Internar, cuidar, reinternar: a porta giratória na RAPS de uma cidade de Minas Gerais

Abstract

Brazil’s Psychiatric Reform was a significant milestone in the mental health field, promoting advances, such as the progressive and generalized reduction of psychiatric beds, and the implementation of community-based substitutive services. However, it is noticeable that these mechanisms are still not sufficiently consolidated to allow deinstitutionalization to be sustainable. Having said that, the revolving door phenomenon, which is characterized by repeated hospitalizations and readmissions, highlights the vulnerabilities of the Brazilian Psychosocial Care Network (Rede de Atenção Psicossocial [RAPS]) and the challenges in coordinating care between the services and the territory, posing a significant challenge to Psychiatric Reform and to RAPS. This study aims to comprehend the factors that contribute to maintaining this phenomenon by examining the experiences of users assisted at a RAPS facility in the interior of Minas Gerais, and to understand how revolving door patients, their families, and RAPS professionals perceive these factors which lead to the recurrence of psychiatric hospitalizations. The study employs a case study methodology, using the Thematic Content Analysis method. For this research, one user, one family member, and reference therapists were interviewed. The analysis indicated that recurring hospitalizations are associated with insufficient territorial support, discontinuity of care, limited dialogue between users and the team in the Individual Therapeutic Project (Projeto Terapêutico Singular [PTS]), prioritization of pharmacological treatment, socioeconomic vulnerabilities of users and their families, the absence of a support network, and gender-related violence.