Leitos de saúde mental em hospital geral: um estudo sobre as articulações com os CAPS e a continuidade do cuidado

Abstract

Introduction: The implementation of mental health beds in general hospitals is based on the criticism of the asylum model of exclusion and the need to integrate mental health with other clinics in search of comprehensive care. These equipment constitute spaces for expanding access to mental health care, thought in the logic of territorial care, but their existence alone does not guarantee that non-asylum care is developed in them. Objectives: This study aims to understand and analyze the factors associated with the care of users hospitalized in mental health beds in a general hospital. Method: Based on research in 749 AIH mirrors (Hospital Admission Authorization) billed by the SUS between January 2018 and July of 2019, in the health micro-regions of Ubá and Muriaé/MG, users who underwent hospitalization in five general hospitals that have mental health beds authorized by the Ministry of Health were identified. This context is characterized by the mental health beds implemented in the validity of ordinance 148/2012, where CAPS teams provide support to hospital teams. Sociodemographic variables (gender, race/color, age), clinical variables (CID, duration of hospitalization, reason for discharge, rehospitalization and procedure performed) and RAPS organization variables (CNES of CAPS, CNES of the hospital) were transcribed from the AIH's to compose the initial database of this study. Other clinical variables (follow-up by the CAPS before hospitalization and whether care continued afterwards) and RAPS organization variables (presence of articulation between CAPS and bed during hospitalization, presence of articulation for referral to bed, distance between CAPS and bed, presence of CAPS in the municipality of residence, number of beds implanted, presence of hospital bed in the municipality of residence) were constructed and collected in 10 CAPS services of reference of those users. From the data collected in the CAPS services, an outcome of interest was created, which constitutes the care received by the CAPS teams before, during and after hospitalization in the beds. Data were analyzed using the SPSS statistical program and R language. Through multivariate analysis, we identified the clinical, sociodemographic and organizational factors of the RAPS that were associated with the care offered by the CAPS teams to users. Results: The beds have been activated for the care of acute mental suffering, however, most of the time the CAPS services have not participated in this decision, suggesting the persistence of the use of hospitalization in general hospitals in times of crisis. The actions carried out during hospitalization have still occurred in a fragile way between CAPS and hospital teams. The variables that influenced the higher chances of subjects hospitalized in LSMHG receiving care by CAPS teams were rehospitalization, length of hospitalization and the CAPS of reference of this subject. The action most offered by the CAPS teams to individuals who underwent hospitalization was post-discharge care. We believe that these beds are provoking movements of changes in the territories by allowing the continuity of care by the CAPS teams to the hospitalized subjects, but it is necessary to pay attention to the risks of general hospitals and CAPS continuing to perpetuate the logic of medicalcentered care. In addition, it is the directions of municipal, state and federal policies that can contribute to the establishment of powerful territorial health teams capable of acting in a logic of psychosocial care.