A atenção psicossocial no Sistema Único de Saúde (SUS) e as ações de matriciamento em saúde mental: análise a partir da organização dos serviços de saúde em municípios alagoanos no período de 2016 a 2022

Abstract

This thesis aimed to analyze the impacts of the organization of health services within the SUS (Unified Health System) on psychosocial care for mental health matrix support actions in Alagoas municipalities from 2016 to 2022, within the context of deepening neoliberalism. Initially, exploratory research was conducted to build the state of the art in the Virtual Health Library, SciELO, Dialnet, CAPES Journals, Thesis and Dissertation Catalog, PubMed, and Cochrane. A qualitative approach and theoretical-methodological assumptions of historical and dialectical materialism were adopted. For foundation and situational analysis, reference books were used alongside documents such as ordinances, decrees, state and municipal health plans, health policies in public agencies, and official government websites; and field research approved by the CEP/UFAL under protocol 6485.9922.0.0000.5013. In the first stage of the field research, 120 professionals participated, including 67 municipal coordinators/responsible for primary care and 53 for mental health from 89 of the 100 Alagoas municipalities with CAPS (Psychosocial Care Centers), ENASF-AP (National Policy for the Support of Primary Care), or EMulti. In the second stage, 10 coordinators participated, comprising 6 from CAPS and 4 from ENASF-AP, from 5 Alagoas municipalities. To gather information, questionnaires and focus groups were utilized, consolidating data into spreadsheets, tables, graphs, and transcribed reports, which, with the aid of Bardin's thematic analysis, were organized into three thematic sections: a) Health policies in monopolistic capitalism and SUS in Brazil; b) Matrix support as a strategy for coordination between health services; and c) The organization of work in health services and its execution in multiprofessional teams: potentialities and challenges for matrix support. The initial discussion addressed the socioeconomic and political changes of monopolistic capitalism on the dynamics of health services, influenced by social issues, state intervention, and social policies. The next section deepened the concept of matrix support as a strategy for coordination between mental health services and primary care in the territory, according to definitions of Brazilian health policy guided by SUS, highlighting regulatory changes over time, including in the Alagoas context where matrix support is implemented in 63.72% of municipalities despite the lack of local regulations, emphasizing the debate on obstacles and challenges to implementation. The final thematic section revisited general and conceptual understandings of work, and work in health services until the establishment of multiprofessional health teams in SUS, pointing out the challenges of matrix support in Alagoas municipalities based on the organization of work and execution of matrix actions, addressing issues related to professional training and experience, forms and criteria for professional hiring based on political indications, job precarization, management priorities, profiles of hired professionals, and superficial use of some tools. The thesis argues that political reformulations are possible and necessary for the organization of SUS, emphasizing the need to define norms for hiring professionals and continuity of work in care, ensuring that the permanence of workers is not conditioned by political indications or changes in municipal management so that mental health policy can be effectively implemented with critical reflection on the forms and strategies to confront job precarization in the neoliberal context.