Acesso de novos usuários aos Centos de Atenção Psicossocial nas Áreas de Planejamento 3.1, 3.2 e 3.3, no município do Rio de Janeiro, sob a perspectiva da gestão dos serviços.

Abstract

This work aimed to bring to the discussion of the Psychiatric Reform the theme of the access of new users in the CAPSs (Psychosocial Attention Centers). We present a brief historic of the Psychiatric Reform and then explore the concept of access as conceived by Giovanella and Fleury. Thereafter, we demonstrate how access relates to the concepts of territory and responsibilization, being operationalized in the everyday of the CAPSs based on the concept of reception. Bringing these questions into the everyday of the CAPSs, we realized an exploratory research composed by three stages. In the first stage, following the access s definition by Giovanella and Fleury, we demonstrated how it appears in the National Mental Health Conferences. In the second (descriptive) and third (analytical) stages, we will consider the CAPS II and III of the 3.1, 3.2 and 3.3 AP s (Programmatic Areas). In the second stage, we present data from the accountabilities of 6 CAPSs, referring to the year of 2016. We noted that there is a model of accountability, nevertheless the CAPSs don t stick to it completely, which caused difficulties in the data analysis. We exposed general data about the quantity of users attended in the CAPSs, as well as the number of new users welcomed in the year of 2016, and we concluded that the CAPSs of the AP 3.2 presented lower values than the others. In the third stage (analytical) we used semi-structured interviews to understand how the access of new users happens in the referred CAPS in the perspective of the services management, taking into consideration what we call process of reception, evaluation and decision-making, which comprehends the moment the user arrives for the first time in the service, until the evaluation of whether the user has indication for treatment in the CAPS, and analyzed the results according to the concepts exposed before. We interviewed 7 professionals linked to the services management and found three types of organization of these processes: daily reception, reception group and mini teams. Thereafter, we exposed themes that are present in the interviews and that are related to all kinds of processes. We concluded that: the criteria for the treatment in the CAPSs is the severity, which is apprehended in two dimensions: sinthomatologic (acute or not) and of vulnerability, independent of the diagnosis; situations in which the user is in its first crisis, possibilities of chronification and suicide risk amplify the complexity of the evaluation and the referral of the users that are not indicated to treatment in the CAPS has been difficult, mainly to ambulatories in the network. Finally, we indicate the need of more studies about the themes in this research.