Saúde mental na atenção primária: a prática médica em foco

Abstract

Primary Health Care (PHC) has emerged as a way to face the growing demand in mental health and, in this context, medical practice needs to correspond to this reality, distancing itself from mere medicalization and approaching approaches that promote a comprehensive and shared care. Therefore, the present study aimed to analyze medical practice when faced with cases of mental health in the population from the perspective of the physician who works in the PHC in a city in the state Alagoas, Brazil. This was a qualitative study, developed from an exploratory approach. The population consisted of five physicians, intentionally selected by the criterion of convenience, characterized by their performance in PHC, attending mental health cases in their respective family health units, belonging to a city in Alagoas, in the 5th health region. The data was collected/produced by means of a semi-structured interview script - prepared specifically for this purpose of the research. The interviews were conducted individually, at a pre-scheduled time and place, in face-to-face and/or virtual mode given the need to adapt to the covid-19 pandemic scenario. The data produced was treated using content thematic analysis. As for the results, they point to a medical practice in mental health oriented by the biomedical model, with emphasis on the use of the medication approach in detriment of other therapeutic conducts. For the participants, mental health care in PHC has a deficit character, marked by a feeling of isolation and insecurity, considering the incipient support of the care network, the multiprofessional and interdisciplinary work, as well as the existence of a reference and counter-reference system marked by deficiencies and lack of dialogue between the PHC physicians and the specialist, not meeting the demands and expectations in mental health cases. Furthermore, for the participants, their training process in mental health valued the hospital setting, with underutilization of the spaces in PHC. Guided by the results of the study, an educational product was developed, an interactive guide, to assist the medical professional practice, regarding the care of patients in mental distress in PHC. The methodological basis of the educational product followed the principles of the CTM3 method (term in Portuguese for product design, theoretical framework, methodological framework). At the end of the study, it is concluded that medical practice in mental health in PHC still retains characteristics of the biomedical model, having difficulties to implement the principles and concepts of psychosocial care, although its importance is recognized, as well as the need for transformation of the performance. Thus, it is expected that the findings allow the expansion of the discussion about medical practice, in order to propose advances and improvements in mental health care in PHC. In the same way, it is hoped that the proposed educational product can help medical professionals to be sensitized to work in PHC in the mental health field, in order to recognize the network of care in which they are inserted, and which they can use, so as to expand their work, bringing to their practice other forms and tools of care.