Trilhas do cuidado interseccional : práticas de saúde mental a adolescentes escolares na 28ª Região de Saúde.

Abstract

Introduction: The mental health of adolescents is crossed by diverse contexts and social markers that intersect such as gender, sexuality, race, class and geographic location. In view of this, the interconnection between health and education is necessary to promote mental health care practices in an integral and contextualized way in the context of the Psychosocial Care Network (RAPS). General objective of the dissertation: To analyze, in the light of intersectionality, the mental health care practices for adolescent students produced and implemented in the interaction with the Social Determinants of Health (SDH) within the scope of the 28th Health Region. Manuscript I: Intersectionality and Adolescent Mental Health in the Psychosocial Care Network: an integrative review. Objective: to identify how the concept of SDH is articulated with the Intersectionality device in research on adolescent mental health within the scope of RAPS. Method: integrative literature review of national and international articles, published between 2011 and 2024, in the PubMed, Scopus, Web of Science, and Virtual Health Library databases with descriptors in Portuguese and English. The final sample comprised nine articles. Results: the studies show the central role of SDH in the mental health of adolescents and the way in which they intersect, producing suffering. They expose weaknesses of the RAPS, such as the coexistence of divergent care paradigms, precarious working conditions, the need for professional qualification on intersectionality, and difficulty in intersectoral action. They point to the power of intersectoriality as a practical tool for intersectional work and the expansion of understanding about mental health through an intersectional analysis, which considers the lack of access to basic rights as risk factors for the mental health of adolescents. Final considerations: intersectionality is a useful tool for the analysis and transformation of care practices, as it allows us to understand the relationship between structural inequalities and experiences of suffering, which require intersectoral responses, contextualized with the reality of the subjects and aimed at social transformation. Manuscript II: Mental Health and Adolescent Care: conceptions, practices and organization of the Psychosocial Care Network in the 28th Health Region. Objective: to analyze, in the light of intersectionality, how the conceptions of health and education professionals about health, mental suffering and care for adolescents are expressed in the practices and organization of RAPS in the 28th Health Region/RS. Method: participant research, carried out from two methodological axes articulated with each other, accompanied by a field diary. The first axis was composed of semi-structured interviews, carried out with representatives of health and education management. In the second axis, health and education professionals answered an online questionnaire. 19 people participated in the research, seven interviews and 12 questionnaires. For the search, organization and construction of maps from the data, the NotebookLM® and Google® Sheets tools were used as assistants. The data were analyzed from the perspective of the Production of Meanings and discussed through the lens of intersectionality analysis. Results: most of the participants were women and with postgraduate degrees, all were white and cisgender, working in urban and rural territories, from 11 municipalities in the region. The analysis showed the coexistence and tension between two mental health paradigms: biomedical and psychosocial care. The professionals identified that the suffering of adolescents is related to both individual factors and social inequalities, such as discrimination, violence and fragility of care relationships. Despite this, they report that the care practices offered are still fragmented, centered on referrals and poorly articulated between sectors, with few specific actions for adolescents. Although rurality and social class are recognized as markers, structural racism and gender and sexuality issues remain invisible. The lack of knowledge about the concept of intersectionality limits the understanding of the multiple differences that cross the youth experience. Final considerations: the need to intersect the understanding of mental health and adolescence is highlighted, aiming at the transformation of professional practices, overcoming the logic of referrals and the medicalization of life, in line with the Extended Clinic. Manuscript III: Mental health and suffering of adolescent students in the 28th Health Region: intersecting perceptions and experiences. Objective: to understand the conceptions of adolescent students from the 28th Health Region about health, mental suffering and care practices, in the light of intersectionality. Method: participant research with 131 adolescents from seven public schools in the region, aged between 14 and 19 years old The data were produced through the preparation of letters by the adolescents, intended for health or education professionals. The data were produced during the XV Drug Discussion Forum. The analysis followed the perspective of the Production of Meanings, using intersectionality as a theoretical framework. Results: Adolescents define mental health as the ability to deal with challenges in an interdependent way, through family and community support. Suffering was associated with relational and social factors, such as lack of family dialogue, violence, bullying, school pressures, comparisons on social networks and inequalities, which affect young blacks, LGBTQIAPN+ and poor people more intensely. The main demand is for qualified listening, capable of validating experiences and feelings, and overcoming the logic of medicalization of life. The adolescents also suggest the creation of safe spaces for conversation, dialogue circles, psychological support and community practices, also highlighting cultural and sports activities as practices that promote mental health. Final considerations: youth malaise reflects structural inequalities, present in the neoliberal culture and that intersect, which requires territorialized and intersectoral care practices, aiming at social justice and respecting the singularity of the subjects.