escolhidas pelo Sistema Único de Saúde (SUS), no começo do século XXI, para iniciar o processo de construção de redes de cuidado para SMCA: a implantação de Centros de Atenção Psicossocial Infantil e Juvenil (CAPSi) e o desenvolvimento de estratégias para articulação intersetorial da saúde mental com setores historicamente envolvidos na assistência à infância e adolescência, como educação, assistência social, justiça/direitos. A criação dos CAPSi e o direcionamento intersetorial são aqui consideradas ações-chave para alavancar a montagem de uma rede pública ampliada de atenção em SMCA, de base territorial, capaz de acolher as diferentes ordens de problemas envolvidos na SMCA e ampliar o acesso ao cuidado.

Atenção básica e cuidado colaborativo na atenção psicossocial de crianças e adolescentes: facilitadores e barreiras

“…In Brazil, recent studies have confirmed the importance of PHC, with emphasis on ESF, in the SMCA network, mainly to increase access 5,9 , also highlighting CAPSi's strategic role in the validation and organization of the territorial demand 1,10 . Mental health actions in PHC, integrating an expanded network, can reduce unnecessary referrals and increase user and family adherence to treatment.…”

“…Matrix-based strategies and other forms of collaborative care were progressively gaining prominence as means of integrating mental health in PHC, within the scope of the Brazilian psychiatric reform 14 . Despite the relevance of SMCA-PHC articulation, national studies have pointed out a set of deadlocks for its consolidation, among which the following stand out: a) PHC professionals lack of SMCA training, compromising the reception of problems, the possible interventions and qualified referrals 15 ; b) scarce information about existing services in the territory, work functions and processes, overburdening users and family members in the independent search for care 15 ; c) lack of knowledge of the mandate of each sector, including SMCA, weakening the best use of resources 10 . The potentialities and challenges registered suggest the need to advance and evaluate SMCA-PHC articulation experiences.…”

Perceptions of the Process of Work in a Psychosocial Care Center for Children and Youth

“…When Studies (Couto, 2012;Lima, 2014) suggest that the application of psychiatric reform principles to mental health care in children and adolescents occurred much too slowly in Brazil. Additionally, according to Couto (2012), pediatric mental health was always second to adult mental health with regards to the production of care.…”

“…Additionally, according to Couto (2012), pediatric mental health was always second to adult mental health with regards to the production of care. Lima (2014) suggests that this reinforces the idea of pediatric mental illness as a disability.…”

“…Harm reduction strategies are also involved in cases involving the use of alcohol and other drugs. However, in addition to these strategies, pediatric mental health must also consider the particularities of the system surrounding the child or adolescent, and must include additional sectors in the production of care, such as basic health care, education, social work, as well as the justice and legal systems (Couto, 2012;Lima, 2014;Minist ry of Health, 2014). There is also the need to include the family in the treatment process, to use the appropriate language, and offer play-based interventions (Avellar & Bertollo, 2008;Guerra, 2005).…”