Tendências e contratendências do trabalho com grupos no contexto de disputa de modelos de atenção em saúde mental: uma análise a partir de dois Centros de Atenção Psicossocial
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Data
2020-03-27
Autores
Schühli, Vitor Marcel
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Universidade Estadual Paulista (Unesp)
Resumo
A pesquisa buscou investigar as condições atuais do trabalho com grupos realizado nos Centros de Atenção Psicossocial (CAPS), serviços estratégicos da política pública de atenção à Saúde Mental. No processo de reforma psiquiátrica brasileira, a transformação da rede assistencial e das práticas em saúde passou a considerar os grupos como um dos principais meios de trabalho dos profissionais em saúde mental. Os diferentes interesses e projetos políticos envolvidos neste processo se atualizam na dimensão particular da disputa entre o modelo biomédico e o modelo de atenção psicossocial, que propõem diferentes arranjos tecnológicos e distintas finalidades para o trabalho com grupos. A fim de apreender as tendências e contratendências desse tipo de atividade, partiu-se das concepções dos profissionais acerca do trabalho que realizam com grupos em suas relações com o processo de trabalho e com os modelos de atenção. Para tanto, conjugou-se a pesquisa teórica em referenciais do campo da Saúde Coletiva e da Reforma Psiquiátrica, com a pesquisa empírica em dois Centros de Atenção Psicossocial da cidade de Curitiba (PR). A análise reuniu dados de observação participante, questionários aplicados para todos os profissionais que realizavam grupos no momento inicial da pesquisa (trinta), três sessões de grupo focal com dez participantes e entrevistas semiestruturadas com sete participantes. Participaram da pesquisa profissionais de diferentes núcleos profissionais, incluindo enfermagem (técnicos e nível superior), psicologia, assistência social e terapia ocupacional. Os referenciais teóricos permitiram compreender os dados no movimento mais amplo de transformação das práticas em saúde, bem como as influências do atual momento de acumulação flexível do capital no trabalho com grupos no âmbito dos CAPS pesquisados. As formas de organização e gestão do trabalho se mostraram determinações importantes nos modos de operacionalização dos grupos, que apresentam potências e obstruções, sendo tensionados em favor da lógica biomédica. Neste sentido, a produção de grupalidade se revelou uma contratendência, motivo pelo qual recuperamos contribuições teóricas da Psicologia Histórico-Cultural e da Psicologia Social Latino-americana acerca do processo grupal que podem aportar contribuições para o modelo de atenção psicossocial, enquanto modelo alternativo de atenção. Este percurso nos permitiu qualificar a tese de que o trabalho com grupos, na disputa de modelos de atenção em saúde mental, tem sido tensionado no sentido da instrumentalização de práticas biomédicas, seja pelo fortalecimento do modelo biomédico nas políticas de saúde mental, seja pela refuncionalização de conceitos e práticas do modelo de atenção psicossocial sob parâmetros administrativos e gerenciais que subvertem as finalidades do cuidado em favor das necessidades do capital, mediadas pelas instituições.
This study aimed to investigate the current conditions of the group work carried out at Psychosocial Care Centers (CAPS), which are strategic services of Public Mental Health Policy. In the course of the Brazilian Psychiatric Reform, the transformation of the assistance network and health practices began to consider groups as one of the primary work methods for mental health professionals. Different interests and political projects involved in this process are updated into the particular dimension of the dispute between a biomedical model and a psychosocial care model, which propose different technological arrangements and distinct goals for group work. In order to apprehend the tendencies and countertendencies for this kind of activity, we initially considered the professionals’ conceptions about their group work practice and their relations with the work process and health care models. Therefore, we combined theoretical research in the fields of Collective Health and Psychiatric Reform with the empirical research in two Psychosocial Care Centers (CAPS) of Curitiba City/PR. The analysis gathered data from participant observation, questionnaires applied to all professionals who were conducting group work at the beginning of the research (thirty), three focus group sessions with ten participants, and semi-structured interviews with seven participants. Professionals from different areas, including nursing (technical and university levels), psychology, social work and occupational therapy participated in the research. The theoretical references enabled understanding of data on the broader movement of transformation of health practices, as well as the influences of the current moment of flexible capital accumulation on group work in the context of the studied CAPS. Forms of work organization and management revealed themselves as important determining factors for group operationalization modes, which present potencies and obstructions, being pressed out in favor of the biomedical logic. In this sense, groupality production proved to be itself a countertendency, and that is the reason for retrieving the theoretical contributions of both the Historical-Cultural Psychology and the Latin American Social Psychology for the group work process that may provide further contributions for the psychosocial care model as an alternative health care model. This path enabled to qualify the thesis that group work, in the dispute of mental health care models, has been pressed towards instrumentalizing biomedical practices, either by reinforcing the biomedical model in mental health policies or by reconfiguring concepts and practices of the psychosocial care model under administrative and managerial parameters that subvert the purposes of health care in favor of capital needs, mediated by institutions.
This study aimed to investigate the current conditions of the group work carried out at Psychosocial Care Centers (CAPS), which are strategic services of Public Mental Health Policy. In the course of the Brazilian Psychiatric Reform, the transformation of the assistance network and health practices began to consider groups as one of the primary work methods for mental health professionals. Different interests and political projects involved in this process are updated into the particular dimension of the dispute between a biomedical model and a psychosocial care model, which propose different technological arrangements and distinct goals for group work. In order to apprehend the tendencies and countertendencies for this kind of activity, we initially considered the professionals’ conceptions about their group work practice and their relations with the work process and health care models. Therefore, we combined theoretical research in the fields of Collective Health and Psychiatric Reform with the empirical research in two Psychosocial Care Centers (CAPS) of Curitiba City/PR. The analysis gathered data from participant observation, questionnaires applied to all professionals who were conducting group work at the beginning of the research (thirty), three focus group sessions with ten participants, and semi-structured interviews with seven participants. Professionals from different areas, including nursing (technical and university levels), psychology, social work and occupational therapy participated in the research. The theoretical references enabled understanding of data on the broader movement of transformation of health practices, as well as the influences of the current moment of flexible capital accumulation on group work in the context of the studied CAPS. Forms of work organization and management revealed themselves as important determining factors for group operationalization modes, which present potencies and obstructions, being pressed out in favor of the biomedical logic. In this sense, groupality production proved to be itself a countertendency, and that is the reason for retrieving the theoretical contributions of both the Historical-Cultural Psychology and the Latin American Social Psychology for the group work process that may provide further contributions for the psychosocial care model as an alternative health care model. This path enabled to qualify the thesis that group work, in the dispute of mental health care models, has been pressed towards instrumentalizing biomedical practices, either by reinforcing the biomedical model in mental health policies or by reconfiguring concepts and practices of the psychosocial care model under administrative and managerial parameters that subvert the purposes of health care in favor of capital needs, mediated by institutions.
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Palavras-chave
Grupos, Processo grupal, Processo de trabalho em saúde, Saúde mental, Reforma psiquiátrica, Modelos de atenção em saúde mental, Groups, Group process, Health work process, Mental health, Psychiatric reform, Mental health care models