The outpatient setting and mental health care: Models under analysis

Abstract

Psychosocial Care Networks (RAPS) have undergone constant reconfiguration in recent years, creating tension in the integration of mental health outpatient clinics into their formal structure. This article analyzes the care models and tensions that permeate the outpatient setting within this field. The discussion stems from a section of a doctoral thesis, developed through intervention research with a cartographic approach, in a mental health outpatient clinic in a medium-sized municipality in the metropolitan region of Curitiba, Paraná. Data collection strategies included document analysis of the (re)composition of the RAPS (2011–2023), participant observation as a researcher-worker, and the proposal of a therapeutic group within the service. Three phases are identified: the first, under a traditional model; the second, marked by normative changes and team recomposition, driving a review of practices towards the psychosocial model; and the third, characterized by loss of professional autonomy, specialization, and fragmentation of actions. It is argued that tensions persist between the asylum/biomedical and psychosocial models, as well as disputes between matrix integration and fragmented specialization. Field experience indicates that, as relevant as creating services, is defining care models that guide practices aimed at the comprehensiveness of the Brazilian Unified Health System (SUS). KEYWORDS Ambulatory care. Psychiatric rehabilitation. Unified Health System. Psychiatric Reform.