Itinerários terapêuticos de usuários da Saúde Mental em uma periferia de Contagem-MG: um estudo interseccional no Distrito Sanitário de Vargem das Flores

Abstract

In Brazil, health is recognized as a constitutional right of every citizen. However, the country’s historical context of profound social inequalities has posed persistent challenges for the Unified Health System (SUS) in ensuring this right in practice. In the field of Mental Health in particular, the citizenship of individuals experiencing psychological distress is often not fully guaranteed. Within this context, this Master's thesis aimed to understand the therapeutic itineraries of people who have experienced intense psychological distress and were undergoing psychosocial follow-up in primary care of the Vargem das Flores Health District - a peripheral area of Contagem, Minas Gerais, marked by severe social vulnerability. This qualitative study employed the methodology of therapeutic itineraries, widely used in Collective Health to examine trajectories of care. The approach sought to grasp the subjective universe of mental health service users in the territory, identifying pathways, barriers, and strategies mobilized in their search for care, as well as the meanings attributed to experiences of illness and healing. Data were produced through narrative interviews with ten adult participants, predominantly low-income Black women with limited formal education. The material was analyzed through Reflexive Thematic Analysis, drawing on the critical social theory of intersectionality and the perspective of the social determination of health. These frameworks were fundamental for interpreting the studied reality. The results reveal how racism, sexism, poverty, and stigma associated with mental illness intersect to shape both the production of suffering and the trajectories of care-seeking. Far from being passive recipients, participants develop complex navigation strategies across formal and informal care networks, highlighting the crucial role of faith, religiosity, and traditional knowledge as complementary therapeutic resources. The analysis also points to major barriers to accessing specialized services, excessive medicalization within primary care, and high staff turnover as key factors that undermine the continuity and comprehensiveness of care. It concludes that understanding these itineraries through the lenses of intersectionality and the social determination of health is essential to improving mental health practices and advancing public policies capable of confronting the structural inequalities that permeate the health–illness–care process.