Reabilitação psicossocial: concepções e práticas na construção de uma rede possível
Data
2018-08-29
Autores
Freitas, Valeria Nancy de 
Orientadores
Lima, Laura Camara
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Esta pesquisa teve como objetivo problematizar as concepções e práticas em Reabilitação Psicossocial adotadas pelos profissionais atuantes na Rede de Atenção Psicossocial (RAPS) de um município da Baixada Santista. Não obstante a construção histórico-conceitual do conceito de Reabilitação Psicossocial, a partir de 2011 ele passa a configurar também como um dos componentes da RAPS, cujos objetivos incluem a promoção de ações de caráter intersetorial destinadas à inserção produtiva, formação e qualificação para o trabalho, garantia da melhoria das condições concretas de vida, ampliação da autonomia, contratualidade e inclusão social das pessoas em sofrimento mental e com necessidades decorrentes do uso de crack, álcool e outras drogas, e de seus familiares. No âmbito dessa pesquisa o termo agregará ainda a menção a um equipamento da RAPS que se responsabiliza diretamente pelo desenvolvimento de tais ações, a Seção de Reabilitação Psicossocial (SERP). O estudo teve caráter qualitativo, estando ancorado na perspectiva metodológica da pesquisa intervenção. Essa escolha foi uma estratégia com vistas a criar condições para encontros e devires, e assim provocar novas reflexões, desnaturalizando saberes e desestabilizando lugares confortáveis. Foram convidados a participar da pesquisa profissionais da RAPS que trabalham nos cinco Centros de Atenção Psicossocial (CAPS) de referência territorial para adultos, no CAPS de referência para problemas relacionados ao uso de Álcool e outras Drogas (CAPS ad) e na SERP. Os instrumentos para produção dos dados foram: grupos focais coordenados pela pesquisadora e registros em diário de campo redigidos por ela. A fundamentação teórica provém da análise institucional e de conceitos definidos por autores de referência na área. Foi realizado um grupo focal para cada um dos CAPS, com presença de todos profissionais que se portaram voluntários e de um profissional da SERP que aceitou participar. O local escolhido pelas equipes para a realização do grupo foi uma sala dentro dos CAPS, geralmente a sala de reunião da equipe. As falas dos participantes foram registradas, transcritas na íntegra e submetidas a análises temáticas, organizadas em função de eixos que se destacaram na leitura sistemática e que foram considerados importantes para a análise do tema. Os diários de campo trouxeram dados complementares que serviram para incrementar a compreensão do que foi trazido nos grupos e para elaborar a análise da implicação. O que se percebeu na prática é que o processo de reabilitação é multifacetado, mobilizado ou atravessado pelas diferentes concepções de loucura e mesmo de reabilitação que os profissionais têm, pelas dinâmicas político-institucionais e pelas diferentes (com) vivências que experimentam nos serviços diante dos desafios diários que o trabalho em saúde mental impõe. Os resultados apontam para a necessidade de aprofundar a discussão sobre o que é reabilitação junto aos profissionais da RAPS; provocar uma ressignificação coletiva das práticas e concepções que envolvam a todos, e problematize o lugar da SERP nesse contexto. A viabilização dos grupos focais, envolvendo profissionais de todos os CAPS e da SERP apontou um caminho possível para o fortalecimento da RAPS através da participação e corresponsabilização de todos que deles participaram. Corresponsabilização essa que não significa apenas assumir os problemas coletivamente, mas também, buscar a potência coletiva para superar as dificuldades. A análise temática permitiu identificar os seguintes temas: Reabilitação, Cuidado, Equipe/Profissional e Rede. Para qualquer um dos quatro temas analisados, os impactos, tanto negativos como positivos, repercutem sempre nos usuários. As diferentes concepções sobre reabilitação e as práticas adotadas denotam, muitas vezes, as forças manicomiais que disputam com a ReformaPsiquiátrica o tipo de cuidado que será ofertado ao usuário, desafio esse que atravessa todos os outros temas estudados, em um movimento de avanços e retrocessos. A análise da implicação identificou que todo o movimento da pesquisadora de olhar para si, para sua relação com a SERP, com os outros serviços, para os usuários e para a pesquisa serviu para perceber que nunca somos neutros. Foi preciso manter a atenção voltada para o exercício de uma postura ético-política, se colocando em análise, e deixando de lado a tendência à arrogância acadêmica, de forma a se permitir desconstruir certezas e poder falar honestamente do duplo lugar de profissional da RAPS e de pesquisadora. No entanto, entendemos que essa análise não esgota todos os aspectos da implicação, devido ao forte vínculo institucional existente. O estudo indica que a construção de um novo pensar/fazer reabilitação na RAPS não se constrói apenas com teorias, mas também com afetos, trocas e bons encontros.
The goal of this research is to problematize the conceptions and practices of psychosocial rehabilitation adopted by professionals that act in the Psychosocial Attention Network (RAPS) of a city in Baixada Santista. Regardless the historicalconceptual psychosocial rehabilitation concept construction, from 2011 it also starts to configure as one of RAPS components, whose goals include the promotion of intersectoral character destined to productive inclusion, formation and qualification for the work and guarantee of improvement of the concrete life standard, autonomy growth, contractuality and social inclusion of people in mental suffering and in need due to the use of crack, alcohol and other substances, and their familiars. In this research, the term will gather an attention point that takes responsibility for the development of such actions, the Section of Psychosocial Rehabilitation (SERP). The study’s had qualitative character in it’s methodological perspective of interventionresearch. This choice was a strategy with insights of creating conditions to meetings and, thus, provoke new reflections, denaturalizing knowledgements and destabilizing comfortable places, besides contributing to indicatives of the need of new and further investigations. RAPS professionals that work on five territorial reference for adults Psychosocial Attention Centers (CAPS) were invited to participate of the research, in addition to the workers of alcohol-and-other-drugs-related-problems-reference CAPS and SERP. The utilized data production means were: focal groups coordinated by the researcher and field diaries for her drawn up. The theorical grounding comes from the institutional analysis and from well-defined concepts by reference-authors of the area. For each one of the CAPS’s it was realized a focal group, with the presence of all volunteer professionals and one SERP professional that has accepted to participate. The speeches of the participants were registered, transcripted integrally and submitted to thematical analysis, organized in function of four segments that stood out in the systematic lecture and were deemed important to the theme analysis: rehabilitation, nursing, team/professional and networking. The field diaries brought complementary data that increased the comprehension of what’s been brought in the groups and to elaborate the implication analysis. What can be seen in practice is that the rehabilitation process has many faces, mobilized or crossed by different conceptions of madness and even of rehabilitation that the professional has, through politicalinstitutional dynamics and the different acquaintanceships they experience on the services before the daily challenges that the work in mental health imposes. The results point the necessity to deepen the discussion about what rehabilitation is among the RAPS professionals; inducing a collective resignification of the practices and previous conceptions that co-charges everyone and criticize the SERP placement in this context. The focal groups viabilization, involving professionals of the whole CAPS and SERP points a possible path towards the strengthening of RAPS through everyone's participation and co-charging. Co-charging does not only mean to take on the problems as a collective, but also, search for collective potential. The themed analysis permitted to identify the following themes: Rehabilitation, Nursing, Team/Professional and Networking. For any of the four analyzed themes, the impacts - whereas negative as positive - always rebounds on our users. The different conceptions of rehabilitation and adopted methods often betokens the asylum influences that disputes with the Psychiatric Reform movement the type of caring that will be offered to the user, challenge which crosses all the other studied themes, in a movement of advances and regressions. It was needed to keep the attention towards the exercise of an ethicalpolitical positioning, putting ourserlves under analysis, and leaving aside the tendency to academic arrogance, in a way of allowing ourserlves to deconstruct certainties and being able to speak honestly from the double-placement of both RAPS professional and researcher. However, it’s understood that this analysis does not deplete all aspects of the implication. We consider and understand the impossibility of parsing our full implication, due to the strong institutional bond existing. The study concludes that the construct of a new thinking/doing of rehabilitation is not built only on theory but also with affection, exchanges and good encounters.
The goal of this research is to problematize the conceptions and practices of psychosocial rehabilitation adopted by professionals that act in the Psychosocial Attention Network (RAPS) of a city in Baixada Santista. Regardless the historicalconceptual psychosocial rehabilitation concept construction, from 2011 it also starts to configure as one of RAPS components, whose goals include the promotion of intersectoral character destined to productive inclusion, formation and qualification for the work and guarantee of improvement of the concrete life standard, autonomy growth, contractuality and social inclusion of people in mental suffering and in need due to the use of crack, alcohol and other substances, and their familiars. In this research, the term will gather an attention point that takes responsibility for the development of such actions, the Section of Psychosocial Rehabilitation (SERP). The study’s had qualitative character in it’s methodological perspective of interventionresearch. This choice was a strategy with insights of creating conditions to meetings and, thus, provoke new reflections, denaturalizing knowledgements and destabilizing comfortable places, besides contributing to indicatives of the need of new and further investigations. RAPS professionals that work on five territorial reference for adults Psychosocial Attention Centers (CAPS) were invited to participate of the research, in addition to the workers of alcohol-and-other-drugs-related-problems-reference CAPS and SERP. The utilized data production means were: focal groups coordinated by the researcher and field diaries for her drawn up. The theorical grounding comes from the institutional analysis and from well-defined concepts by reference-authors of the area. For each one of the CAPS’s it was realized a focal group, with the presence of all volunteer professionals and one SERP professional that has accepted to participate. The speeches of the participants were registered, transcripted integrally and submitted to thematical analysis, organized in function of four segments that stood out in the systematic lecture and were deemed important to the theme analysis: rehabilitation, nursing, team/professional and networking. The field diaries brought complementary data that increased the comprehension of what’s been brought in the groups and to elaborate the implication analysis. What can be seen in practice is that the rehabilitation process has many faces, mobilized or crossed by different conceptions of madness and even of rehabilitation that the professional has, through politicalinstitutional dynamics and the different acquaintanceships they experience on the services before the daily challenges that the work in mental health imposes. The results point the necessity to deepen the discussion about what rehabilitation is among the RAPS professionals; inducing a collective resignification of the practices and previous conceptions that co-charges everyone and criticize the SERP placement in this context. The focal groups viabilization, involving professionals of the whole CAPS and SERP points a possible path towards the strengthening of RAPS through everyone's participation and co-charging. Co-charging does not only mean to take on the problems as a collective, but also, search for collective potential. The themed analysis permitted to identify the following themes: Rehabilitation, Nursing, Team/Professional and Networking. For any of the four analyzed themes, the impacts - whereas negative as positive - always rebounds on our users. The different conceptions of rehabilitation and adopted methods often betokens the asylum influences that disputes with the Psychiatric Reform movement the type of caring that will be offered to the user, challenge which crosses all the other studied themes, in a movement of advances and regressions. It was needed to keep the attention towards the exercise of an ethicalpolitical positioning, putting ourserlves under analysis, and leaving aside the tendency to academic arrogance, in a way of allowing ourserlves to deconstruct certainties and being able to speak honestly from the double-placement of both RAPS professional and researcher. However, it’s understood that this analysis does not deplete all aspects of the implication. We consider and understand the impossibility of parsing our full implication, due to the strong institutional bond existing. The study concludes that the construct of a new thinking/doing of rehabilitation is not built only on theory but also with affection, exchanges and good encounters.