Caracterização da assistência à saúde mental na infância e adolescência no estado de Minas Gerais

Abstract

Introduction: Although the worldwide prevalence of mental disorders in childhood and adolescence is close to 13.4%, little is known about the installed capacity of services and qualified professionals in Minas Gerais (MG). Considering the high risk of continuity between childhood and adult disorders, effective and early intervention can minimize the burden on the individual and the family, and reduce costs to health systems and communities. In Brazil, the service specialized in attending to this profile of patients is the Centro de Atenção Psicossocial Infantojuvenil (CAPSi). Objectives: To characterize the mental health care of children and adolescents in MG, from 2007 to 2020, in relation to availability services, professionals and profile of care. Method: This is an observational, descriptive study that has as its scope the mental health services for children and adolescents in MG. Data were collected regarding childhood and adolescence mental health throughout the available period: 2007 to 2020 for data from health services and 2013 to 2019 for data referring to outpatient production (Registro de Ações Ambulatoriais em Saúde – RAAS) and hospital production (Autorização de Internação Hospitalar – AIH). The databases used are in the public domain: Cadastro Nacional de Estabelecimentos de Saúde, Sistema de Informações Ambulatoriais, Sistema de Informações Hospitalares e Conselho Federal de Medicina. Descriptive and comparative analyzes were performed. This study was exempted from consideration by the Ethics Committee. Results: Minas Gerais has 42 CAPS that cater exclusively to children and young people. There was an increase of 381% in the number of services in the period from 2013 to 2020 and, even so, there are two macro-regions of the State that do not have CAPSi. The geographical distribution of services and professionals is uneven and most of them are concentrated in the central region. The State has 2.31 higher education professionals and 0.53 child and adolescent psychiatrists per 100,000 children and adolescents. In the period from 2013 to 2019, the number of RAAS issued in the State increased by 356%. The mean age of patients treated at CAPSi increased from 10.88 (±4.31) in 2013 to 11.36 (±4.28) years in 2019. The proportion of boys was higher throughout the period and more than 90% of the consultations took place in the same municipality as the domicile. Individual consultations were the most frequent. There were 16.63 admissions to general hospitals per 100,000 children and adolescents in 2019. The average age of hospitalized patients increased from 13.08 (±4.23) in 2013 to 14.26 (±3.33) years in 2019. Emotion and behavior disorders were more prevalent in outpatient visits, while mood and psychotic disorders stood out in hospitalizations. The State has 0.27 overnight hospital beds for 100,000 children and adolescents, and all these beds are located in the capital. There are no data on specific beds in general hospitals. In addition to patients with severe and refractory mental disorders, moderate and some mild disorders, but refractory to initial treatments, also require specialized monitoring. At least 3% of the population needs ongoing mental health care, which represents a total of 653,548 children and adolescents in MG. Considering the criterion of inhabitants per region for the implementation of CAPSi, MG has 75 eligible micro-regions and, considering only the population, there is the possibility of implementing 300 CAPSi. As Brazil is a middle-income country, there is a deficit of 24.39 professionals per 100,000 children and adolescents in MG. The State has gaps in assistance in all expanded health regions. The number of services, professionals and beds in the state is below world estimates, even when compared to countries with similar income. Final considerations: Despite the increases in the offer of services and professionals, there are still quantitative and distribution deficiencies in the State of Minas Gerais. Investments in the health network, in the training of professionals, in the construction of public policies and indicators are necessary to improve care.