A POLÍTICA DE SAÚDE MENTAL E O DIREITO À SAÚDE: A experiência da Rede de Atenção Psicossocial de Paço do Lumiar-MA a partir de 2011

Abstract

This dissertation aims to evaluate the implementation process of the Psychosocial Care Network of Paço do Lumiar, assessing its effectiveness in achieving the objectives established in the network's regulations, specifically in Ministry of Health/General Management Ordinance No. 3,088 of December 23, 2011. To this end, the historical-dialectical method was used to understand the trajectory of the constitution of Mental Health Policy in the country. This is a qualitative research study with literature review, documentary research with analysis of secondary data from the Ministry of Health systems, and field research with semi-structured interviews with technicians, managers, and users of the Psychosocial Care Network of Paço do Lumiar. Initially, we discuss the treatment of madness in the history of humanity, the birth of the asylum and psychiatry, highlighting the constitution of the Psychiatric Reform in the world and its influences in Brazil. In the second part, we discuss the Psychiatric Reform and the Brazilian anti-asylum movement, highlighting the establishment of Mental Health Policy as a social right in the context of the changes suffered by the Psychiatric Reform in the country following the rise of neoliberal ideas, especially in the period of 2016-2022.Finally, we address the configuration and functioning of the Psychosocial Care Network (RAPS) in the municipality of Paço do Lumiar. As a result of this study, it was found that the RAPS in Paço do Lumiar presents weaknesses and gaps in care, with slow implementation of its services over the years until 2025. Therefore, there is a concentration of demands in specialized services, because the outpatient and asylum model is still present in its operation, failing to meet the objectives established in the Psychiatric Reform Law of psychosocial and community-based care. There are also reports of rights violations among RAPS users, as well as difficulties in establishing dialogue and sharing care among the health facilities of the RAPS in Paço do Lumiar. Furthermore, there is a scenario of a deficit in the number of professionals which, added to the insufficient number of health facilities, compromises the establishment of comprehensive care within the SUS (Brazilian Unified Health System). The social control exercised by the Municipal Health Council is weak, and there are no user associations in the municipality to defend their interests, which makes the implementation process of the network vulnerable in this territory. The year 2023 marks the resumption of the construction of the Psychiatric Reform in the country and, at the municipal level, the year 2025 begins a new administration more committed to the consolidation and implementation of the Psychosocial Care Network (RAPS). However, given the period in which this research was conducted, this was not enough to change the challenging situation for RAPS. Therefore, the evaluation found an incipient fulfillment of RAPS objectives, which demands strong efforts to materialize this policy that continues to be marked by stigmas and violations of rights.