Mental health and suicide prevention: the contradictory access in a reference city of southern Brazil

(Brut Carniollus, Unsplash)

This article was exclusively written for The European Sting by Ms. Mariele de Paula, 3rd year in medical school, academic from Ingá University Center (Uningá), member of the International Federation of Medical Student Associations of Brazil. 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.

Maringá is a Brazilian city that occupies the third place in the list of the most populous of its state, Paraná. According to the Ministry of Health from Brazil (DATASUS), Maringá has a per capita suicide rate of 5.70, while the national rate is 5.01.

Starfield (2002) explains the difference between the concepts of access and accessibility. The second one refers to the fact that people come to services and the first one use of services in order to meet the user’s needs in a resolute way.

In this sense, Maringá, even with a huge structural in the accessibility of treatment of mental illness, about thirty-eight Basic Health Units (UBS) with one psychologist in each unit, nine teams of the Family Health Care Center, Public Psychiatric Emergency Service, Mental Health Complex, with services from the Psychosocial Care Centers and the Intermunicipal Health Consortium, has a large deficit in access to services. Observing the flow of patients in the UBSs, it is clear that the initial reception in mental health is still very deficient in most of these units, as many employees are neither qualified nor motivated to serve the population looking for these services, unaware of the necessary information for the user benefit from proper access.

Considering that the suicidal population sometimes looks for primary care services before committing suicide attempts, we find at this point a chance to prevent them from occurring. Among the factors that hinder the effective access of users to health services in our region, the main ones are bureaucratization, the delay of actions and procedures and the long waiting time for consultation until getting access to multidisciplinary treatment.

These difficulties may be mainly related to the high flow of patients compared to the number of medical professionals and psychologists available at the UBSs, as well as the mismanagement of existing service strategies, such as community therapy, which allows reaching a large number of patients at the same time.

Therefore, the training of professionals involved in public health, especially those in primary care, is indispensable. These professionals should have strategies of approaches that allow effective access to public services by the patient, and become close to users, building reliance between them, which allows the expression of suicidal intent.

Thinking about the population that does not seek medical help, but are at risk, the Community Health Agents, after receiving specific training, could also be provided with strategies to approach and screen for suicidal behaviors of their assigned population during home visits. This screening can be facilitated by means of a mental health stratification questionnaire, which allows to detect risk factors for the development of mental disorders, such as depression, generalized anxiety, mood disorders, drug abuse, in order to refer and direct this patient directly to the indicated service, reducing the rate of undiagnosed psychiatric patients whose illness may be aggravated by lack of specialized treatment. In addition, attention to the psychiatric patient should be given in an integral and continuous manner, aiming at protection against possible crises.

References

ABREU, K. P. et al. Comportamento suicida: fatores de risco e intervenções preventivas. Revista eletrônica de enfermagem, v. 12, n. 1, 2010.

BOTTI, N. C. L. et al. Características e fatores de risco do comportamento suicida entre homens e mulheres com transtornos psiquiátricos. Cogitare Enfermagem, v. 23, n. 2, 2018.

CAMPOS, R. T. O. et al. Avaliação da qualidade do acesso na atenção primária de uma grande cidade brasileira na perspectiva dos usuários. Saúde em Debate, v. 38, p. 252-264, 2014.

DATASUS Ministério da Saúde.Sistema de Informações sobre Mortalidade (SIM). Access 21/08/2019, available in: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sim/cnv/ext10br.def

IBGE. Instituto Brasileiro de Geografia e Estatística. Access 21/08/2019, available in: https://cidades.ibge.gov.br/brasil/pr/maringa/panorama

Maringá é referência nacional em atendimento à saúde mental. Access 21/08/2019, available in: http://www2.maringa.pr.gov.br/site/index.php?sessao=88b1d65db75588&id=33466

PADILHA, C. S.; OLIVEIRA, W. F. Terapia comunitária: prática relatada pelos profissionais da rede SUS de Santa Catarina, Brasil. Interface-Comunicação, Saúde, Educação, v. 16, n. 43, p. 1069-1086, 2012.

About the author

Mariele de Paula, 3rd year in medical school, academic from Ingá University Center (Uningá), member of the International Federation of Medical Student Associations of Brazil and extension director of academic league of medical genetics. Raphaela Montalvão Morais and Giovanna Furini Lazaretti both of 3rd year in medical school, academics from Ingá University Center. These students from the same year and localities articulated themselves with the objective of reporting and solving a current problem that has occurred in their city.