Saúde Mental na Atenção Primária: um estudo local sobre sofrimento emocional e acesso ao cuidado em tempos de saúde mental global.

Abstract

This research focuses on the emotional suffering and access to their respective care in Primary Care at the local level, and seeks to dialogue with the panorama of the field of Global Mental Health. Around the world, millions of people suffer from mental health problems, but about 75% do not receive the treatment they need, especially in middle- and low-income countries. In Brazil, frequently, many seek assistance in the Family Health Strategy by expressing emotional distress through somatic complaints, which may be associated or not with physical and/or mental illnesses. However, the rate of recognition of suffering by general practitioners is still low. Considering there is no health without mental health and also the precariousness of mental health care, the objective is to investigate the patients' perception of emotional distress and access to their care in Primary Care. The relevance of this research is due to: lack of research on the theme, high prevalence of emotional distress and high socioeconomic impact, treatment gap. Adopting a qualitative perspective, two studies were carried out. An empirical study with focus groups and another theoretical-conceptual study by literature review on the terms "access" and "treatment gap". Focus groups with patients in waiting rooms occurred in units with Primary Care services in 2.2 Catchment Area in the Municipality of Rio de Janeiro. A questionnaire was created based on the instrument McGill Narrative Interview (MINI). The narratives were interpreted using the Content Analysis method and resulted in five categories: 1) Explanation of Emotional Distress; 2) Communication of Emotional Distress to the Physician; 3) Communication of the Structure of Care; 4) Communication of Emotional Distress and Services Context; 5) Facilitators and Barriers. The barriers involve intrinsic patient beliefs, physician attitudes and a tumultuous care contexto. These barriers interact and shape an antitherapeutic looping, which compromises access to care. Analyzing the barriers according to a multidimensional model of access, it was verified that these correlate to the symbolic, technical and organizational dimensions, but they also reflect the conjuncture of the economic-social and political dimensions of access. Strategies to overcome barriers and guide the development of socially sensitive and culturally relevant approaches that facilitate access to the care of emotional distress in Brazilian PHC were discussed.