Bosi Maria Lucia Magalhães, Melo Anna Karynne da Silva, Carvalho Liliane Brandão, Ximenes Veronica Morais, Godoy Maria Gabriela Curubeto
Universidade Federal do Ceará, Fortaleza, CE, Brazil.
Universidade de Fortaleza, Fortaleza, CE, Brazil.
Rev Bras Epidemiol. 2014;17 Suppl 2:126-35. doi: 10.1590/1809-4503201400060011.
The Brazilian Psychiatric Reform, an ongoing process, and its developments involve the construction of new ways of seeing the subject in illness, establishing the mental health field in a new way of understanding the social determinants that reflect in the deinstitutionalization and social inclusion.
This study, multidimensional analysis of the relationship between social determinants and deinstitutionalization in mental health focusing on a community movement in Northeast Brazil, whose proposed work is subjective and psychosocial dimensions, aims to explore and analyze how the experiences in course of the Movement highlights the importance of social determinants, the perspective of professionals.
The methodological approach outlined in the qualitative approach in the form of case studies, employing techniques such as interviews and focus groups. The categorization of analytical information was built from the relationship established between a model based on the constituent dimensions of the psychiatric reform, covering different planes, namely epistemological, healthcare, legal and socio-political, and social determinants of health - living conditions, and work environment, community networks and support, economic, cultural and environmental behaviors and lifestyles.
The results show emphasis on the social subject, making the processing and knowledge of professionals, adding new ways to produce health; dialogue with multiple stakeholders, building autonomy, participative management, concern for professionalization; reorganizing the work process; appreciation of the everyday activities that weave and; invention of a new social site, among other elements in close interface with the determinants of health.
These elements indicate that care practices woven into the daily life of the Movement involve the disassembling the traditional model of mental health care, stimulating new forms of citizenship, thus contributing to the institutionalization and promoting equality of income, social cohesion and participation policy for the promotion and protection of health.
巴西精神卫生改革是一个持续的过程，其发展涉及构建看待患病主体的新方式，以一种理解社会决定因素的新方式确立精神卫生领域，这些社会决定因素反映在去机构化和社会包容方面。
本研究聚焦巴西东北部的一场社区运动，对精神卫生领域社会决定因素与去机构化之间的关系进行多维度分析，其拟开展的工作涉及主观和社会心理层面，旨在探索和分析该运动过程中的经历如何从专业人员的视角凸显社会决定因素的重要性。
采用案例研究形式的定性研究方法，运用访谈和焦点小组等技术。分析信息的分类基于一种模型建立，该模型以精神卫生改革的构成维度为基础，涵盖不同层面，即认识论、医疗保健、法律和社会政治层面，以及健康的社会决定因素——生活条件、工作环境、社区网络与支持、经济、文化以及环境行为和生活方式。
结果显示强调社会主体，促使专业人员进行处理和认知，增添产生健康的新方式；与多个利益相关者对话，建立自主性、参与式管理，关注专业化；重组工作流程；重视日常活动的交织；创造新的社会场所，以及与健康决定因素密切相关的其他要素。
这些要素表明，融入该运动日常生活的照护实践涉及拆解传统精神卫生照护模式，激发新的公民形式，从而有助于去机构化，并促进收入平等、社会凝聚力以及促进和保护健康的参与政策。
