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A CRONIFICA??O NOS SERVI?OS SUBSTITUTIVOS NA REDE DE SA?DE MENTAL DE NATAL/RNSevero, Ana Kalliny de Sousa 24 July 2009 (has links)
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Previous issue date: 2009-07-24 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / 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 Reforma Psiqui?trica Brasileira, atrav?s da Estrat?gia de Aten??o Psicossocial, tem objetivado construir pr?ticas de cuidado ao louco a partir de servi?os de atendimento comunit?rio que contemplem a vida concreta dos sujeitos. Entretanto, transformar os modos tradicionais de cuidados exige o enfrentamento de uma s?rie de obst?culos epistemol?gicos, pol?ticos e culturais. Um dos desafios atuais trata de processos de cronifica??o dos usu?rios, dos modos de gest?o, dos dispositivos e dos profissionais, bem como da rede assistencial. Investigar como esses processos de cronifica??o v?m sendo constitu?dos na rede de sa?de mental de Natal, compreendendo seus efeitos nas equipes de trabalho e nos usu?rios foi a proposta dessa disserta??o. A an?lise institucional foi utilizada como perspectiva te?rica e metodol?gica, subsidiando o uso de ferramentas-conceitos como a an?lise da implica??o, auto-gest?o e auto-an?lise, e restitui??o. A pesquisa foi desenvolvida no ambulat?rio de sa?de mental no distrito sanit?rio leste da cidade de Natal/RN, com a participa??o dos t?cnicos e usu?rios. Os procedimentos da pesquisa foram: pesquisa bibliogr?fica e documental sobre o servi?o e sobre a tem?tica analisada; an?lise dos registros do servi?o; observa??o participante da rotina institucional durante tr?s meses e registros no di?rio de campo; rodas de conversa, uma com a equipe e com os usu?rios. Elencamos dois pontos principais de discuss?o: 1. A l?gica de organiza??o do ambulat?rio de sa?de mental e as pol?ticas intersetoriais; 2. Os processos de trabalho e de gest?o desenvolvidos no ambulat?rio de sa?de mental. As an?lises indicam uma diversidade de demandas atendidas no servi?o que tem favorecido aos processos de cronifica??o dos usu?rios, desse dispositivo e da rede substitutiva. Os processos de trabalho est?o dissociados da esfera pol?tica e dos processos de gest?o. Nesse sentido, apontamos a necessidade de rever o dispositivo ambulatorial bem como os modelos de gest?o adotados no contexto da Reforma Psiqui?trica brasileira
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