The praxis of mental health care and the manifestation of stigma: an ethnographic study in mental health centers in the Biobío Region, Chile.

内容摘要

In this article, we inquire into how mental health praxis reproduces stigma toward users of mental health centers in the Biobío Region of Chile, focusing on the relational space of interactions where stigma is expressed and sustained. Based on a qualitative research design with an ethnographic approach, from June to September 2018 we conducted participant observation in both formal and informal contexts of health services, as well as ethnographic and semi-structured interviews. We identified a persistent tension between the community mental health model promoted by public health policies and biomedical approaches to the care of users with psychiatric diagnoses. These tensions shape the daily practice of health personnel and, consequently, the type of interventions that users receive in their interactions and participation within health services. They manifest in at least two dimensions: first, in the predominance of the biomedical model over other medical practices, which impacts and constrains the exercise of professional roles; and second, in the working conditions faced by mental health professionals, which lead them to experience burnout. We argue that both dimensions, in their interrelation, influence trajectories of mental health care and contribute to the reproduction of stigma toward people living with mental health conditions. En este artículo nos preguntamos cómo la praxis en salud mental reproduce el estigma hacia usuarios de los centros de salud mental en la Región del Biobío en Chile, partiendo del espacio relacional de las interacciones, donde el estigma se expresa y sostiene. Desde un diseño de investigación cualitativa con enfoque etnográfico, de junio a septiembre de 2018, se realizó observación participante en contextos formales e informales de los dispositivos de salud, entrevistas de tipo etnográfica y entrevistas semiestructuradas. Identificamos una constante tensión entre el modelo comunitario en salud mental, promovidas por las políticas de salud pública, y las formas biomédicas en la atención de usuarios con diagnóstico psiquiátrico, que impactan en la práctica cotidiana de atención del personal de salud y, por ende, en el tipo de intervención que los usuarios reciben en la interacción y participación en los dispositivos de salud. Dichas tensiones se manifiestan en al menos dos ámbitos: por un lado, en la preponderancia del modelo biomédico frente a otras prácticas médicas, impactando y constriñendo el ejercicio de su rol profesional; y, por otro, se expresa en las condiciones del trabajo que deben desempeñar los profesionales en salud mental, lo que los conduce a experimentar agotamiento. Sostenemos que ambos ámbitos, de manera interrelacionada, impactan en las trayectorias de atención en salud mental e inciden en la reproducción del estigma hacia personas que padecen enfermedades de salud mental. In this article, we inquire into how mental health praxis reproduces stigma toward users of mental health centers in the Biobío Region of Chile, focusing on the relational space of interactions where stigma is expressed and sustained. Based on a qualitative research design with an ethnographic approach, from June to September 2018 we conducted participant observation in both formal and informal contexts of health services, as well as ethnographic and semi-structured interviews. We identified a persistent tension between the community mental health model promoted by public health policies and biomedical approaches to the care of users with psychiatric diagnoses. These tensions shape the daily practice of health personnel and, consequently, the type of interventions that users receive in their interactions and participation within health services. They manifest in at least two dimensions: first, in the predominance of the biomedical model over other medical practices, which impacts and constrains the exercise of professional roles; and second, in the working conditions faced by mental health professionals, which lead them to experience burnout. We argue that both dimensions, in their interrelation, influence trajectories of mental health care and contribute to the reproduction of stigma toward people living with mental health conditions.