The complexity of crisis care: contributions of deinstitutionalization to the creation of innovative practices in mental health

Abstract

The implementation of local public policies in mental health in the context of the Sistema Único de Saúde, oriented by the psychiatric reform guidelines and based on the intersectoriality, has posed new challenges in mental health, such as the development of community-based networks and services aiming at replacing the asylum model, establishing rights and creating a new social environment to madness. The study has introduced and discussed that the critical knowledge built on practices of reality changes from Gorizia and Trieste's experiences expressing and proposing a different ethical, theoretical, and political viewpoint to understanding madness and its relationships in the social context. It allows therefore for a new way of thinking the creation of community-based services. Based on this referential and discussions on proposals of changing the way of thinking and acting in collective health, it was sought to build on and reflect on major subjects for the creation of the Núcleo de Atenção Psicossocial da Zona Noroeste given the mental health experience gained in the municipality of Santos for the period between 1989 and 1996, as an open, 24-hour, community-based service, and questioning the process' breakthroughs and contradictions. The present article introduces and discusses one of these subjects, i.e., crisis care, focusing on: psychiatric deinstitutionalization; activation of the actors involved and generation of new responses; the living together and the production of freedom in the daily care: and the hospitality 24-hour both as a resource and a right.