Análise das falas de familiares e usuários do CAPS diante das camadas distais do modelo de Dahlgren e Whitehead sobre determinantes sociais em saúde

Abstract

Introduction: Mental well-being encompasses intrinsic and extrinsic factors of human beings, including biological, psychological, emotional, and sociocultural factors inherent to each society. Psychosocial Care Centers function as specialized care facilities for individuals with severe mental disorders and distress, integrating the network of outpatient care. Objective: To analyze the statements of family members and users of the Psychosocial Care Center regarding the layers Living and working conditions and General socioeconomic, cultural, and environmental conditions, according to the Dahlgren and Whitehead model. Method: This is a cross-sectional, descriptive, and exploratory study with a qualitative approach. Data collection took place at the Chiquita Bacana Psychosocial Care Center II, located in the municipality of Santa Cruz, Rio Grande do Norte, in the Trairi region. The inclusion criteria considered all users aged 18 and over who sought care at the Psychosocial Care Center during the data collection period and were accompanied by a person they identified as family. Structured interviews were conducted and divided into thematic categories. The findings were analyzed using the Social Determinants of Health model by Dahlgren and Whitehead. Results: Statements from 12 users and 12 family members were analyzed and are presented in thematic categories. Users and family members were unemployed or engaged in informal activities; those working expressed satisfaction with their roles. The primary source of income cited was social assistance programs and pension benefits. Most respondents lived in their own homes. The majority lived with others, with an average of three to four people per household. Regarding water supply, participants reported difficulties in access. Basic sanitation conditions included mentions of septic tanks and drainage systems; for waste collection, burning waste and collection vehicles were cited. Users and family members reported consuming three to four meals per day. The most frequently mentioned healthcare services were Basic Health Units and regional reference hospitals; the most commonly cited public services were health posts and educational institutions. Participants showed little interest in participating in cultural activities or those related to public policies. Most participants stated they lived in areas with adequate public lighting. Reports on urban paving included mentions of both unpaved and paved streets, with the greatest dissatisfaction related to public safety. Conclusion: The analysis of the collected statements suggests that living and working conditions, along with socioeconomic, cultural, and environmental factors, play a determining role as protective or vulnerability factors affecting the mental health of the studied population. These effects are directly linked to the quality, access, and effectiveness of available services and resources.