Saúde Mental e Morte: subsídios para implantação dos Cuidados Paliativos na Atenção Básica

The objective of this work was, from a bibliographical survey, to discuss the relationship between the subjects “Mental Health” and “Death”, in order to analyze possible contributions of the Psychiatric Reformation tied with the sphere of Palliative Cares. The characterization of madness as a social problem is related to the development of the capitalist mode of production. Unable to fulfill the requirements imposed by capital, insane persons are excluded from society and locked in psychiatric hospitals in order to be treated. In the same way, death is incompatible with the capitalist principles of accumulation of goods. Dying people are then transferred to the hospital in order to hide their invalidity, non-production and felt inexistence of wealth. Some principles for care in mental health that could be shared in the palliative cares are: deinstitutionalization; organization of assistance in a network; psychosocial assistance; interdisciplinarity and construction of the autonomy of family members and users. In this sense, some challenges are distinguished, between them, professional training.

DE VOLTA PARA CASA: ESTUDO COM EGRESSOS DE HOSPITAIS PSIQUIATRICOS

O presente trabalho tem como objetivo descrever e avaliar o impacto da implantação do programa De volta para casa, na consolidação da reforma psiquiátrica no Brasil. O método adotado foi a pesquisa quanti- qualitativa numa abordagem de estudo de caso. O local do estudo foi às três (03) residências terapêuticas localizadas no município de Santo André. Todos os 25 (vinte e cinco) moradores foram sujeitos da pesquisa, utilizamos como instrumentos: entrevista semi-estruturada, livro de anotações diárias e os prontuários. Os resultados forma analisados segundo Bardin (1979) construindo categorias que demonstrassem com clareza: o perfil sócio demográfico dos egressos de hospitais psiquiátricos, e demonstrasse os indicadores de qualidade e autonomia. Procurando focar a implementação do processo de reabilitação psicossocial com estes moradores.

DE VOLTA PARA CASA: ESTUDO COM EGRESSOS DE HOSPITAIS PSIQUIATRICOS

O presente trabalho tem como objetivo descrever e avaliar o impacto da implantação do programa De volta para casa, na consolidação da reforma psiquiátrica no Brasil. O método adotado foi a pesquisa quanti- qualitativa numa abordagem de estudo de caso. O local do estudo foi às três (03) residências terapêuticas localizadas no município de Santo André. Todos os 25 (vinte e cinco) moradores foram sujeitos da pesquisa, utilizamos como instrumentos: entrevista semi-estruturada, livro de anotações diárias e os prontuários. Os resultados forma analisados segundo Bardin (1979) construindo categorias que demonstrassem com clareza: o perfil sócio demográfico dos egressos de hospitais psiquiátricos, e demonstrasse os indicadores de qualidade e autonomia. Procurando focar a implementação do processo de reabilitação psicossocial com estes moradores.

Saúde mental: concepções e práticas profissionais de um campo em tensão

A Reforma Psiquiátrica, atual política de saúde mental, redireciona os recursos da assistência psiquiátrica para o modelo de base comunitária, substituindo o modelo asilar. A abordagem proposta pela Reforma Psiquiátrica procura conjugar o esforço teórico e prático para a construção da Rede de Atenção Psicossocial. O presente trabalho objetivou desvelar concepções e práticas de trabalhadores da saúde mental, construídas na práxis de suas trajetórias profissionais e contextos de vida, em relação à incorporação do modelo de atenção psicossocial ou manutenção de princípios asilares, caracterizadores da tradicional prática profissional em saúde mental. Objetivou também identificar pontos de tensão, que caracterizam interesses de diferentes naturezas, como obstáculos e desafios à implementação da Reforma Psiquiátrica. A pesquisa, de natureza qualitativa, contou com 10 entrevistas de profissionais atuando na área, baseada na técnica de depoimento oral e em roteiro do tipo temático, sendo 3 enfermeiros, 3 psicólogos, 3 psiquiatras e 1 terapeuta ocupacional. Os relatos dos profissionais foram organizados em categorias gerais e específicas tendo em vista a interpretação das narrativas à luz da literatura especializada. Através dos discursos dos profissionais do campo da saúde mental é possível observar que um tensionamento ideológico marca fortemente o espaço da saúde. Alguns profissionais relataram a busca por construir práticas em equipe interdisciplinar, pautadas pelo modelo psicossocial; porém, referem à resistência de outros profissionais da equipe. Praticamente todos os profissionais apresentam discursos de humanização no campo da saúde mental, mas alguns não enunciam visões críticas aos modelos asilares. Alguns trabalhadores revelam a crença na possibilidade de coexistência integrada entre o Modo Asilar e Modo Psicossocial. Para estes trabalhadores de CAPS, é desejável a permanência dos hospitais psiquiátricos e é possível a humanização dos mesmos. Essa questão indica, ao que parece, que as práticas em saúde mental ainda operam sobre premissas epistemológicas diferenciando sujeitos que podem ou não circular no meio social. A existência dos hospitais psiquiátricos, considerados como instituições totais, é problematizada e questionada pela Luta Antimanicomial, indica a permanência da lógica asilar que respalda a continuidade dos hospitais, exclusivamente psiquiátricos, entre os serviços de atendimento, com o apoio de parte dos profissionais da rede de saúde mental. Concordantes com a possibilidade de coexistência do modelo asilar e modelo psicossocial, estes profissionais permitem-nos demonstrar que mesmo uma visão clínica pretensamente humanizadora, que defenda em seu discurso um tratamento digno, pode operar no modelo teórico-metodológico positivista e não está necessariamente vinculada a uma postura política de sujeitos de direitos e de cidadania. Os profissionais que apresentaram em suas narrativas a não concordância com a permanência dos hospitais psiquiátricos, defendem que as transformações sejam clínicas e políticas nos saberes e nas práticas em Saúde Mental. Estes trabalhadores já fizeram ou fazem parte de movimentos sociais, apontados como lugares de reflexão crítica sobre ideias instituídas contribuindo, ao que parece, para o processo de desnaturalização de concepções construídas culturalmente e orientadoras de práticas profissionais. Diante de tais constatações podemos indagar e refletir se a desinstitucionalização, concreta e simbólica, encontra-se no horizonte de uma política pública de atenção em Saúde Mental que realmente tenha como projeto a sua real implementação e se a permanência dos hospitais psiquiátricos e das comunidades terapêuticas estaria descaracterizando as propostas iniciais da construção da Atenção Psicossocial, considerando os interesses privados e a manutenção da lógica asilar, contrários aos princípios do SUS.

O agente comunitário e o usuário de álcool: discursos sobre a concepção e a assistência na Atenção Básica

Estima-se que 52% da população mundial faz uso de álcool, sendo a droga mais consumida no mundo. Ao usuário, o álcool torna-se prejudicial devido às consequências nos níveis biológicos, sociais e funcionais. Assim, a redução do uso abusivo da substância é um dos objetivos da Organização Mundial de Saúde (OMS) e uma das prioridades na agenda de saúde pública mundial. No Brasil, a Política do Ministério da Saúde para a Atenção Integral aos Usuários de Álcool e Outras Drogas teve como objetivo a criação de uma rede de atenção integral a eles - a RAPS (Rede de Atenção Psicossocial). A RAPS é considerada um grande avanço da Reforma Psiquiátrica, já que integra os diversos pontos de atenção disponíveis no Sistema Único de Saúde (SUS). Um dos pontos da RAPS é a Atenção Básica (AB), que através da atuação das equipes da Estratégia Saúde da Família (ESF) tem a possibilidade de monitoração, prevenção do uso e colaboração na reinserção social dos usuários de álcool e outras drogas devido à proximidade e criação de vínculo entre o serviço e usuário. Para que o vínculo seja estabelecido o Agente Comunitário de Saúde (ACS) é a peça fundamental, visto que conhece a comunidade e reconhece suas necessidades, além de ser a figura que medeia as relações entre a equipe de saúde e os usuários. Assim sendo, o objetivo deste estudo foi descrever e analisar o discurso de ACS sobre o uso de álcool e a assistência prestada na AB. Trata-se de um estudo qualitativo de teor descritivo, cuja pesquisa ocorreu em cinco municípios da região central do Estado de Santa Catarina. Foram realizadas entrevistas semiestruturadas, analisadas através do método da Análise de Conteúdo. A análise das entrevistas resultou na formulação de duas categorias e quatro subcategorias empíricas. Os resultados evidenciaram que os ACS percebem o consumo de álcool como inerente a população em virtude da cultura caracterizada pelo consumo habitual e festivo da droga. Eles percebem que o uso do álcool torna-se um problema quanto à definição social atribuída pela comunidade, ressaltando as consequências para a família e outras perdas vivenciadas pelos usuários com base nas repercussões sociais. Quanto à assistência prestada por eles aos usuários de álcool, os resultados indicaram uma prática desprovida de instrumentos ou habilidades para a abordagem adequada do uso, evidenciando uma prática infundada pelos ACS. A prática está pautada também nas crenças em relação aos usuários de álcool, que estão muito ligadas aos estigmas relacionados a estes usuários em geral e não em evidências científicas. Conclui-se que a partir do conhecimento das percepções e práticas deste profissional, é possível direcionar ações que potencialize a prática dos ACS, já que são profissionais com grandes possibilidades de atuação diante da prevenção e tratamento do abuso de álcool e reabilitação social do usuário

CENTRO DE ATENÇÃO PSICOSSOCIAL ÁLCOOL E DROGAS (CAPS-ad): A EX-PERIÊNCIA DOS PROFISSIONAIS DE SAÚDE MENTAL NUMA UNIDADE DA BAIXA MOGIANA

O uso abusivo de substâncias psicoativas tem sido objeto de preocupação e alvo de políticas públicas de enfrentamento, praticamente no mundo todo. O reconhecimento de que tal forma de uso acarreta relevantes consequências econômicas, sociais, acadêmicas, familiares e de saúde física e mental, tem levado as autoridades competentes a criar programas que visam a fazer frente à expansão desse fenômeno. No Brasil, após um período em que o tratamento oferecido aos usuários de substâncias era predominantemente asilar, vem ocorrendo mudanças significativas no modelo de atenção a essa população, notadamente com a implantação dos Centros de Atenção Psicossocial Álcool e Drogas, dentro da estrutura do Sistema Único de Saúde SUS. O presente estudo tem por objetivo identificar e analisar a percepção dos pro-fissionais de saúde mental que atuam no CAPS-ad, sobre a pertinência e a eficácia das abor-dagens e técnicas por eles utilizadas no atendimento aos usuários de substâncias psicoativas. Visa também a conhecer a formação acadêmica e complementar desses trabalhadores; a natu-reza das relações profissionais que se estabelecem entre os membros da equipe; os resultados obtidos com o trabalho e o grau de satisfação dos profissionais com esses resultados. Objetiva ainda a identificar a representação que eles fazem desses usuários e o grau de confiança na proposta CAPS-ad. Para a coleta de dados utilizou-se a técnica de entrevistas semi-estruturadas e o tratamento dos dados foi realizado com base na técnica de Análise de Conte-údo de Laurence Bardin. A investigação revelou que os profissionais não têm formação para lidar com dependência química, que a equipe não atua de forma interdisciplinar e que o trata-mento é realizado de forma aleatória e com baixa eficácia. A representação que fazem do usu-ário é a de um indivíduo doente e ou vitimado pelas condições familiares e sócio-econômicas. Constatou-se também que a maioria dos profissionais tem dúvidas quanto à adequação do CAPS-ad como proposta para cuidar dos usuários de álcool e outras drogas.

DE VOLTA PARA CASA: ESTUDO COM EGRESSOS DE HOSPITAIS PSIQUIATRICOS

O presente trabalho tem como objetivo descrever e avaliar o impacto da implantação do programa De volta para casa, na consolidação da reforma psiquiátrica no Brasil. O método adotado foi a pesquisa quanti- qualitativa numa abordagem de estudo de caso. O local do estudo foi às três (03) residências terapêuticas localizadas no município de Santo André. Todos os 25 (vinte e cinco) moradores foram sujeitos da pesquisa, utilizamos como instrumentos: entrevista semi-estruturada, livro de anotações diárias e os prontuários. Os resultados forma analisados segundo Bardin (1979) construindo categorias que demonstrassem com clareza: o perfil sócio demográfico dos egressos de hospitais psiquiátricos, e demonstrasse os indicadores de qualidade e autonomia. Procurando focar a implementação do processo de reabilitação psicossocial com estes moradores.

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

Estratégias de cuidados por familiares de portadores de transtornos mentais severos residentes na zona rural do alto sertão paraibano

In the current configuration of the Brazilian Psychiatric Reform, family plays a key role in mental health care: shared responsibility and active participation in the process of rehabilitation of people with severe mental disorders. It´s considered that the family member who cares can help users in their daily tasks and articulating trajectories, networks and ways to potentiate social connections. This research was motivaded by interest in the subject and by the lack of research and studies about this reality in rural areas. This study aimed to identify ways of mental health care by relatives of severe mental disorder patients living in rural zone located at sertão of Paraiba. Methodologically was made a work with qualitative research structured in two moments. In the first one, was held a Documentary Research in CAPS II in order to identify: a) users living in rural that had a history of at least one psychiatric hospitalization, b) users who no longer use the reference service (CAPS II) for at least one year. The second stage consisted by home visits and semi-structured interviews with eleven families in rural areas. Results pointed out a profile composed by 56 users: 56 women and 26 men aged between 50 and 64 years, unmarried, without study, farmers and housewives, living six miles from CAPS II and carriers with severe mental disorders. Strategies and resources used by the families for mental health care were: religion, work, medication and help from relatives, neighbors and community. Factors related to non-use of substitute services were lack of internment in CAPS II and lack of money and transportation. The hospital, the house arrest, the police aid and religion were strategies used by family members as support to psychiatric crises. The data pointed to non-solving of care offered by psychosocial support network and the importance of redirecting practices aligned to the asylum model in favor of psychosocial strategies that aimed at rehabilitation and community participation in mental health care

Perfis e práticas dos profissionais de saúde mental em dois hospitais psiquiátricos de grande porte

In the Brazilian network of psychosocial care, health professionals are important actors in the process of transformation of mental health public policies among various services. In the reality of psychiatric hospitals, one should understand the need to expand the debate about the current context of practices developed. This study aimed at analyzing the process of psychiatric reform and the mental health policy in the State of Rio Grande do Norte (RN) from the profiles and practices of higher-level professionals in two psychiatric hospitals. This is a cross-sectional and descriptive research, with quantitative and qualitative data, conducted in two psychiatric hospitals of RN. The universe of the target population was 95 professionals, taking into account the margin of error of 8%, non-response rate and the inclusion criteria: holding effective link with the institution by means of approval in public examination for, at least, six months, being state or municipal servant; having a minimum weekly workload of 20 hours in service; participating in care and/or activities with patients and families in a direct way. The final sample consisted of 60 professionals. The tool for data collection was a questionnaire with closed and semi-open questions about socioeconomic profile, and mental health policies, practices and training. Quantitative data were tabulated in the statistical software SPSS, and simple and bivariate statistics, chi-square type, was used for analysis by adopting the significance level with the value p<0,05. In order to analyze data, the content analysis of Bardin was used. The qualitative findings obtained with the semi-open questions in Analyse Lexicale par Context d'un Ensemble de Segments de Texte (ALCESTE) were grouped into four thematic axes: Professional action in mental health; Mental health training; Scenarios of psychiatric reform and psychiatric hospitals; Mental health policies and practices: challenges for professionals in hospitals. The profile of professionals has revealed the majority of women (89,7%), nurses (36,7%), aged 50-59 years (42,9%), weekly workload of 40 hours (52,4% ), time of completion of graduation from six to 15 years (57%), and 21,4% reported to have specialization in mental health. Regarding the practices developed in individual care, it was found an association between those who do not build or partially conducts the therapeutic project and those who conduct care related to observation and annotation. In family care, it was obtained care consultation during crisis; and, in group care, recreational activities. In the analysis of thematic axes, it was noted that, despite changes identified in the profiles and practices of higher-level professionals in care services for mental health, with the implementation of new public policies for this field, the findings indicate the confluence of asymmetries and divergences in the actions of the teams in psychiatric hospitals, difficulties in managing services, frequent readmissions, reduced quantitative of available services and equipment, high demand of users, disarticulation of the network of psychosocial care, and the very shortage of skilled human resources to compose these services. Accordingly, the evidenced scenarios partially outline the current political and ideological mismatch of the national process of psychiatric reform that denies the role of care actions conducted within hospitals, although it has not gone far enough with the creation of new services that justify the total extinction of this institution

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.

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 .

Matriciamento em saúde mental: atuação de núcleos de apoio à saúde da família

In the context of break with psychiatric hospitals, the Brazilian Psychiatric Reform is a historical process of reformulation of knowledge and mental health practices. In this way, the Centers of Support for Family Health (NASF) have been acting in the supply of matrix support in mental health. So, the present research aims to analyze the actions which the NASF is taking for the matrix support in mental health in the city of Natal/RN. This is a kind of research descriptive, exploratory and qualitative. The data collection, was made by a direct observation of the professional pratices and semi-structured interviews with health professionals NASF's. The Data were analyzed according to thematic analysis technique, with the support of the content analysis method, which is a way to investigate clusters of meanings which make up the communication of the investigated object. Three analytical categories were organized by this method, whose titles were inspired in two theories in the health field called “Health to Paidéia” and “Expanded Clinic”. The name of the categories are: 1. “Mental illness in brackets: working dimensions of the Centers of Support for Family Health interfaces with the concrete subject”, which is about the work process of NASF; 2. “Freedom and engagement in the arrangement of matrix support in mental health”, which explore the matrix support limitations in mental health in Natal/RN from the professionals interviewed at the NASF’s; 3. “Between the desire and interest: influence of expert orientation in mental health in Psychosocial Care Network” (RAPS), which is related to matrix support in mental health, as an organizational arrangement responsible to ensure intersectoral and comprehensive care, strategies inside of context of the constitution of RAPS. We can extract and say that the actions of NASF teams in the brazilian city called Natal/RN, still not part of a structured link with health care networks, as happens with the absence of discussions and lack of professionals in the matrix support. In addition, there is a difficulty to do an specialized orientation in mental health because of the lack of human resources in this area and of the insufficient number of the replacement services for psychiatric hospital pratices, bringing up the discussion about the consolidation and expansion of RAPS in fact investigated.

Articulação entre saúde mental infanto-juvenil e atenção básica em Natal-RN: limites e possibilidades

In the case of Brazilian Psychiatric Reformation, mental health juvenile reveals itself as a great challenge, with major gaps in terms of needs, services and actions on mental illness in children and adolescents. This research is a qualitative study of descriptive and exploratory, having to analyze the actions and practices of mental health juvenile articulated between the Psychosocial Care Center juvenile (Caps i) and the basic care in Natal-RN, and specific, identify the limits and possibilities for an important precedent of the care network. After submission to the Research Ethics Committee (CEP) of the University Hospital Onofre Lopes (HUOL) of the Federal University of Rio Grande do Norte (UFRN) obtained approval contained in opinion number 777.067 / 2014. For the data collection, it was initially carried out a documentary research in the Municipal Health Department of Christmas about the phenomenon under study, and subsequently, applied semi-structured interviews with the subjects of the research, which were workers Caps i of Natal-RN. The analysis was woven as the thematic analysis technique, understood within the method of content analysis. The results and discussions were organized by categories and subcategories, namely: CATEGORY 1: Limits and weaknesses in the linkage between the Caps i and basic care, with the subcategories: 1.1 Lack of specialized services and devices articulators in network, 1.2 The diversity of situations in the demand juvenile assisted; CATEGORY 2: possibilities for an effective network, with the subcategory: 2.1 Intersectoral collaboration as a strategy for solving attention. The analysis revealed that the integration and coordination of mental health services juvenile and primary care in the city of Natal-RN, has incipient initiatives and/or inadequate for the resolvability intersectoral, where the devices of attention to health involved cannot establish bonds effective and long-lasting in the perspective of co-responsibility and sharing of care. On the other hand, it appears that the existing shares and practiced, configure an exercise in approximation to the dialog between mental health juvenile and basic care. It is highlighted that the shared care and the establishment of intersectoral collaboration within and outside of the health sector is possibility of facilitating the necessary dialog between the services and professionals involved, thus, enabling a better prospect of resolvability of the Network of Psychosocial Care for the youth in reality being investigated.