ANÁLISE INSTITUCIONAL DA PSIQUIATRIA NA ORGANIZAÇÃO DO CUIDADO E NO TRABALHO MULTIPROFISSIONAL EM CENTROS DE ATENÇÃO PSICOSSOCIAL

Abstract

Introduction: The growing demands in the field of mental health and the transformations in care practices highlight tensions between different models of care. The persistence of the biomedical paradigm in community-based services challenges the principles of the Brazilian Psychiatric Reform and undermines the development of interdisciplinary approaches. Institutional analysis offers a theoretical-methodological framework capable of revealing instituted forces, instituting movements, and analyzers present in practices, allowing for an understanding of how certain rationalities are maintained or transformed within institutions. Objective: To analyze how psychiatry guides care practices and interprofessional relations within teams at psychosocial care centers (CAPS), based on the theoretical framework of Institutional Analysis. Methodology: This is a qualitative, exploratory study based on semi-structured interviews with six psychologists and six psychiatrists working in psychosocial care centers across different regions of Brazil. Data were analyzed using thematic content analysis, by Bardin, with interpretation grounded in Institutional Analysis, in dialogue with the field of collective health. Results and Discussion: Six thematic categories emerged from the interviews: 1. conceptions of mental health, 2. conceptions of mental illness, 3. the role of psychiatry, 4. conceptions of care, 5. foundations of effective care, and 6. conditions and challenges for multiprofessional collaboration. Psychiatry has been recognized as an institution that exerts influence over care practices and work dynamics, upholding biomedical and hierarchical rationalities — expressions of the instituted. The analyzers such as crisis management, diagnostic logic, and professional hierarchies reveal tensions and contradictions within the studied context. Meanwhile, instituting forces drive the redefinition of care, promote user autonomy, strengthen multiprofessional collaboration, and challenge medicalization. Final Considerations: The study reveals the institutional role of psychiatry within CAPS, whose biomedical hegemony shapes clinical practices, professional relationships, and modes of care organization. Although at times acknowledged as contributive and even expected by teams, this centrality tends to constrain broader perspectives, relegating psychosocial and collective approaches to a secondary place. In this context, tensions and ambiguities emerge: different professional groups, both medical and non-medical, reproduce hegemonic logic while simultaneously expressing resistance and openness to interdisciplinary and innovative practices. These disputes highlight possibilities for the reinvention of care and professional relations, underscoring the need for strategies that foster multiprofessional cooperation and critical reflection on the ways of acting and interacting within mental health services.