Experiências de usuários e profissionais na implantação da Gestão Autônoma da Medicação na Rede de Atenção Psicossocial

Abstract

The psychosocial care model, a result of the Brazilian Psychiatric Reform, brought important advances in the treatment of people with mental disorders or in harmful use of alcohol, crack cocaine, and other drugs. The psychosocial rehabilitation, a permanent goal of the services that make up the Rede de Atenção Psicossocial (RAPS), proposes actions to promote opportunities for recovery and autonomy of people with mental suffering in the various areas of life. However, it is observed, in the daily life of mental health devices and in the relationship between professionals and users, contradictions to this principle, especially in situations that involve the exercise of negotiation and the user’s decision about his own therapeutic project, especially with regard to pharmacological treatment. In response to this challenge, the Gaining Autonomy & Medication Management (GAM) is an innovative strategy in the field of mental health, aimed at reflecting on the role of medication and other care practices in daily life, encouraging users to develop personal and social attributes that can: increase quality of life and well-being; express knowledge from the subjective experience of medication; have access to rights related to treatment; exercise the power of contractuality, dialogue, and shared management of care with health professionals. Therefore, this research – part of a project of the Laboratório de Estudos e Pesquisas Qualitativas Interdisciplinares em Saúde (LabQuali) in Programa de Pós Graduação em Ciências da Saúde (PPGCS/Unimontes) – aimed to analyze the effects of participation in GAM groups for professionals and users of the Centro de Atenção Psicossocial (CAPS II) in the city of Janaúba – MG. For this, a qualitative study was carried out, in the configuration of research-intervention, in which a GAM group was implemented in this service. Six professionals and twelve users of the health service participated in the study. For data collection, a semi-structured interview was used, carried out in two moments: before (M1) and after (M2) the participation in the GAM groups. The interviews were recorded, transcribed and processed in the ATLAS.ti software, through the Coding Cycles technique, and late examined by Discourse Analysis, theoretically instrumented by studies of the Micropolitics of the Health Work Process and by the qualitative examination of its care technologies. Three axial categories were defined concerning the micropolitical dimension of care: the institutional plan, related to the participants’ description of their routine; the intercessor spaces, developed in the actors’ intersubjective relations; and the subjective production of the agents in the ways of meaning and acting in health. Dissonances were revealed between the statements alluding to the psychosocial care policy, with the competition of emancipatory and restrictive conceptions and technologies of care, which are deepened in the drug treatment. We concluded the importance of the micropolitical analysis of care in psychopharmacological treatment, favoring the processes of contractuality, and user autonomy.