Community mental health network care: an evaluative approach in a Brazilian state

Abstract

Abstract In recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of the RAPS in Minas Gerais (MG), the second most populous state of Brazil, generating indicators that can enhance the strategic management of the SUS in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of ‘Family Health Strategy (ESF),’ ‘Expanded Family Health Center (NASF),’ and ‘Psychosocial Care Centers (CAPS)’ but a lack of ‘Beds in General Hospitals (LHG),’ ‘Unified Electronic Medical Records’ and ‘Mental Health Training Activities for Professionals’. In the process dimension, adequate implementation of actions such as ‘Multidisciplinary and Joint Care,’ ‘Assistance to Common Mental Disorders by Primary Health Care,’ ‘Management of Psychiatric Crises in CAPS,’ ‘Offer of Health Promotion Actions,’ and ‘Discussion of Cases by Mental Health Teams’ point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of ‘Psychosocial Rehabilitation Actions,’ ‘Productive Inclusion,’ ‘User Protagonism,’ ‘Network Integration,’ and practical activities for the effectiveness of collaborative care. We found a better implementation of RAPS in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of RAPS are scarce throughout the Brazilian territory, a fact also found in MG, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management.