Saúde mental, território e serviços públicos de saúde: interações de direitos e condições de acesso no meio rural

Abstract

The right of access to public policy on care and treatment in mental health is of paramount importance for the non-aggravation of psychiatric conditions. Primary Health Care, the gateway to specialized mental health service, carries out risk stratification, the main instrument for guaranteeing access to mental health treatment, to the working population in rural areas. It was delimitated, in this context, the foundation, problematization and development of the PhD dissertation research with the theme: mental health, territory and public health services and general objective of analyzing how the guarantee of rights of access, barriers and health care of the rural working population, in condition of mental illness, are provided, to the integrated health service, in three municipalities belonging to the 20th Regional Health - Paraná, namely: Toledo, Marechal Cândido Rondon and Diamante D'Oeste. It consists of a qualitative case study, with substantiated and operationalized methodological resources and procedures through semi-structured interviews and a questionnaire for data collection, in addition to theoretical sources, observing the procedures of Human Subjects Research (HSR). The living conditions of the rural working population with mental disorder, residing in the municipalities listed for this research, were chosen as a problem, together with the barriers of access and continuity to mental health services, considered fundamental determinants of the right to health and quality of life in the context of sustainable rural development. And, as object of study, the right of access to protective care and mental health treatment in the rural context. The research subjects were 15 patients with mental disorders, who attend or attended CAPS or specialized care in mental health, and a family member who accompanies the user during assistance and in daily life, adding up to a sample of 30 subjects surveyed. The managers of the municipal departments of these three municipalities and the manager of CISCOPAR were also listed, adding up to 5 managers. As a result, the essentiality of guaranteeing continued access to specialized treatment for health and mental health needs promotion by primary health care teams is highlighted, especially for the rural population, which is now being executed in the health territory and residency via matrix support, risk stratification, appointments, local care integrated with specialized care. The difficulties pointed out by users and family members were related to collective transportation, the cost, the time of departure and return, and the distance to reach the service. Regarding the managers, the main difficulty is having professionals who are qualified to serve via SUS, the decentralization of service to the territory, and matrix support, still in an embryonic stage, also seen as a way of expansion and quality of services. These factors have an impact on rural development, because by guaranteeing the conditions of access of the rural population to the necessary health services, with adherence and permanence in the service for the necessary time, an increase in quality of life and sustainable rural development is generated, thus strengthening the permanence of this population in rural areas, as well as rural development, their condition of participation and autonomy in relation to their health.