Construção e desenvolvimento de indicadores de saúde mental: um estudo de caso
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Data
2024-06-07
Autores
De Rossi, Aline Fernandes [UNIFESP]
Orientadores
Furtado, Juarez Pereira [UNIFESP]
Tipo
Dissertação de mestrado
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Esta pesquisa teve como objetivo analisar o percurso de construção e desenvolvimento de indicadores de Saúde Mental em Centros de Atenção Psicossocial (CAPS) na zona sul da cidade de São Paulo. O campo da atenção psicossocial no Brasil é marcado por disputas importantes na construção cotidiana da política pública nacional de Saúde Mental, sendo que, ao longo dos últimos 23 anos da Lei Federal 10.216, modelos substitutivos como os CAPS têm sido implantados como equipamentos estratégicos da Rede de Atenção Psicossocial (RAPS). Dessa forma, compartilhamos das referências que apontam que processos avaliativos poderiam superar a comparação de serviços substitutivos com serviços hospitalocêntricos, de acordo com a mudança assistencial na lógica de cuidado. Aponta-se, ainda, que o uso de indicadores em Saúde Mental é mais restrito quando comparado às outras áreas da saúde como a Atenção Primária e a Hospitalar. O processo metodológico da pesquisa foi qualitativo de caráter exploratório e do tipo estudo de caso, captando a experiência de um fazer por meio da observação participante. Realizou-se consulta às fontes documentais produzidas nos CAPS e em documentos técnicos oficiais. Os dados foram analisados sob os referenciais teóricos da avaliação, da reabilitação psicossocial e da cogestão. Como resultado, produzimos narrativas sobre a experiência de construção de indicadores em duas fases: a primeira, iniciada em 2020 por um grupo formado por representantes do Colegiado Local de cada CAPS, mostra o desenho de indicadores comuns e específicos de cada serviço. A segunda, iniciada em 2022 por diferentes atores, focou na elaboração de um indicador de desfecho – nomeado como indicador de reabilitação psicossocial. Discutimos a participação de trabalhadores da assistência na produção da gestão compartilhada e na circulação de saberes, apontando aproximações e limites da cogestão. Concluímos que, no cenário deste estudo de caso, houve a tentativa de utilizar indicadores como métricas que encerram em si a interpretação de uma realidade, demonstrando uma lógica de gestão direcionada aos resultados e ao desempenho. Contudo, entendemos que houve um esforço em operacionalizar conceitos a partir das discussões sobre atenção psicossocial entre as equipes e, nesse sentido, existem perspectivas possíveis no campo da avaliação para a construção de elementos que forneçam condições de revisar e fortalecer a assistência em Saúde Mental no SUS.
The goal of this paper is to analyze the path of construction and development of Mental Health Indicators in Psychosocial Care Centers (CAPS) in the South Zone of São Paulo City. The field of psychosocial care in Brazil is identified by important debates about the daily construction of national public Mental Health Policy, and over the last 23 years since the Federal Law 10,216, substitute models such as CAPS have been implemented as strategic component of the Psychosocial Care Network (RAPS). Consequently, we share the references indicating that evaluation processes could overcome the comparison of substitute services with hospital centered services, based on the change in care logic. It is also worth noting that the use of indicators in Mental Health is more restricted when compared to other Health-related areas, as Primary Care and Healthcare. The research methodology was qualitative, exploratory in nature, and based on a case study, capturing the experience through participant observation. Documentary sources produced in CAPS and official technical documents were consulted. The data were analyzed using the theoretical frameworks of assessment, psychosocial rehabilitation, and co-management. As a result, narratives were produced about the experience of building indicators in two phases: the first, beginning in 2020 by a group of representatives from the Local Board of each CAPS, details the design of common and specific indicators for each service. The second, beginning in 2022 by different participants, focused on the development of an outcome indicator – named “psychosocial rehabilitation indicator”. The participation of healthcare workers in the creation of shared management and the exchange of knowledge was debated, highlighting similarities and co-management limits. In the scenario of this case study, the conclusion reached was that there was an attempt to use indicators as metrics that determine in themselves a reality interpretation, indicating a management logic aimed at results and performance. However, it is understood that an effort was made to operationalize concepts based on psychosocial care discussions between teams and, in that regard, there are possible perspectives in the field of evaluation for the construction of components able to provide conditions for reviewing and strengthening Mental Health care in the Brazilian Unified Health System (SUS).
The goal of this paper is to analyze the path of construction and development of Mental Health Indicators in Psychosocial Care Centers (CAPS) in the South Zone of São Paulo City. The field of psychosocial care in Brazil is identified by important debates about the daily construction of national public Mental Health Policy, and over the last 23 years since the Federal Law 10,216, substitute models such as CAPS have been implemented as strategic component of the Psychosocial Care Network (RAPS). Consequently, we share the references indicating that evaluation processes could overcome the comparison of substitute services with hospital centered services, based on the change in care logic. It is also worth noting that the use of indicators in Mental Health is more restricted when compared to other Health-related areas, as Primary Care and Healthcare. The research methodology was qualitative, exploratory in nature, and based on a case study, capturing the experience through participant observation. Documentary sources produced in CAPS and official technical documents were consulted. The data were analyzed using the theoretical frameworks of assessment, psychosocial rehabilitation, and co-management. As a result, narratives were produced about the experience of building indicators in two phases: the first, beginning in 2020 by a group of representatives from the Local Board of each CAPS, details the design of common and specific indicators for each service. The second, beginning in 2022 by different participants, focused on the development of an outcome indicator – named “psychosocial rehabilitation indicator”. The participation of healthcare workers in the creation of shared management and the exchange of knowledge was debated, highlighting similarities and co-management limits. In the scenario of this case study, the conclusion reached was that there was an attempt to use indicators as metrics that determine in themselves a reality interpretation, indicating a management logic aimed at results and performance. However, it is understood that an effort was made to operationalize concepts based on psychosocial care discussions between teams and, in that regard, there are possible perspectives in the field of evaluation for the construction of components able to provide conditions for reviewing and strengthening Mental Health care in the Brazilian Unified Health System (SUS).
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Citação
DE ROSSI, Aline Fernandes. Construção e desenvolvimento de indicadores de saúde mental: um estudo de caso. 2024. 145 f. Dissertação (Mestrado Interdisciplinar em Ciências da Saúde) - Universidade Federal de São Paulo, Instituto de Saúde e Sociedade, Santos, 2024.