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Salud mental en nivel primario de atención en el contexto del modelo de salud mental y psiquiatría comunitario en el area occidente de Santiago, Chile : diagnóstico de situación, desafíos y recomendaciones
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RESUMO: Nos processos de reforma psiquiátrica a nível mundial destacaramse experiências construíram
um caminho de desenvolvimento na saúde mental mais inclusivo e integrado no contexto do
modelo de saúde mental de base comunitária. Às experiências de impacto global como as
registradas em Inglaterra e na Itália, somam-se algumas experiências na América Latina e
Caribe, as do Brasil, Argentina (Rio Negro) e Chile. No caso chileno, ainda que a implementação
de uma saúde mental de base comunitária não tenha o mesmo alcance que o das experiências de
reforma mencionadas, encontra-se um elemento diferenciador: a integração da saúde mental nos
cuidados primários de saúde. No Chile, os cuidados primários de saúde desenvolveram-se multo
desde a Declaração de Caracas e, apesar das dificuldades encontradas, procurou-se desde então
integrar a saúde mental nos cuidados primários; padrão que se veio a reproduzir nos seguintes
níveis de cuidados do modo a desenvolver um percurso e continuidade adequados nos cuidados
prestados ás pessoas pela rede de serviços . Este trabalho tem como objetivo caracterizar a
presença da saúde mental no nível de cuidados primários no setor ocidental de Santiago, no Chile.
Para tal, foi feita uma colheita de dados bibliográficos para a devida contextualização e foi
conduzida a aplicação do instrumento EVARED, versão 2016, que é uma ferramenta desenvolvida
e validada na Universidade do Chile. Paralelamente, foram reunidas informações presentes no
programa estatístico nacional (REM)1 sobre aspectos relevantes da saúde mental no nível de
cuidados estudado. As informações colhidas visam apresentar o estado atual da saúde mental no
nível primário numa área territorial de Santiago caracterizada por ampla dispersão geográfica,
povoações populosas, com grupos de importante vulnerabilidade social e com altos indices de
dependência do Sistema Público de Saúde. As principais questões abordadas nesta tese examinam
os avanços nessas questões e, ao mesmo tempo, buscam propor novos desafios e oportunidades
de crescimento para melhoria do acesso e da qualidade dos cuidados de saúde mental. Esta tese
indica as oportunidades e as brechas na prestação de serviços. Além disso, apresenta uma visão
crítica das barreiras detectadas no sistema de saúde que entravam e restringem o desenvolvimento
atual e potencialmente futuro das redes de saúde mental, bem como a melhoria dos serviços de
base comunitária na atenção primária para as pessoas mais vulneráveies da nossa sociedade.
ABSTRACT: Psychiatric reform experiences have been highlighted during last decades due to its capacity to mark a development path for mental health that is more inclusive and integrated in the context of the community mental health model. Within these experiences with global impact we can find countries such as England or Italy, and importat developments in Latin America and the Caribbean such as Brazil, Argentina (Rio Negro) and Chile. In the case of Chile, although the installation of community mental health does not have frontiers of reform as in the mentioned experiences, a differentiating element is distinguished: the integration of mental health in primary care. Primary health care in Chile has had a great development since Caracas Declaration and from there it intends to integrate, not without difficulties, mental health in general health, a pattern that will be reproduced in the following levels of care to achive an adequate transit and continuity of care for people within the health care network. This work aims to characterize the presence of mental health in the primary care level in the western sector of Santiago de Chile. To this end, a compilation of bibliographic data has been carried out, accompanied by the application of EVARED instrument version 2016, a tool developed and validated by the University of Chile. In parallel, some relevant aspects of mental health in primary care were obtained from the national statistical program (REM1). The information collected aims to provide a state of mental health at the primary care level in a territorial area of Santiago with a wide geographic dispersion, massive populations, groups of significant social vulnerability and high dependency rates of the public health system. The main points addressed in this thesis examine advances in the area and at the same time seeks to propose new challenges and opportunities to improve access and quality of mental health care. In addition, it provides a critical view of the barriers detected in the health system that surround and restrict the current and future development of mental health networks, as well as the improvement of community-based services in primary care for most vulnerable people in our society.
ABSTRACT: Psychiatric reform experiences have been highlighted during last decades due to its capacity to mark a development path for mental health that is more inclusive and integrated in the context of the community mental health model. Within these experiences with global impact we can find countries such as England or Italy, and importat developments in Latin America and the Caribbean such as Brazil, Argentina (Rio Negro) and Chile. In the case of Chile, although the installation of community mental health does not have frontiers of reform as in the mentioned experiences, a differentiating element is distinguished: the integration of mental health in primary care. Primary health care in Chile has had a great development since Caracas Declaration and from there it intends to integrate, not without difficulties, mental health in general health, a pattern that will be reproduced in the following levels of care to achive an adequate transit and continuity of care for people within the health care network. This work aims to characterize the presence of mental health in the primary care level in the western sector of Santiago de Chile. To this end, a compilation of bibliographic data has been carried out, accompanied by the application of EVARED instrument version 2016, a tool developed and validated by the University of Chile. In parallel, some relevant aspects of mental health in primary care were obtained from the national statistical program (REM1). The information collected aims to provide a state of mental health at the primary care level in a territorial area of Santiago with a wide geographic dispersion, massive populations, groups of significant social vulnerability and high dependency rates of the public health system. The main points addressed in this thesis examine advances in the area and at the same time seeks to propose new challenges and opportunities to improve access and quality of mental health care. In addition, it provides a critical view of the barriers detected in the health system that surround and restrict the current and future development of mental health networks, as well as the improvement of community-based services in primary care for most vulnerable people in our society.
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Palavras-chave
Saúde Mental Organização de serviços Cuidados primários Modelo de saúde familiar Integração da saúde mental Saúde mental comunitária Chile Mental Health Organization of mental health services Primary care Family healh model Integration of mental health Community mental health model Chile