Acesso das pessoas com transtornos mentais à rede de atenção à saúde:uma abordagem por método misto

Abstract

Introduction: access to health care for people with mental disorders still represents a significant challenge, especially when related to autonomy and social inclusion, because it is intrinsic to the ability to make decisions and act independently in social spaces, without the yoke of medicalization of the asylum model and social guardianship. Access in freedom involves individual and collective potential, availability and reach of information and adequate resources for an assertive choice that meets their unique needs and encompasses comprehensive and equitable health actions in the devices and services of the different points of the Health Care Network. Objective: to understand access to health for people with mental disorders, registered in Psychosocial Care Centers in municipalities under the jurisdiction of the Regional Health Superintendence of Juiz de Fora. Method: this is mixed-method research with a basic Explanatory Sequential design that is characterized by an initial quantitative approach, necessarily followed by a qualitative approach, methodologically based on Pierre Bourdieu's “Reflexive Sociology”. In the quantitative, observational, crosssectional survey approach, a data collection instrument was applied to 240 participants present in the territory of eight municipalities belonging to the Regional Health Superintendence of Juiz de Fora (30 participants per municipality). And, in the qualitative, descriptive and exploratory approach, semi-structured, individual interviews were conducted, based on a script consisting of guiding questions and directed to 13 participants selected from the total sample. The participants in this research, called Agents, are people with mental disorders, over eighteen years of age and male or female, registered and frequent in Psychosocial Care Centers. Data analysis: data on sociodemographic characteristics, psychiatric history and possible comorbidities, and care at different points in the Health Care Network were consolidated in a spreadsheet from the Statistical Package for the Social Sciences and initially analyzed using descriptive statistics techniques. Statistical measures such as mean, variance, range, frequency distributions and percentiles were applied to process the data collected using the quantitative approach, to characterize the participants based on the determinants, conditions and outcomes of access studied. The data collected using qualitative approach were processed using Bourdieu's praxiology to deepen the findings of the quantitative approach and understand the relationship between the agents and the Health Care Network, a structure of the social space that is fundamental to ensuring people's access to health services. Triangulation was used to understand the phenomenon under study, based on the integration of quantitative and qualitative results originating from the analyses of these approaches. Results: the quantitative research analyzed the socioeconomic profile, health conditions and 20 access to services of 240 participants. The data indicated an adult population (mean age of 46.76 years), with a male majority (52.5%) and positioned in the D/E socioeconomic stratum (55.8%). Regarding education, 62.1% had only elementary education, and 86.3% did not have a paid job. Regarding health, 67.5% reported a diagnosis of mental disorder, 79.2% a history of psychiatric hospitalizations, 99.2% psychiatric treatment (among these, 94.2% drug treatment). In addition, 35.4% had hypertension and 17.1% diabetes. Regarding access to health services, 92.9% were registered in a Basic Health Unit; In the last 6 months, 77.9% sought care at the Basic Health Unit where they are registered and 41.3% rated the care as "good". Only 51.7% reported fully understanding medical advice (while 43.3% "more or less") and 75.8% did not participate in health promotion activities. The main means of transportation used was the city bus (43.7%), followed by walking (28.2%). These data indicate challenges inherent to accessibility, continuity, and understanding of health care and the need to strengthen public policies to ensure comprehensive care. The qualitative research, as a further investigation, showed the participants' experience regarding access to health care, regarding its determinants and conditions and the relationship between use and health services. The reports were categorized in conjunction with the dimensions of access to health care and showed a focus on psychiatric diagnosis in primary care and difficulty in obtaining medication, directly impacting the comprehensiveness of care and continuity of treatment. The pandemic worsened this situation, reducing attendance at the Psychosocial Care Center and making it difficult to receive care at the Basic Health Unit. Final considerations: this research represents an innovation for scientific knowledge in the field of public health, because the person with mental disorders is the vocal agent, the decision for its methodological approach and its comprehensive perspective on the investigation of access to health in this population. People with mental disorders have difficulty accessing health because they do not have freedom to use devices and services at different points in the Health Care Network, since they are not included in comprehensive and equitable health actions. Their access is also intrinsically related to the treatment of mental disorders and based on the biomedical modality, as stated in the premise of this thesis.