A dimensão sociocultural da reforma psiquiátrica: articulando redes para a consolidação da estratégia de atenção psicossocial

This thesis aims to discuss on articulations that have been produced on the socio-cultural field in the Psychiatric Reform process and its pertinence to the streghtening of Psychosocial Care Strategy (EAPS) in Fortaleza/CE. Such interest has been justified by the need to promote not only the production of these networks, but also interfaces to enable strategies of support and sociability from the perspective of deinstitutionalization of madness. We were inspired by the cartography perspective of Deleuze e Guattari, and determined as objectives: 1) to discuss the complexity of Psychiatric Reform process and analyze the EAPS as a model for the current Mental Health policy in the country; 2) to map socio-cultural strategies connected to the CAPS network in the city, investigating experiences that already exist or may be constituted as everyday social support networks; 3) from that mapping to start, define and discuss some aspects that converge to the accomplishment for this new mental health paradigm, drawing a cartography of the issues and movements in progress. The mapping was carried out in 2009 and consisted of semi-structured interviews with the coordinators of the 14 existent CAPS and with some people connected to the Coordination of Mental Health. Besides, during the whole development of the study, we have taken part in public events that brought us clues on the connection between mental health and culture. From the survey produced, we defined three vectors for discussion (Art, Labour and Partnership with Social Movements) which have been highlighted as effective possibilities of intervention in the socio-cultural field of Psychiatric Reform in Fortaleza and reveal important paths on the fulfillment process of a new pattern of care. For each of these axes, we chose a field of empirical research (Projeto Arte e Saúde, COOPCAPS e MSMCBJ) in which we could better understand their strengths and difficulties, starting from open interviews with some of their actors and the production of a diary of sensations in 2010. We have seen that they are articulated with the proposal of EAPS, being part of the concerns to the National Mental Health Policy and also the municipal administration. However, we have noticed to be necessary to promote those dimensions further, focusing on its complexity at the macro and micro policies, with the purpose of leading the Psychiatric Reform process

A articulação entre a estratégia saúde da família e o Centro de Atenção Psicossocial: análise de experiência em município do Nordeste brasileiro

The antimanicomial psychiatric reform is a process that seeks to deconstruct the exclusionary logic caused by hospitalizations, providing strategies for social reintegration of individuals. In this sense, the primary care through the Family Health Strategy - FHS comes progressively becoming strategic space in mental health interventions, configured as a field of practice and production of new modes of care. In this perspective, there has been a process of implementing this proposal in the Areia Branca City/RN, through the articulation of Psychosocial Care Network and the Family Health Strategy / ESF. However, this process has not been able to bring changes in practices. From the view that the relationship between mental health and primary care is a challenge currently being faced, that improving the care provided and the expansion of the access to services with guaranteed continuity of care depend on the effectiveness of this joint, established themselves as research objective: To investigate how is the relationship between the FHS team and CAPS team in care mental health in the town of Areia Branca - RN from the speeches of professionals. And if you had specific purposes: 1) Know the demand in existing mental health in the town of White Sand - RN served by FHS; 2) Identify limits and difficulties in the relationship between the ESF teams and CAPS; 3) Identify potential for linkages between ESF teams and CAPS for the establishment of local RAPS. This was a descriptive, exploratory study with a qualitative methodological design, whose subjects were professionals from the Family Health Strategy, professionals Psychosocial Care Center and responsible for the conduct / management of mental health in the municipality. The research tools used informal observations, semistructured interviews and focus groups were used. The data obtained were analyzed for the content analysis of Bardin, allowing discuss the relevance of the theoretical framework with data obtained through observation and interpretation of the relationship between the Family Health Strategy and the network of Psychosocial Care in Areia Branca-RN. On the one hand, there was strong demand for mental health arising from users and their families and / or caregivers. On the other, it was verified that although there is some progress with regard to perceptions of mental health, there are still practical, historical and contextually rooted, which act as barriers to effective response to this demand in view of deinstitutionalization. In this sense, it is considered important to emphasize that the teams of the Family Health Strategy should be trained to ensure the health practice with integrity and incorporating the mental health network in the municipality. This training must occur through continuing health education.

A atenção à crise e o apoio matricial: analisadores da estratégia atenção psicossocial

The National Policy on Mental Health is characterized as a territorial - political community , and it has the Psychoso cial Care Strategy (Eaps) as guideline for the proposal and the development of their actions. In its design, CAPS is idealized to be a strategic equipment within the Psychoso cial Care Network/RAPS. Matricial support and at tention to the crisis constitute strategic areas of action of CAPS in its replacement mission , and as it is g uided by the scope of deinstitutionalization, those are essential to the success of these services. We argue that sustain crises in existential territories of life is a condition for the effectiveness of psychosocial care and, ultimately, to the sustainability of its Reform. In this direction, the matricial support tool reveals a territorial supporter, intercessory and powerful in building a psychosocial care to the crisis. Recognized as one of the major challenges by the Brazilian Ministry of Health, forward these fronts materializes for workers in their mi cropolitical crafts. Our research arises as an investment toward empower them , and aimed to understand the operationalization of attention to the crisis and matricial support in a CAPS II, in the view of its workers . Besides, it aims to examine such practi ces forward the principles and purposes of Psychosocial Care Strategy. Inspired by the research - intervention and by the political and social ideas of Institutiona l Analysis, we offer a space for reflection and exchange, by implicational interviews , enablin g workers to launch them in analysis of practices in the EAPs view. We have done a documentary consulting CAPS Technical Project, and a return stage to the institution, by organizing workshop and conversation groups with CAPS workers. The results have show n that there are institutional logics in competition on that service. When operating the logic risk, some difficulties in sustaining most intense crisis situations were identified, the psychiatric hospital internment is used as a facility, particularly in view of some cases, in which the aggressiveness of the person in crises becomes aggressive, and when the brackets SAMU, the CAPS III and Comprehensive Care Beds do not respond satisfactorily to their users requests. Order weaknesses were indicated in this thesis as macropolitical and micropolitical interfering in network support. The matricial actions were identified as a powerful intercessor resource in crisis care appeared weakened, and indicates little porosity in the relationship between the Service and the territory where it takes place. Noticed by the logic of home care, without operate primarily as a knowledge exchange device, we saw capture points in the logic of assistance with ambulatoriza tion production of CAPS, welfare practices and "ext empore " . T he E APs , although it emerge s as a guiding, it is not seen to workers as effective practice. On the one hand, the results signaled that the attention to the crisis and the matricial actions are developed without tenacious connection with the purposes of EA Ps, on the other hand, successful cases were indicated with the main leads to conducting wire of intersectoral actions to the powerful bonds and to the participation of user in their care process es , indicating insurgent forces tha t intend by traditional lo gic .

Análise do modelo de gestão implantado no Centro de Atenção Psicossocial CAPS II OESTE de 1995 a 2005, situado no distrito sanitário Oeste do município de Natal/RN, à luz da Co-gestão

This dissertation has as aim the praxis of co-management of the health service of CAPS II OESTE of Natal-RN, where health workers, family members got to materialize guidelines and principles of psychiatric Brazilian reform in real possibilities of subjectivity construction, whereas they changed social relations in daily life. The path chosen to record was from testimonials and contributions of those who meant their done. Redeeming this story from social representations of the majority of their builders was an instigating, delicate and rewarding task, emphasizing the living memory, rebuilt in a line of time which could not be found in simple documentary collections. Mainly, by knowing that service routine was intense and had as characteristic the singular mobility itself from a creation process and therefore not always its dynamic allowed adequate records. At the same time, from this occurred the field and bibliographic research which allowed the detailed information from the prior milestones and motivated to the practice here reported. The rereading of concepts in an interface with the reports of the interviewees enabled the verification that the model of mental health advocated by psychiatric reform was understood. Once noticed the presence of the beliefs and values of people in motivating energy for the progress of reform, it has gone to fetch theoretical subsidies of administrative order to understand how they saw this building and that uniqueness has been printed. The theoretical way and praxis have tracked here has allowed to analyze how occurred such a process of production and subjectivity and collectives that when organize enabled themselves for analysis and intervention, including in crisis situations. Therefore, it was revealed that ethical and multi-disciplinarity, the humanitarian sense, the coresponsibility, co-production and horizontal management were the key factors for spread from a changing protagonist. One can thus conclude that co-management from that collective has been multi-disciplinary weaving a cross

Tratamento do Centro de Atenção Psicossocial para usuários de álcool e outras drogas CAPSad II Leste Natal/RN : uma avaliação da efetividade

The treatment for abusive users of alcohol and other drugs suffered significant modifications until arriving to the psychosocial model that is used by Centro de Atenção Psicossocial CAPSad II Eastern Natal/RN (Psychosocial Support Center). That model appears starting from Brazilian sanitary and psychiatric reforms which are expressed in the principles and propositions of Sistema Único de Saúde SUS (Unique System of Health). The Psychiatric Reform meant a rupture with the mental hospital and hospital centered treatment pattern which was destined to the abusive users of alcohol and other drugs. The new proposal offers the universalization, democratization, regionalization and completeness of the actions in the field of mental health. It gathers a strictly interdisciplinary health staff. The purpose of this study is to evaluate the effectiveness of the treatment for abusive users of alcohol and other drugs offered by CAPSad II Eastern Natal/RN. The evaluation used, as priority, the qualitative social research through an evaluating study starting from the non-experimental model. The methodological process used different instruments of data collection: bibliographical and documental researches, systematic observations at CAPSad II Eastern Natal/RN and, mainly, the semistructured interviews (21) that were accomplished with the professionals, users and relatives of CAPSad II Eastern Natal/RN. The investigation showed the effectiveness of the service and, therefore, CAPSad II Eastern Natal/RN constitute itself as the main confronting strategy to the mental hospital and hospital centered treatment pattern of caring the abusive users of alcohol and other drugs

Estudo representacional da participação familiar nas atividades dos centros de atenção psicossocial no município de Natal-RN

Comprehending social representations of users relatives of Psychosocial Care Centers (CAPS) from Natal-RN, about their participation in the activities of these services, was the purpose of this study. The research instrument used was a semi-structured interview, led to 28 relatives of users of East and West CAPS II, East and North CAPS-ad, involved in the Relative Therapeutic Group, in Relative Meeting, in the Assembly of Users, Technicians and Relatives, according to the therapeutic schedule of each health services, between August to November 2007. Data obtained in family and users identification were characterized with the aid of charts and boards in absolute and/or percentage values. The discursive material from the guide from interviews was submitted to the informational resource ALCESTE (Analyse Lexicale par Contexte d'un Ensemble of Segments of Texte), and analyzed on the basis of the Theory of Social Representations and Central Nucleus Theory. Most of the relatives were women, married, aged over 50 years, who participated for more than two years in CAPS activities, and a coexistence of more than 11 years with the user. From the classification system of ALCESTE were selected categories, identified by: Category 1, Treatment Improvements and Expectations; Category 2, Living User Before and After; Category 3, Activities Relevance, Contradictions and Suggestions; Category 4, Guidelines -- Psychopharmacology and Medicalization; Category 5, Family Participation and Activities; and Category 6, Therapeutic Conditions Thanks, Tips and Vulnerability. The social representation of the family exists in the desire for change, identifying that we need to promote change by the continuity of therapeutic activities and overcome the detected inconsistencies, targeted by strengthening and by the stability of improvements in living and health conditions of users, experienced in CAPS treatment. The central nucleus had corresponded to positive changes in health and living conditions of users, and the peripheral elements were constituted by family conducts before and during treatment, and the expectations of changes in activities, especially in workshops. Despite this family participation be considered important, it still does not meet conditions to promote the inclusion of family, under an emancipating point of view, capable of causing in subject the hope for autonomy, initiative, individual and collective growths, a closer and active involvement in therapeutic activities, in workshops and discussions

Atuação do enfermeiro na estratégia de atenção integrada às doenças prevalentes na infância

This study aimed to describe nurses' actions in the strategy of Integrated Management of Childhood Illness in the city of Natal, Rio Grande do Norte. This is a qualitative study with descriptive approach. The universe consisted of nurses from the Family Health Strategy, totaling 16 participants. For the research project was submitted for approval by the Ethics Committee of the Universidade Federal do Rio Grande do Norte, obtaining Opinion No. 187/2012. Data were obtained in two ways: a questionnaire survey to profile the training of nurses and an interview guided by a structured interview. Interviews were treated in the light of analysis of thematic category Bardin. The results showed the central thematic study "Integrated Management of Childhood Illness in the context of nursing activities" category and three analyzes: "Understanding the Integrated Management of Childhood Illness", "Difficulties invibializam use IMCI "and" Working conditions for nurses in the Integrated Management of Childhood Illness. " It is observed that nurses consider the Integrated Management of Childhood Illness useful, effective and important to keep sick children within the logic curative. However disregard the character of health promotion and disease prevention thereof. It was found that the participants still hold the attendance of crinaças within the biomedical model and that these same professionals are subjected to increasingly precarious working conditions and unhealthy due to lack of human and material resources. It was found that the interviewees do not follow the protocols of strategy because of barriers related to prescription medications by nurses, the medical, the lack of incentives, training and supervision by the municipal health and the Regional Nursing Council

O dispositivo alta nos Centros de Atenção Psicossocial/CAPS : loucura, vida cotidiana e organização social

The present paper proposes an analysis about the Brazilian Psychiatric Reform as a public policy and deriving from a research developed with the workers of a Psychosocial Attention Centre III (CAPS III) and the managers of the Psychosocial Attention Web (REAP) in Aracaju. This analysis is developed as an investigation of the discharge at those services, understood not as a procedure, but as a dispositive from which different elements can be articulated: users, knowledge, technical procedures, police measures, juridical decisions, laws, services edifying. This, form the background of the articulation between mental alienation and the subject of right alienation, in the ways through which this articulation develops to the relations between madness,citizenship, internment and substitutive practices. Our investigation about the discharge as a dispositive was built with some narrative constructions, as a discourse analysis inspired by Michel Foucault s method, from the perspective of some of the main dispositive operators: workers and managers. The main aspect observed were: the articulations built by the discharge as a dispositive based on two discursive grate, the Reform as a new treatment substituting internship, and the Reform as juridical insertion and users rights practice; the exercise of these discursive grades based on the workers and managers perspective; the transference of limitations and contradictions of these grades to the competence of the dispositive operators, emerged in an outstanding way, as sometimes those operators are liable for the emergent limitations and difficulties, and some other times they are restrained by their institutional role, which is to maintain the domination relations articulated by the dispositive; finally, some aspects extracted which the dispositive operators - when they were expected to act in a way to maintain certain power relations - were capable to resist, managing other power relations from the dispositive, that we call, as Agamben, dispositive profanity

Construção e evidências de validação de instrumentos de pesquisa para avaliação da assistência nos centros de atenção psicossocial

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES

Avaliação da estrutura e processo de trabalho dos centros de atenção psicossocial

Objective: Evaluate the work structure and process in Psychos ocial Care Centers (CAPS) and the professionals profile, the satisfaction, conditions and work overload. Methods: Cross - sectional study conducted in five CAPS in Campina Grande city. The study sample consisted of five coordinators, 42 graduate professional s, 26 mid - level (technical and auxiliary nurses, and caregivers), and the medical records pertaining to 413 users followed up. Data were collected using validated questionnaires (CAPSUL - rating CAPS in southern Brazil) and adapted to the study, between July and October 2014. The questionnaires were double entered and submitted to validation in the sub - program “Validate Epi Info 3.5.4” , used along with the “SPSS 17.0” for processing the statistical analyzes. Measures of central tendency and dispersion were ap plied to the descriptive analyzes; “Fisher's” exact test to check the CAPS impact on hospital admissions and the “Bonferroni” adjusted to verify the diagnoses according to sex. 5% significance level was adopted. The study was approved by the Ethics Committ ee of the Rio Grande do Norte Federal University (UFRN), protocol 719.435, of 05.30.2014. Results: From the structure analysis were identified contextual factors that influenced the work process of CAPS professionals, such as: deficiencies with regard to h uman resources; forms of health professionals employment and qualifications; temporary contract existence. As to process dimension, it was found that the home visits performance by health professionals shows to be ineffective, given its insufficiency and i rregularity, which can be explained by the high demand, reduced staff and transportation lack. It was low coverage of items inherent to Therapeutic Individual Project, as the income generation program, insertion at work and home visit. The reference and co unter reference flow are still not satisfactorily organized. There was statistically significant difference for the diagnosis, with a predominance of mood disorders related to stress among women and those related to alcohol and other drugs among men (p <0. 05). There was an association between the degree of health professionals satisfaction and working conditions, overload and factors related to the content and working conditions, the security measures, comfort and CAPS appearance, contact between the teams and users, families treatment by the teams, temporary employment relationship. Conclusion: The data collected indicate the need for the CAPS organization through increased investments in the sector in order to enhance the infrastructure as potentiating el ement of practices with a view to changing the care model for mental health proposed by the Psychiatric Reform. It is hoped therefore that this research will contribute to better planning in CAPS unit management, with another tool to improve the dimensions involving the structure and the professional work process and improve this mental health care model.

Atuação dos profissionais no atendimento às famílias nos centros de atenção psicossocial

This study aimed to evaluate the work of professionals to care for families in Psychosocial Care Centers ( C APS) of Rio Grande do Norte ( RN), from the roles and functions performed by these professional services. For this, it was pointed out the following objectives: To describe the profile and the activities conducted by mental health teams in the RN CAPS ; Know the opinion of professionals in the mental health teams of the poli ti c , practices and training in mental health; Check the suitability of the roles and functions of professionals working in the RN CAPS in relation to care for families . This is an analytic al cross - sectional study of quantitative and qualitative approach . Data were c ollected through a questionnaire in 33 CAPS RN, between March and October 2014 , after being approved by the Research Ethics Committee / UFRN , opinion nº217.808 , CAAE : 10650612.8. 1001.5537 , on March 1 2013. T he sample was adopted , defined by inclusion and exclusion criteria , and is composed of 183 professionals. The database preparation followed two steps: 1. Preparation and processing of data of closed questions of the questionnai re concerning the characterization and practices in mental health research subjects through informational resource Statistical Package for Social Scienses (SPSS) Statistics version 20.0 ; 2. To check the significance level was chosen by applying the chi - squ are test. Preparation and treatment of the corpus formed by the answers to open questions relating to the policies, practices and training in psychiatry through Analyse lexicale pair Contexte software d' un Ensemble of Segments of Texte ( ALCESTE) together a nd categorized by content analysis technique , Bardin (2004) . The data analysis is supported in the literature . It m ade explicit the results through three articles waxing the following results. In the first, participants profile was characterized by a predo minance of females (76.5 %), aged 40 - 58 years ( 61.7 %). They work between 30 and 40 hours per week (63.5 %), working in mental health for over 10 years ( 98.4%). The sample directs the care of family groups ( 65.7%), predominantly the care team of social worke rs, nurses, psychologists and occupational therapists . The doctor performs emergency care without interaction with the staff (48.6%) . On the difficulties encountered in services are ranked in : materials and supplies ( 75.1%), financial ( 78.5%) and structura l ( 66.9%). The second article contains qualitative data organized into five categories : Promoting the rehabilitation of users of CAPS ; Needs training ; Conflicts and satisfactions of teamwork ; Practices developed in CAPS ; Effective difficulties of Mental He alth Policy . The third article highlights the inadequacy of care for families ( 93.4%) and comparing the care families and groups in CAPS both types show to be inadequate : family ( 92.63%), groups ( 92, 60%). The main data obtained reveal the urgent need for transformation in psychosocial care . It shows also the importance of investments in inputs, physical structure and training of human resources for the CAPS.

A CRONIFICAÇÃO NOS SERVIÇOS SUBSTITUTIVOS NA REDE DE SAÚDE MENTAL DE NATAL/RN

Brazilian Psychiatry Reform, through Psychosocial Care Strategy, has intended to build insane people care practices from community care services which contemplates the subjects complete lives. However, to change the traditional care ways demands the facing of a series of epistemological, political and cultural obstacles. One of the current challenges deals with patients aggravation processes, with management ways, with devices and with professionals, as well as with the assistance network. The purpose of this thesis was to investigate how these aggravation processes has been constituted in Natal mental healthcare network, understanding its effects in the work teams and patients. Theoretical and methodological perspective used was Institutional analysis was, subsidizing the usage of concept-tools as the implication analysis, selfmanagement and self-analysis, and restitution. The research was carried out at the Natal East Sanitary District Mental Healthcare Clinic, with the participation of technicians and patients. The research procedures were: literature and document research on the attendance and the analyzed theme; attendance registers analysis; participating observation of the institutional routine for three months and field log entries; talking groups, one with the team and one with the patients. Two main discussion points are shown: 1. The mental healthcare clinic organization logic and the intersector politics; 2. The work and management processes developed at the mental healthcare clinic. The analysis show diversity in the attended demands in the service, which has favored the patients aggravation, this device and the substitute network processes. The work processes are apart from the political sphere and from the managements processes. In this sense, we show the need to reevaluate the clinic device as well as the management models adopted in the Brazilian Psychiatry Reform context

A palavra cantada nos espaços intersubjetivos de um centro de atenção psisossocial do município do Natal/RN

The psychiatric care and mental health are undergoing constant change over the History. The Brazilian Psychiatric Reform, which brings up the deinstitutionalization as a structuring in the restorative care process. The Reform has as one of the mainly substitutive services the Centers for Psychosocial Care (CAPS), which work from the Singular Therapeutic Project (PTS) in order to restore the autonomy and restore the dignity of users. The therapeutic workshop is some of the resources used and work several kinds of activities as: writing, handcraft, music, poetry, and so forth. This study set up to apprehend the social representations of helping of the music workshop carried out in the CAPS II east of Natal/RN, from the reports given by the participants of the workshop, using the focal group as technique. This is a descriptive exploratory study with a qualitative approach. A total of 16 users participated in four musical therapeutic workshops from April to May 2010. The study was approved by the Ethics and Research Committee of UFRN. The discursive material from the workshop was submitted to the informational resource of Analyse Lexicale par Contexte d um Ensemble de Segments de Texte, ALCESTE, and analyzed based on the Theory of Representations and the Central Core Theory. The majority of subjects were men (62.5%), single (62.5%), aged 40-49 years (37.6%) and elementary school level (56.2 %). The reports were transcribed and submitted to the classification system of ALCESTE, which elected the following categories: Category 1 - Experience in the Word Family Sung, Category 2 - Musical Experiences and Approaches, and Category 3 - Feelings and emotions evoked by music. The representation of these individuals is anchored in the experience they have with the CAPS, lived and socialized by common sense, through this particular social group workshop objectified in music therapy as a therapeutic modality enjoyable. The central core revealed the intrinsic relationship between users and the music, establishing a relationship of openness to use the same while its therapeutic use in workshops of substitute services for mental health. Peripherals elements issues are related to listen, share and experience music in the family. Intermediary Elements relate to the feelings and emotions evoked by music, given her close relationship with it. It was found in the study that music can be construed as an artifact of good therapeutic responsiveness to users, configuring it as an invigorating and enjoyable therapy, confirming the need for continuity of this activity, as well as its expansion into the service

Reinternações psiquiátricas no Rio Grande do Norte: implicações e impacto das novas estratégias de atenção à saúde mental

The Brazilian Psychiatric Reform based on the desinstitucionalization of the assistance, translated to the emphasis on community/territorial treatment and in the social inclusion of the mental suffering, promoted advances in the psychiatric restructuring. In the Rio Grande do Norte (RN), we can enumerate as advances of the Brazilian Psychiatric Reform the expansion of the mental health care chain and the implementation of some strategies that, together, aims to further the psychosocial attention of the individual with psych suffering and to reduce the indices of psychiatrics readmissions in the state. In the current Brazilian‟s mental health situation we were interesting in answered the following question: what the impact of the substitutes services‟ extension in the revolving door phenomenon? This search aims to analyze the revolving door phenomenon occurrences based on the news strategies of mental health care in the Rio Grande do Norte. This is a descriptive-exploratory study with a qualitative approach, oriented by the theoretical framework of critical-dialectical approach about the Brazilian Psychiatric Reform and using the thematic oral history as method of information collects. The search was realized on the Hospital João Machado (HJM), estate reference in psychiatric treatment, and the participants was 20 professionals that work on it. The collection of information had started after the approval of the UFRN Research Ethics Committee with the opinion number 216/2011 and CAAE number 0021.0.051.000-11 and was realized using the direct observation and semi-structured interview. The study‟s results were categorized in two categories and five subcategories of analysis. CATEGORY 1) Current situation of the mental health care chain in the RN, with the subcategories: 1.1 Impact of the new services of mental health care in the revolving door phenomenon in the RN; 1.2 Implications of the new services of mental health care in assisting user to the HJM; 1.3 Issues the permeate the mental health care chain in the RN. CATEORY 2) Main causes of the revolving door phenomenon in HJM, with the categories: 2.1 Family problems; 2.2 Lack of assistance after discharge from psychiatric hospital. In summary, we conclude that the extension of the mental health care chain contributed for the reduction of the psychiatrics re-hospitalization‟s indices in RN. However, we realized that territorial services of mental health care are not the only responsible for the revolving door phenomenon. Factors as family problems and the disarticulation of the assistance after the discharge from hospital influence on the perpetuation of hospitalizations and re-hospitalizations in the local scenario. To study the revolving door phenomenon that occur in the psychiatrics‟ assistance considering the news strategies of mental health care allowed us to approach the advances and challenges brought by the RPb and by the desinstitucionatization in the state, indicating the need for further discussions and problem-solving strategies of psychosocial care.

Desistência ao tratamento de usuários de crack no centro de atenção pssicosocial em Campina Grande/PB

This study aimed to analyze the phenomenon of abdication of monitoring/treatment of crack users in a CAPS AD in Campina Grande-PB. That s an exploratory , description approach ,whose theoretical focus was historical-dialect of public politics on alcohol and drugs. The information collected was realized by using the technique of semi-structured interviews, combined with the crack users registered in CAPS AD in Campina Grande between 2007 and 2011.The material collected was subjected to thematic analysis method, obtaining the extraction of the following categories and subcategories of analysis: CATEGORY 1: Factors of abdication of monitoring/treatment in CAPS AD in Campina Grande PB with subcategory 1.1. Abdication on their own , 1.2. To take work/employment, 1.3 . Search for more intensive treatment , 1.4. Due to relapse; CATEGORY 2 : Treatment/monitoring in CAPS AD to the subcategory, 2.1. The dependence of crack and family support as reasons that led to frequent CAPS AD. CATEGORY 3: Living with crack addiction without treatment/monitoring in CAPS AD with the subcategory, 3.1. Religiosity as a therapeutic tool .The results showed a distance between priority for community treatment and the reality where there is lack of information about this kind of treatment and the admission as a solution. The discourse about the abdication of treatment of crack users make reference to the importance of family support, to the influence for the phenomenon of relapse and the affection to religious conceptions. Although the subjects recognize the qualifications of CAPS AD treatment, they try by themselves or by family influence, another ways of hospitalization. This leads us to conclude that it is necessary reflection and assessment of the work of CAPS AD. Counting on the social changes and the need of answers that the phenomenon requires