Mental health in primary care: a unique therapeutic project

(Anh Nguyen, Unsplash)

This article was exclusively written for The European Sting by Ms. Kristen Guilarducci Laureano, a second-year medical student at the Pontifical Catholic
University of Goiás. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

In an urban community of 100 people, 17 have thought about suicide at some point of their lives; 5 have planned only and 3 have attempted it. Suicide is often seen as the result of a decision-making process that considers the positive and negative aspects of being alive, therefore the conclusion is that it is better die than being alive.

However, those situations are the exception, because it is often linked to mental health problems, which, if properly diagnosed and treated, will lead to a reduction of attempts and deaths related to it. Approaching and preventing suicide risk is a responsibility of all health professionals, no matter what caring level.

However, Primary Health Care (PHC) occupies a privileged role at care not only for articulation of network support for people in risk, but also their relatives and friends. It starts from a vast understanding of the health-disease process, so that it coordinates care rationalizing the use of expensive technologies and therapeutic resources and structuring care at different levels of the Unified Health System (SUS).

Besides that, it may also use other resources such as involving the community in building the necessary support. It is evident that suicide goes beyond the limits of psychiatry and psychology, so that Primary Care professionals are essential for its prevention, aiming to reduce the rates of attempts and consummated suicides, as 45% of those who died by suicide were attended by PHC professionals in the month before their death and only 19% had consulted with a mental health professional.

Thus, this sector allows the construction of a unique therapeutic project (PTS) that involves a more frequent monitoring and may integrate community actions, PHC service and specialized services. The person in risk can, in the same week, go to psychotherapy, Psychosocial Care Centers (CAPS), to have a consultation with the family health team, a joint consultation between the FHS team and the NASF (Family Health Support Centers) or participate in a community activity.

The CAPS aims to replace the logic of hospital-centered care, offering its users the necessary care without removing them from everyday life such as: family, work, other social circles, leisure and the exercise of their civil rights. The NASF aims to provide matrix support, increasing the resoluteness of Primary Care teams, expanding their scope of actions.

The frequency will depend on the suicide risk severity level and the conditions proposed at the PTS. Thus, it is essential to emphasize that patients can reach PHC through the subject by their own will, as a demand for care; through family, people or community; through the identification of the professional in a follow-up; or through social assistance or education.

In conclusion, due the strengthening and expansion of the SUS gateway, access to mental health services in the region has increased. However, in order to fulfil the function, actions are required to equalize meeting scheduled and spontaneous demands, in addition to expand the supply of PHC, ensuring a PTS for mental health.

References

1.         Fortalecimento da atenção primária à saúde: Estratégia para potencializar a coordenação dos cuidados. De Almeida P, Fausto M, Giovanella. Revista Panamericana de Salud Publica/Pan American Journal of Public Health, vol. 29, issue 2 (2011) pp. 84-95.

2.         Avaliação do Risco de Suicídio e sua Prevenção. Coleção Guia de Referência Rápida. Rio de Janeiro, 1ª edição/2016. PREFEITURA DA CIDADE DO RIO DE JANEIRO.

3.         Entrapment, positive psychological functioning and suicide ideation: A moderation analysis. Teismann T, Brailovskaia J. Clin Psychol Psychother. 2019 Oct 15.

About the author

Kristen Guilarducci Laureano is a second-year medical student at the Pontifical Catholic
University of Goiás. She is interested in film, psychiatry and public health. She believes mental health is a 21st century priority. She is a member of the IFMSA BRAZIL PUC GO committee.