O CAPS e a internação psiquiátrica no itinerário terapêutico de pessoas em sofrimento psíquico na perspectiva dos usuários

Abstract

This research’s theme is inserted in the mental health field. The study of the therapeutic itineraries through the perspective of the users of health services is not yet a topic that receives much emphasis in the scientific realm, thus neglecting the active participation of the primary recipients of the complex social process known as Psychiatric Reform in the understanding of their centrality in the caring process. For this reason, this research sought to understand, through the therapeutic itineraries, the perception of people (that are in psychic suffering and that had been through the experience of psychiatric hospitalization) about a type 1 Center for Psychosocial Support (CAPS) and the psychiatric hospitalization throughout their path in search for health. Interviews were conducted with six people, between the ages of 27 and 52, patients in a type 1 CAPS. This is a qualitative research and, for the analysis of the transcripted material, it adopted the procedures inspired in the concept of indicators by González Rey and in the content thematic analysis. Five analytical categories were discussed: (1) The mental hospital is present, whose indicators revealed the need for strengthening RAPS, because before the depletion of territorial resources the hospitalization was used. The hospitalization also took place after the insertion in the CAPS and the teams were indicated as poorly qualified for the caring; (2) The CAPS: an interaction space and a substitute for social life, whose indicators show the service as a foster, respectful, free and reliable space, but, at the same time, promoter of dependency instead of autonomy, and as the only living space for some of the interviewees. The indicators blend with the idea of the new form of chronification created inside the deinstitutionalization devices; (3) How do crisis occur: from the suffering to the diagnostic label, whose indicators showed that the crisis were triggered by concrete life situations that generated suffering experiences due to the absence of citizenship rights guarantees, such as food, income, employment, family conflicts mediation. Such complex situations are reduced to diagnostic categorizations, transforming into reductionist labels of life experiences; (4) What is the purpose of psychotropic medication?, whose indicators showed a multiplicity of meanings assigned to the psychotropics, for example: healing, controlling, being an accessory to another treatment seen as the main one, and being iatrogenic, compared to a poison or promoter of another disease, obesity, or chemical dependency; (5) Health and social support, whose indicators revealed the presence of informal resources in the therapeutic itineraries, such as spiritual and cultural practices, family interaction, friends’ support. As a contribution, this study allows for a reflection about the possible fragilities of RAPS in smaller towns, taking into account the itineraries of the type 1 CAPS users that were interviewed, which holds characteristics of interaction and substitute of social life, allocating the caring of crises to the urgency and hospitalization services. Primary care services aren’t considered a point-of-care.