A desinstitucionalização dos sujeitos com transtornos mentais: uma análise da situação em Petrópolis

Abstract

This study constitutes a monographic investigation focused on the deinstitutionalization of individuals with mental disorders in the municipality of Petrópolis/Rio de Janeiro. The city's last psychiatric hospital, Casa de Saúde Santa Mônica, is only ceasing operations in 2024, 23 years after the enactment of the Psychiatric Reform Law. Petrópolis was compelled to strengthen its Psychosocial Care Network, particularly through the establishment of Therapeutic Residential Services, in order to accommodate the last patients from the hospital psychiatric hospital. Concrete challenges persist in implementing deinstitutionalization, manifesting in the following aspects: a) the institutionalizing nature of state actions in social policies in general, and in mental health policy in particular; b) the necessary infrastructure therapeutic residences, the number and types of Centers for Psychosocial Care (CAPS) available; c) the acceptance of patient reintegration by families, which encompasses issues related to the Continuous Cash Benefit (BPC), guardianship, and, primarily, the estrangement between families and patients due to the prolonged duration of hospitalization. In this context, the research question is as follows: What are the structural and institutional limits and possibilities that emerge in the deinstitutionalization process for individuals with mental disorders in Petrópolis? The general objective is to analyze the structural and institutional limits and possibilities associated with the deinstitutionalization of individuals with mental disorders in Petrópolis, considering structural aspects, institutional factors, and the relationships between these individuals and their families, as perceived through the municipal deinstitutionalization team over the past five years. The specific objectives are: to identify and analyze the main characteristics of the municipal mental health policy and the key actors involved; to describe and analyze the development of the infrastructure required for deinstitutionalization, including its limits and possibilities; and to examine the deinstitutionalization team's reports on interactions with families to identify the challenges encountered in facilitating family reintegration for service users. Regarding the methodology, the study was supported by documentary analysis of the judicial process that oversaw the hospital's closure in the municipality, as well as by the analysis of two focus groups with members of the deinstitutionalization team. Data analysis was conducted using Bardin's Content Analysis approach, which enabled the identification of eight thematic categories permeated by affects, contradictions, and multiple meanings that traverse the experiences of the subjects involved in the everyday execution of the Municipal Mental Health Policy. The research results demonstrate that, although the deinstitutionalization process was catalyzed by both the actions of the Public Prosecutor's Office of the State of Rio de Janeiro (MPRJ) and the municipal team responsible for its implementation, historical, cultural, and institutional barriers remain that hinder progress in the local mental health policy.