Mental health: Network is insufficient to serve children – – Health

Brazil has 292 Caps (Psychosocial Care Centers) dedicated to caring for children and adolescents, with care gaps in different regions. Acre, Roraima and Tocantins do not have any units, while Alagoas, Amapá and Rondônia have only one.

Even in states like São Paulo, which has 79 children and youth Caps, the demand is very high, says Valéria Campinas Braunstein, counselor at the Regional Psychology Council.

By law, Caps i care for children and adolescents who present intense psychological suffering resulting from serious and persistent mental disorders, including those related to the use of psychoactive substances, and other clinical situations that make it impossible to establish social bonds and carry out life projects, like some patients on the autistic spectrum.

The Ministry of Health recognizes that it is necessary to expand the service. “We know that it is still not enough”, says Sonia Barros, director of the Department of Mental Health and senior professor at the Institute of Advanced Studies at USP.

She highlights, however, the increase in funding and incentives for city halls to request the installation of children and youth Caps. Since January, eight units have been enabled, and an existing one requested a change in operation to serve adults.

“We have discussed the possibility of a consortium, bringing together two or three small municipalities that are unable to have a Caps and articulating a reference service for the region”, explains the director. This type of Caps is recommended for municipalities or regions with a population of over 70 thousand inhabitants.

Expansion is one of the needs for mental health care for children and young people. Such as Sheet showed, cities such as São Paulo and Curitiba record an increase in cases of self-harm and attempted suicide among this population and the complexity of the problem demands action on several fronts.

Families need help

Helena (fictitious name), 59, is the only one in the family to give an interview about what happened. On March 6, 2020, her 14-year-old granddaughter committed suicide. The young woman’s mother, then 34 years old, couldn’t stand it and took her own life shortly afterwards, on June 2nd.

“We were confused. A thousand things were going through our heads. Could it be that she had depression and we didn’t realize it? Could it be that she was liking someone and was afraid to tell them? Sometimes, teenagers think things are serious that aren’t.”

He is certain that his granddaughter was feeling something that no one could understand. Therefore, she defends the presence of psychologists in schools and health units. “Sometimes, the child doesn’t want to worry the father, the mother,” she says. “The mother is there, but she doesn’t know what’s going through her son’s head.”

Karen Scavacini, founder of the Vita Alere Institute for Suicide Prevention and Postvention and creator of the Mental Health Map, which lists public support services, defends the importance of access to this information by families.

“Father, mother, when you are faced with this issue, you should seek information, try to understand before judging. You may feel scared, it is normal, but you should look for what leads to this situation and, if you have access to a mental health professional, take the child for an evaluation.”

Schools can deal with emotions

Scavacini defends the adoption of protocols in schools. This way, teachers could know in advance how they are going to deal with the situation, from identifying students who need special attention to referring them to professionals or specialized services, and students would know who to turn to, which staff they can talk to about issues that concerns them. afflict.

She and Braunstein also advocate for emotional education classes – for students to learn to deal with frustrations, understand their limits and assess when it is necessary to ask for help – and for the presence of psychologists in teaching units and institutions that serve children after school.

“We cannot work only with remedial psychology. We need to work with preventive psychology, which will spare that child from so much pain that they end up harming themselves and wanting to end their own life”, says Braunstein.

According to Barros, an interministerial group has discussed the need for psychologists in schools. There is no opinion yet, but participants understand that schools need to welcome and listen to students.

“The school must have its focal point, someone with whom children can talk, regardless of whether it is a psychologist”, he states. “It’s not about doing therapy at school, because the therapeutic intervention is outside, in the health unit, in Caps. But rather, doing this intervention of listening, mediation and referral.”

The director also highlights the importance of intersectoral policies to address social aspects that cause suffering, such as school violence, bullying and lack of income.

“It is more than proven that discrimination, racism and LGBTphobia are determinants of mental health problems. Acting in these situations means preventing suicide and the worsening of mental illness.”

Managers must expand service

Other recommended measures are the inclusion of psychologists in Family Health teams and the hiring of professionals for existing services.

“The UBSs have their psychologists, but in insufficient numbers to monitor the development of children and adolescents. I worked in a health center with 80, 90 patients for one professional”, says Braunstein.

For her, the best option would be individualized monitoring, in partnership with pediatrics. “Anyone who has a child takes them to the pediatrician several times in the first years of life, but the child only goes to a psychologist when they have a question. The ideal would be to monitor them from the beginning, understand how the mother and baby relationship is going, observe signs of post-natal depression. childbirth and the relationship between parents and the child.”

The increase in the number of health services with multidisciplinary teams, including psychologists, psychiatrists and social workers, is also essential.

“Having more Caps would mean having more of the same. What we need is to have more equipment, with better distribution throughout Brazil and that offer patients complete care for their needs at all times and with specific approaches”, argues Antônio Geraldo from Silva, president of ABP (Brazilian Psychiatry Association).

Finally, experts call for the application of the National Policy for the Prevention of Self-Mutilation and Suicide, sanctioned in April 2019. Among other measures, the law provides for compulsory notification of self-inflicted violence and ongoing education for managers and health professionals regarding to psychological suffering.

According to Sonia Barros, the Ministry of Health is organizing a continuing education program for all workers in the mental health network. “We are taking care of the mental health of children and adolescents, but always with the perspective that we can and will do better.”

Where to look for help for children and teenagers?

Basic Health Units
The Ministry of Health’s guidance is to seek care at UBSs, where cases are evaluated and, if necessary, referred to specialized services.

Caps Children and Youth (Psychosocial Care Centers)
Parents or guardians can take the young person directly to Caps Infantojuvenil, which will carry out the assessment and, if the case is simpler, forward the young person to the neighborhood UBS.

Mental Health Map
The website, from the Vita Alere Institute, maps public mental health services available throughout the country, in addition to free or voluntary reception and care services provided by NGOs and philanthropic institutions, among others. It also offers booklets with mental health guidance.

CVV (Center for the Valuation of Life)
Volunteers answer free calls 24 hours a day on 188, via chat, email or directly at a physical service point.

He can talk
Help channel created by Unicef ​​for those aged 13 to 24. In addition to personalized service, it brings together testimonials, tips, tests and self-care guides.