“Podemos fazer diferente”: a psicologia na atenção básica do Sistema Único de Saúde

Abstract

The Unified Health System (SUS) emerged from the struggle to transform the health care model in Brazil, and its construction is still in progress. Within the three levels of care that make up the SUS, Primary Care (AB)stands out in thisstudy, which is considered the organizer of the health network and care coordinator, due to its insertion in the territory and proximity to the) users. This level of complexity is formed by multidisciplinary teams that work to provide comprehensive individual and collective care for the entire population. In this direction, due to the complexity involved in the PC context and, aiming to guarantee greater integrality for SUS users, other teams were created in addition to the Family Health (eSF) teams, such as, for example, , the Street Clinic (eCR) and the Expanded Center for Family Health and Primary Care (NASF-AB) teams, which enabled the expansion of health care to include other professional categories, initially not included in this level of care, such as, the psychologist. In this way, the objective of this study is to understand the practices of the psychologist in AB, highlighting the potentialities and challenges experienced in the context of the SUS, which includes the Covid-19 pandemic and the political changes that occurred in 2016 to 2022. The proposal of this research was developed with the accomplishment of two studies: (1) Integrative literature review on the role of the psychologist in PHC nationwide; and (2) The practices of psychologists in PC, the potentialities and challenges of the municipal reality of Vitória - Espírito Santo (ES), considering the crossings generated by the Covid-19 pandemic and the political changes expressed in the Constitutional Amendment 86 (E86), Constitutional Amendment 95 (PEC 95), the National Primary Care Policy (PNAB 2017) and Ordinance No. 2,979. In this study, semi-structured interviews were conducted with 14 participants. Data were analyzed with the aid of software, in the light of psychosocial theories. The integrative literature review enabled the apprehension of four thematic categories: category 1 - “Traditional clinical model in Psychology and initiatives to transform training for psychologists to work in AB”; category 2 - “Psychologist practices/performances: possibilities in AB”; category 3 - “Bond, integral and humanized care and qualification of work processes: potentialities of the work of Psychology in PC”; and category 4 - “Difficulties and challenges of the performance of Psychology in AB”. The research carried out in the municipality of Vitória resulted in five categories, namely: “Practices of psychologists in AB: before and during the Covid-19 pandemic”; “Work organizations in AB: in the Covid-19 pandemic and beyond”; “‘We can do it differently’: relations with the territory and interprofessional partnerships”; “AB and the psychologist: strengths and difficulties”; and “Historical and current particularities of the functioning of the PC in the municipality”. It is considered that the objectives proposed in this research were achieved. It was possible to apprehend the willingness of psychologists to develop collective and integral practices for health promotion, deviating from a purely traditional clinical assistance and approaching the principles of the SUS. The divergent political actions with the proposal of the SUS are also related, with the weakening of the SUS and in specific of the AB, which has resulted in the possibility of fragmentation of the integral attention to the health and in the possibility of the professional psychologist to leave to compose AB's services. The health crisis of the Covid-19 pandemic added to the political scenario, highlighting the importance of financial investment and in teaching and research in Brazilian institutions. It should be noted, therefore, that the diversification of practices discussed in this research does not occur only by the professional psychologist, but by him/her along with the PC teams.