EVALUATION OF THE ORGANIZATION OF CARE IN MENTAL HEALTH IN PRIMARY HEALTH CARE IN BRAZIL

Abstract The article is the result of a cross-sectional study about care in mental health with 29,778 teams from the Family Health Strategy from all over Brazil (87.1% of the total of teams), including a normative evaluation of the data of the second cycle of the National Program for the Enhancement of Access and Quality in Primary Health Care (2013-2014) in the dimensions of the profile of the professionals, promotion of mental health, management, and offer of care. The results showed that 33.8% of the interviewees had precarious labor relationships, and that 60.3% of them did not feel prepared to work in mental health. The offer of the set of actions evaluated only occurred in 9.5% of the teams in all of Brazil (2.2% in the Northern region). Around half of them did not develop strategies to promote health, and only 9.8% actually carried out the management of care. We concluded that the low percentages of implementation on the national level coexist with significant regional inequalities, with the worst results coming from the Northern region. It is necessary to strengthen the actions of promotion of health, the qualification of the teams, to reverse the precariousness of the labor relationships, and to reorganize the management of care.

摘要 本研究为一项关于精神卫生照护的横断面研究，纳入巴西全国范围内的29778支家庭健康战略（Family Health Strategy）团队（占团队总数的87.1%），并基于2013-2014年全国基层医疗可及性与质量提升计划（National Program for the Enhancement of Access and Quality in Primary Health Care）第二周期的数据，从专业人员概况、精神卫生促进、管理及照护服务提供四个维度开展规范性评估。研究结果显示，33.8%的受访者存在不稳定劳动关系，60.3%的受访者表示未做好精神卫生照护工作的履职准备。本次评估覆盖的全套照护措施仅在全国9.5%的团队中得到落实（北部地区仅为2.2%）；约半数团队未制定健康促进策略，仅9.8%的团队实际开展了照护管理工作。研究结论表明，全国层面的措施落实率偏低，同时伴随显著的区域医疗不平等，北部地区的表现最差。本研究提出，需强化健康促进行动、提升团队专业资质、扭转劳动关系不稳定局面，并重构照护管理体系。