Utilização e custo de um serviço público de atenção psicossocial infantojuvenil

Abstract

Mental health care involves not only welcoming those who need it, but also the entire strategy that involves the functioning of services, including economic assessments that include estimates of the cost of the resources needed for their functioning. To identify the use and financially estimate the cost of mental health care for children and adolescents treated at the Center for Psychosocial Care for Children and Adolescents (CAPSi) in Maceió. This is a study with a quantitative, retrospective approach, based on health cost assessment using primary data, delimited from the perspective of a public health service provider, within a three-month time horizon corresponding to July, August and September 2019, with direct costs being identified considering the measurement by measures of central tendency according to the use of the users of the chosen service, using the bottom-up approach to cost valuation. The participants in this study comprise three different groups: companions of service users, CAPSi professionals and SMS professionals from Maceió; that converge to provide information distinct from a single research instrument: the Sociodemographic and Use and Service Costs Inventory (ISDUCS). Thus, for descriptive analysis, absolute and relative frequencies, measures of central tendency, were used. Linear Bivariate Analysis was performed and also considering the significance of p value <0,05 and all tests were applied with 95% confidence. In addition, this study was approved by the Research Ethics Committee (CEP) of UFAL, according to the Consolidated Authorization Opinion under number 3,566,665. Individual consultations and therapeutic workshops totaled 68.1% of all procedures offered to the 726 patients who used this service, during the period studied. These users were mostly adolescents (60.9%), male (63.4%), who had been attending the community health service for over 1 year (78.8%), mainly due to Externalizing Disorders (29.1 %) and Autism (23.8%), used psychotropic drugs (93.4%) with greater use of antipsychotics (63.1%). They were accompanied by women (90.1%), generally the mothers (66.7 %%), without employment (75.2%), low education (64.5%), some also with mental disorders (28 , 4%) and using psychiatric drugs (21.3%). Most of the families came from the V Health District of Maceió (33.5%), were surviving on up to 1 minimum wage (58.9%), usually with access to government social benefits (31.1%). Approximately R $ 233,925.44 is spent per month at CAPSi, with most of it earmarked for payroll (79.9%). The average cost of annual care per user is estimated: R$ 1501.86 in Individual Monitoring and R$ 1657.58 in Therapeutic Program. Predictors of this cost: diagnosis and care offered, length of service, family income, responsible person's mental illness. The clinical and sociodemographic characteristics of the demand and the direction of the care offered directly imply the public cost of mental health for children and adolescents.