Análise da Lei 13.438 e suas implicações no cuidado em saúde mental infantil na atenção primária à saúde (APS)

Abstract

The present dissertation aims to critically analyze the Law 13.438 that makes it mandatory for the pediatrician to use a protocol to evaluate the psychic risk in all babies from 0 to 18 months in Brazil. To this end, we searched the websites of the House of Representatives and the Senate for documents, investigating the processes related to the Bills of Laws (PL) that passed through the Brazilian legislature, as well as videos, articles and other texts that addressed the discussion around this law. Thus, the object of this research is enunciated by the following guiding questions: What is the historical course and the political and ideological conditions linked to the production of Law 13.438? What are its possible reverberations for Primary Health Care (PHC) and, consequently, for the SUS? The methodology used in this study is Bibliographic and Documentary Research with a qualitative approach. The documents and data collected in this research were analyzed from the French Discourse Analysis, a proposal that allows reflection on the subjective, historical and ideological dimension of the senses and meanings of the most varied texts produced in different social contexts. From the data found and the critical analysis of Law 13.438, we can see that it was not the object of consensus among the professionals who work with early childhood, nor did it undergo a more democratic and participatory discussion in society, being restricted to a small number of actors, which did not favor the plurality of opinions with diverse clinical and scientific bases. It was these same actors who also contributed to the dissemination of the understanding that "psychic risk" is equivalent to the risk of autism, that is, early signs of autism in babies. The implementation of this law can generate countless implications in the care of child mental health in PHC, since it does not address or direct the form of care to children and/or how they will be assisted in the SUS, much less what procedures will be used for the comprehensive care of these children and their families. There may be a production of many consultations in child care, but we cannot state what types of health production will happen in these procedures and if there will really be efficacy in health promotion. Besides these aspects, we can see that the law analyzed here does not change the current legal order in the care of babies and their families. To conclude, we affirm that the attention to mental health in early childhood in PHC should be done in the childcare consultations using multi and interdisciplinary strategies and actions, and the instrument of monitoring and surveillance adopted should be the Child's Health Booklet. It is urgent to strengthen the continuing education for PHC professionals and other sectors of the SUS in order to equip these workers for a responsible care and for the promotion of mental health in childhood. With this research, we aim to contribute to the understanding of the importance of strengthening and creating strategies for mental health care for children in primary health care as assumptions for comprehensive health care to children in psychological distress and their families as advocated by the SUS.