Rede de atenção psicossocial na pandemia de COVID-19: implicações da emergência sanitária na atenção à saúde mental na perspectiva de gestores e trabalhadores de Fortaleza

Abstract

The articulation between Primary Health Care (PHC) and Specialized Care (SC) devices enhances comprehensive, continuous, and coordinated care within the Psychosocial Care Network. The COVID-19 pandemic required the reorganization of health services to address the disease and ensure the continued provision of other health services, including mental health needs. This research aimed to understand the implications of the COVID-19 pandemic on Psychosocial Care Network services in Fortaleza from the perspective of managers and workers. The study used a qualitative health research approach. The research setting was a region in the city of Fortaleza, one of the main entry points for COVID-19 in Brazil. Field research was conducted in two Primary Health Care Units and one Psychosocial Care Center, where 26 semi-structured interviews were conducted with care workers and managers at municipal, regional, and service levels. Document analysis was used as a complementary data production technique, analyzing national, state, and municipal public norms and recommendations for organizing PHC and SC in RAPS during the COVID-19 pandemic, from March 2020 to March 2022. For the analysis, the hermeneutic-dialectic perspective was adopted as a method for explaining reality. The results were organized into: challenges faced by Psychosocial Care Network before the COVID-19 pandemic; implications for psychosocial care in territorial mental health services during the COVID-19 pandemic; challenges for RAPS during the COVID-19 pandemic; and pathways indicated for restructuring the network in the post-pandemic period. Pre-existing challenges in the network worsened during the health crisis, with no effective coordinated strategies to define the role of mental health services during the pandemic and/or promote psychosocial care. The focus on COVID-19 weakened the continuity of mental health care, crisis reception, and the use of new remote tools. The situation highlighted neglect of mental health policy, generating tensions regarding service priorities and network disarticulation. For the post-pandemic period, stakeholders indicated necessary mechanisms to strengthen the relationship between devices and the psychosocial care model. The crisis caused by the COVID-19 pandemic represented an update of pre-existing political and health crises, pointing to the need to include mental health in contingency plans for emergency situations, ensuring support for the population and health workers, as well as the articulation between the health network and other policies and sectors aimed at comprehensive care needs and shared responsibility in care. Thus, a reconstruction of psychosocial care is advocated as an investment model for management and worker practices, challenging the asylum model that still permeates policies, services, and practices.