A interface entre os agentes comunitários de saúde e o cuidado em saúde mental no município de Novo Airão - AM

Abstract

Introduction: This study analyzes the mental health care practices carried out by Community Health Workers (CHWs) in the municipality of Novo Airão, Amazonas—a territory marked by logistical challenges, historical inequalities, and a shortage of specialized resources. Acting as a bridge between users and health services, CHWs develop actions that, although not systematized into specific protocols, constitute concrete and sensitive forms of psychosocial care. This research arises from the need to give visibility to these local forms of knowledge and practice, which remain underexplored in the literature, particularly in the Amazonian context. Objective: To understand the daily practices of Community Health Workers (CHWs) in providing mental health care in Primary Health Care in the municipality of Novo Airão-AM. Methodology: This is a qualitative, descriptive, and exploratory study. Ten semi-structured interviews were conducted with CHWs working in both urban and rural areas of the municipality, selected based on their length of experience and territorial engagement. The analysis followed thematic categorization procedures grounded in the listening to participants' narratives, in accordance with the principles of content analysis. The theoretical framework was based on psychosocial care, humanized practices in Primary Health Care (PHC), and continuing education in health. The interviews led to the construction of five main analytical categories: (1) Actions carried out by CHWs in Mental Health; (2) Operational and contextual challenges in Mental Health work; (3) The impact of work on CHWs’ own mental health; (4) Training needs and institutional gaps perceived by CHWs; and (5) Sociocultural and territorial aspects in recognizing mental suffering. Results: The narratives indicate that CHWs engage in active listening, welcoming, and mediation with health units, even without structured technical or educational support. Mental health care emerges as an implicit part of their work routine, especially when dealing with situations involving violence, grief, social exclusion, and psychosocial suffering. The main challenges identified include the lack of mental health training, institutional support, and the fragile structure of the Psychosocial Care Network (RAPS) in rural areas, as well as the emotional burden faced by CHWs. Their immersion in the territory enables CHWs to recognize mental suffering in a broad sense, beyond clinical diagnoses, incorporating affective, cultural, and social dimensions. Despite adversity, these professionals demonstrate a strong commitment to care, acting as “sentinels of suffering” and identifying their work as a source of subjective protection, even when marked by exhaustion. Conclusion: The research highlights the strength and potential of CHWs' work in mental health care within Primary Health Care in an Amazonian municipality. Their often-invisibilized practices build an ethical, relational, and territory-based model of care. Recognizing and valuing these forms of knowledge is essential to strengthening the Psychosocial Care Network (RAPS) and promoting public policies that are more attuned to local realities. Among the suggestions offered by CHWs are the strengthening of intersectoral partnerships, investment in resources that support care in the territories, and the expansion of mental health training. By listening to the CHWs, this study contributes to the development of public policies more deeply rooted in the Amazonian reality and in the daily work of Primary Health Care professionals.