Discursos, saberes e práticas na reforma psiquiátrica brasileira e suas implicações na saúde mental dos(as) trabalhadores(as) dos serviços substitutivos
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Data
2015-02-27
Autores
Silva, João de Deus Gomes da [UNIFESP]
Orientadores
Silva, Geovani Gurgel Aciole da [UNIFESP]
Tipo
Tese de doutorado
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Introdução: Num momento em que diferentes práticas não manicomiais foram testadas e validadas e diferentes dispositivos de base comunitária foram postos em funcionamento, quando novos saberes foram evidenciados, uma produção discursiva conservadora ressurge colocando em risco os avanços conquistados pelo projeto de reforma psiquiátrica brasileira ao longo das duas últimas décadas. Trata-se de uma disputa política e ideológica que vem ofuscando o potencial transformador da clínica (laço social) com a entrada de um discurso gerencialista (modelo econômico) na gestão do cuidado configurando um estado de crise. Objetivos: Neste contexto, o presente trabalho se propõem a analisar a dinâmica das relações entre os discursos, saberes e práticas da reforma psiquiátrica brasileira e suas implicações na saúde mental dos (das) trabalhadores (as) dos serviços substitutivos. Metodologia: Estudo de caso desenvolvido num CAPS que integra a rede de Saúde Mental de Campinas/SP através do convênio de cogestão estabelecido com o Serviço de Saúde Cândido Ferreira". Foram utilizadas como estratégias de aproximação com o campo, observação do serviço, realização de rodas de discussão, entrevistas individuais que foram gravadas, transcritas e analisadas à luz das categorias teóricas da Psicodinâmica do Trabalho. Resultados: A reorganização do trabalho em saúde mental no contexto da Reforma Psiquiátrica favoreceu, por um lado, a construção de outros enunciados discursivos na conformação das trajetórias profissionais dos (as) trabalhadores (as), por outro, os constrangimentos com os quais estes (as) profissionais são confrontados cotidianamente, no âmbito da gestão, levando a transgredir as normas e subverter as regras para poder realizar o trabalho. Estas ambivalências incidem negativamente na cooperação, no reconhecimento e na empatia profissional e, consequentemente, na produção do laço social necessário a integração do louco e da loucura na sociedade. Conclusão. A transformação dos saberes e das práticas profissionais nos serviços de saúde mental não tem sido suficiente para superar os efeitos do modelo manicomial, sendo necessário avançar além da discussão ideologizante do cuidado e da perspectiva gerencialista para retomar a centralidade do trabalho (real) em favor da construção do laço social.
Introduction: With various non-manicomial practices tested and validated, different community-based services inaugurated and new insights being established, a neo-conservative discourse emerges in Brazil, which threatens the progress that has been made over the past two decades through the project of the Brazilian Psychiatric Reform. At its a political and ideological narrative that overshadows the transformative potential of clinical psychology (social role) by endorsing a manageralist approach (economic model) to health care, which finds itself confronted with a worsening crisis. Objectives: Against this background we seek to analyze the discourse, knowledge and practices of the Brazilian Psychiatric Reform, by combining different methods and viewpoints, and evaluate the consequences and effects on the mental health and the wellbeing of the professionals working in substitutive mental health care services. Methodology: This thesis comprises a qualitative single-case study executed in a Center of Psycho-Social Attention (CAPS) in Campinas (São Paulo State), which, based on an agreement with the Health Service Cândido Ferreira, integrates the local network of mental health care services. For the data collection several strategies were employed, including focus group interviews through organized group discussions, individual interviews between the researchers and the professional, personal observation of the services, participation at local events related to the local crisis in the health care services. The taped recordings were first broadly transcribed, submitted to a contextualized analysis and integrated into the thesis. Results: could be shown that the reorganization of mental health care services during the Psychiatric Reform provided an incentive for the construction of alternative modes of discourse that influence the professional trajectory of mental health care professionals. On the other hand, when confronted with the constraints imposed by the organization of the work process, the staff of the substitutive services is led to transgress the norms, bend the rules in order to complete their tasks. These ambivalences have a negative impact on the formation of social bonds, necessary to remove madness from its status of exclusion and integrate it into society. Conclusions: It generally appears that the transformation of knowledge and practices brought about by the Psychiatric Reform has not been entirely successful in overcoming the negative effects associated with the manicomial model of mental health care services. Because of this, the need makes itself felt to go beyond an ideologicalizing narrative of care-taking and a purely manageralist approach and to return to the central position of ?real? work in the construction of a social place.
Introduction: With various non-manicomial practices tested and validated, different community-based services inaugurated and new insights being established, a neo-conservative discourse emerges in Brazil, which threatens the progress that has been made over the past two decades through the project of the Brazilian Psychiatric Reform. At its a political and ideological narrative that overshadows the transformative potential of clinical psychology (social role) by endorsing a manageralist approach (economic model) to health care, which finds itself confronted with a worsening crisis. Objectives: Against this background we seek to analyze the discourse, knowledge and practices of the Brazilian Psychiatric Reform, by combining different methods and viewpoints, and evaluate the consequences and effects on the mental health and the wellbeing of the professionals working in substitutive mental health care services. Methodology: This thesis comprises a qualitative single-case study executed in a Center of Psycho-Social Attention (CAPS) in Campinas (São Paulo State), which, based on an agreement with the Health Service Cândido Ferreira, integrates the local network of mental health care services. For the data collection several strategies were employed, including focus group interviews through organized group discussions, individual interviews between the researchers and the professional, personal observation of the services, participation at local events related to the local crisis in the health care services. The taped recordings were first broadly transcribed, submitted to a contextualized analysis and integrated into the thesis. Results: could be shown that the reorganization of mental health care services during the Psychiatric Reform provided an incentive for the construction of alternative modes of discourse that influence the professional trajectory of mental health care professionals. On the other hand, when confronted with the constraints imposed by the organization of the work process, the staff of the substitutive services is led to transgress the norms, bend the rules in order to complete their tasks. These ambivalences have a negative impact on the formation of social bonds, necessary to remove madness from its status of exclusion and integrate it into society. Conclusions: It generally appears that the transformation of knowledge and practices brought about by the Psychiatric Reform has not been entirely successful in overcoming the negative effects associated with the manicomial model of mental health care services. Because of this, the need makes itself felt to go beyond an ideologicalizing narrative of care-taking and a purely manageralist approach and to return to the central position of ?real? work in the construction of a social place.
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Citação
SILVA, João de Deus Gomes da. Discursos, saberes e práticas na reforma psiquiátrica brasileira e suas implicações na saúde mental dos(as) trabalhadores(as) dos serviços substitutivos. 2015. 201 f. Tese (Doutorado em Saúde Coletiva) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.