O apoio matricial em saúde mental: contribuições das vivências de trabalhadores e usuários de um CAPS III da cidade de Santos-SP
Data
2023-05-22
Autores
Augusto, Natassia Aparecida 
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
O cuidado via Apoio Matricial (AM) ou Matriciamento em Saúde Mental surge como proposta
de metodologia ou “novo arranjo” para a reorganização e gestão do trabalho em saúde,
modificando as práticas anteriormente realizadas (como a interconsulta e a referência e
contrarreferência) em uma forma que produz um cuidado compartilhado entre as equipes
multiprofissionais, na realização de uma clínica ampliada, centrada no usuário e suas demandas
reais, e estimulando o vínculo terapêutico entre profissionais e usuários envolvidos no cuidado
em saúde mental. O Apoio Matricial em Saúde Mental possibilita a articulação do cuidado em
rede, compartilhando entre Saúde Mental e Atenção Básica (AB), estratégias baseadas na
integralidade, bem como pautadas na territorialização dos serviços e diálogos possíveis deste
cuidado em saúde mental. No município de Santos, esse processo iniciou-se com discussões
sobre o tema entre os anos de 2012 e 2013, e sua implantação foi iniciada em meados dos anos
2013 e 2014, tendo sua construção na última década enfrentado muitos desafios pelos caminhos
da implantação. O objetivo desta pesquisa foi analisar as percepções dos profissionais e usuários
de um Centro de Atenção Psicossocial III (CAPS III) do munícipio de Santos-SP, relacionadas
às estratégias de cuidado realizadas no contexto do Apoio Matricial em Saúde Mental, na região
da Zona Noroeste do município de Santos e identificar as contribuições e potências destas ao
processo de Matriciamento. Realizou-se um estudo de abordagem qualitativa, utilizando
roteiros como guias aplicados em entrevistas e discussões em grupo. Os roteiros foram
compostos por questões disparadoras (perguntas abertas), para aplicação em entrevistas e
Grupos Focais, realizados com os profissionais que fazem parte da Equipe de Apoio Matricial
do CAPS ZNO, bem como usuários dos serviços de saúde. Foram realizados dois Grupos Focais,
separadamente, envolvendo os profissionais do CAPS ZNO e outros com os usuários do serviço
de Saúde Mental da região. A produção de dados contou também com registros em um diário
de campo (utilizado durante o processo), a fim de planear os detalhes e observações captadas
durante os processos da pesquisa, contribuindo assim para tornar a pesquisa viva nas impressões
de seus diversos momentos. Os dados foram analisados seguindo a técnica de Análise de
Conteúdo Temática, utilizando Laurence Bardin como referência, partindo inicialmente da
identificação de núcleos de sentido e da criação de categorias de análise. Durante o
acompanhamento do Apoio Matricial realizado na região da ZNO foi possível perceber que
após mais de uma década desde a implantação, mudanças e adaptações têm acontecido na
proposta que vem sendo desenvolvida no território. O processo indicou ter potencial para
desenvolver estratégias de cuidado em saúde mental, que poderiam ir além da oferta de
prescrição de medicamentos, porém com certa necessidade de aprimoramento das ações e olhar
para o processo, relacionado a efetiva corresponsabilização entre as equipes envolvidas no
acompanhamento dos casos, o que se distancia e diferencia da transferência desse cuidado a
apenas uma das equipes. Foi possível observar aproximações e distanciamentos entre as
percepções dos profissionais e usuários sobre o Apoio Matricial, o que permitiu uma reflexão
sobre a proposta para o Produto Técnico desta pesquisa.
Care in Mental Health Matrix Support emerges as a proposal for a methodology or "new arrangement" for the reorganization and management of work health care services, modifying beginning performed practices (such as interconsultation and referral and counter-referral) in a different way that produces a shared care between the multiprofessional teams, providing an expanded clinic practice, centered on health service users and their real demands, and stimulating the therapeutic bond between professionals and these users, involved in mental health care. Matrix Support in Mental Health enables the articulation in a network of care, sharing between Mental Health and Primary Care Health, strategies based on completeness of health care, as well as thinking on the territorialization of services and possible dialogues of this mental health care. In the city of Santos, this process began in mid-2013 and 2014 and its construction in the last decade encountered many challenges along the paths of implementation. In Santos city, this process began between 2011 and 2012, construction in the last decade faced many challenges along implementation. The objective of this research was to analyze the professionals and service users perceptions of a mental health services in the city of Santos-SP, related to health care strategies carried out in the context of Matrix Support in Mental Health, in the Northwest Zone region of this city, and to identify their contributions and potential of this process. It is a study with a qualitative approach, in which scripts were used as guides in interviews and group discussions. These scripts were formed by open questions, for application in interviews and Focus Groups, involving professionals who are part of the CAPS ZNO Matrix Support Team and users (patients) of the Mental Health service. The Focus Groups were conducted separately with each group of people mentioned above. This research also had records in a Diary (used during the Professional Master's process), with the objective of recording some important details during the processes, making the research alive with these impressions of the different moments. The work data were analyzed following the Thematic Content Analysis technique, using Laurence Bardin as a reference and it started with the identification of meaning parts in the text and the creation of analysis categories. During the follow-up of Matrix Support carried out in the ZNO region, it was possible to perceive that after more than a decade since its implementation, changes and adaptations have been happening in the proposal being developed in the territory. The process indicated potential to develop mental health care strategies that could go beyond the offer of prescription medication, however with a need for improvement of actions and looking at the process related to effective shared responsibility among the teams involved in the case follow-up, which is different from transferring this care to only one of the teams. It was possible to observe similarities and differences between the perceptions of professionals and users about Matrix Support, which allowed for reflection on the proposal for the Technical Product of this research.
Care in Mental Health Matrix Support emerges as a proposal for a methodology or "new arrangement" for the reorganization and management of work health care services, modifying beginning performed practices (such as interconsultation and referral and counter-referral) in a different way that produces a shared care between the multiprofessional teams, providing an expanded clinic practice, centered on health service users and their real demands, and stimulating the therapeutic bond between professionals and these users, involved in mental health care. Matrix Support in Mental Health enables the articulation in a network of care, sharing between Mental Health and Primary Care Health, strategies based on completeness of health care, as well as thinking on the territorialization of services and possible dialogues of this mental health care. In the city of Santos, this process began in mid-2013 and 2014 and its construction in the last decade encountered many challenges along the paths of implementation. In Santos city, this process began between 2011 and 2012, construction in the last decade faced many challenges along implementation. The objective of this research was to analyze the professionals and service users perceptions of a mental health services in the city of Santos-SP, related to health care strategies carried out in the context of Matrix Support in Mental Health, in the Northwest Zone region of this city, and to identify their contributions and potential of this process. It is a study with a qualitative approach, in which scripts were used as guides in interviews and group discussions. These scripts were formed by open questions, for application in interviews and Focus Groups, involving professionals who are part of the CAPS ZNO Matrix Support Team and users (patients) of the Mental Health service. The Focus Groups were conducted separately with each group of people mentioned above. This research also had records in a Diary (used during the Professional Master's process), with the objective of recording some important details during the processes, making the research alive with these impressions of the different moments. The work data were analyzed following the Thematic Content Analysis technique, using Laurence Bardin as a reference and it started with the identification of meaning parts in the text and the creation of analysis categories. During the follow-up of Matrix Support carried out in the ZNO region, it was possible to perceive that after more than a decade since its implementation, changes and adaptations have been happening in the proposal being developed in the territory. The process indicated potential to develop mental health care strategies that could go beyond the offer of prescription medication, however with a need for improvement of actions and looking at the process related to effective shared responsibility among the teams involved in the case follow-up, which is different from transferring this care to only one of the teams. It was possible to observe similarities and differences between the perceptions of professionals and users about Matrix Support, which allowed for reflection on the proposal for the Technical Product of this research.