Para além do Mental Health Gap: um olhar ampliado sobre as lacunas locais de cuidado em saúde mental na atenção primária

Abstract

Introduction: One of the main goals of the Global Mental Health Movement is the expansion of access to mental health care in the world, with the “Mental Health Gap” concept as one of its main arguments. The integration of mental health and primary health care represents one of the main strategies for expanding access to mental health care. The effective reduction of the “treatment gap”, globally, initially relies on comprehension of local gaps regarding mental health care in primary care. This research scrutinize, from a quantitative and qualitative perspectives, the local gaps in the care of Common Mental Disorders in Brazilian Primary Care. Methods In its quantitative dimension, it resumes part of the quantitative results presented in the master's degree on epidemiology, presenting, in the form of an article, the gap in pharmacological treatment of Common Mental Disorders in primary care units. In its qualitative aspect, it investigates gaps that involve treatment of Common Mental Disorders in this context through an expanded perspective of mental health care. The qualitative aspect is presented in two chapters. The first, in the form of an article, presents a meta-synthesis of qualitative studies on mental health practices in primary care, encompassing the perception and experience of care gaps by health professionals and service users, as well as main barriers to adequate mental health care. The second, in the autoethnography format, presents the researcher's experience from mental health gap as a mental health professional working for ten years in the interface with primary care. Results The results of the quantitative dimension, point to the important magnitude of the gap in pharmacological treatment of Common Mental Disorders, since less than 20% of users of family health units with severe common mental disorder (CMD-G) were found. in use of psychotropic drugs. The predominance of the exclusive use of benzodiazepines in family health units in Rio de Janeiro, Fortaleza and Petrópolis, in constrast to results from Porto Alegre and São Paulos suggest heterogeneus patterns of treatment quality between those units. The results of the qualitative dimension point to gaps in mental health care in the context of primary care beyond pharmacological treatment. It reveals important gaps involving comprehensiveness, interdisciplinarity and longitudinality of care. The overload of primary care professionals, with precarious working conditions and the high turnover of health professionals compromise the longitudinality of care, hindering the development of psychosocial interventions and compromising development of a healthy bond between users and health professionals. Social adversity and stigma were perceived as important barriers to longitudinal care in the local context, dialoguing with importante Global Mental Health publications. Conclusion The research point to important gaps regarding mental health care in primary care. Contextual factors may, compromise the acceptance of mental health demands, favoring the precariousness and fragmentation of mental health care in this scenario. The expansion of mental health care in primary care must be accompanied by strategies for qualifying care in this context