Mental Health Promotion in the school context: strengths, challenges and the importance of intersectoral collaboration for the field of Psychosocial Care

Abstract

Mental Health Promotion initiatives in schools are described in the international literature as a model of proven efficiency. However, few Brazilian studies are dedicated to this subject, especially concerning multi-agency collaboration between CAPSi and the educational sector. This study assumes that one of the main barriers highlighted in this collaboration refers to the low apprehension, by the psychosocial care network, about the psychosocial challenges in schools. Therefore, through focus groups, this research investigated the main challenges and latent potentialities in the school environment to support the elaboration of health promotion initiatives in schools, according to professionals from a public school in Rio de Janeiro. The results indicate that violence and school conflicts are the main challenges. As a way of coping with such problems, we highlight the overcoming of contact barriers between the different cultures in the school, the increase and democratization of the participation of students and their families in the school routine, and the permanent multi-agency collaboration between the psychosocial network and the school network.

Keywords:
Mental Health Promotion; Psychosocial Care Center; Child and Adolescent; School; Multi-agency collaboration

Resumo

As práticas de Promoção de Saúde Mental em escolas são descritas na literatura internacional como modelo de comprovada eficiência. Entretanto, ainda são escassos os estudos brasileiros dedicados ao tema, sobretudo no âmbito da articulação intersetorial entre os CAPSi e o setor escolar. Neste estudo, parte-se do pressuposto de que um dos principais entraves evidenciados nesta articulação remete à baixa apreensão, por parte das redes de atenção psicossocial, sobre os desafios de ordem psicossocial presentes nas escolas. Portanto, esta pesquisa investigou, por meio de grupos focais, quais são, na percepção de profissionais de uma escola pública do Rio de Janeiro, os principais desafios e potencialidades latentes no ambiente escolar, com vistas a fundamentar a elaboração de iniciativas de promoção de saúde mental em escolas. Os resultados apontam que a violência e os conflitos escolares constituem os principais desafios a serem enfrentados. Como forma de enfrentá-los, destaca-se a superação das barreiras de contato entre as diferentes culturas presentes na escola, o incremento e a democratização da participação de alunos e familiares no cotidiano escolar, e a colaboração intersetorial permanente entre a rede psicossocial e a rede escolar.

Palavras-chave:
Promoção de Saúde Mental; Centro de Atenção Psicossocial; Criança e adolescente; Escola; Intersetorialidade

Introduction

Although belatedly, since the beginning of the 21st century, Brazil has made efforts to build a mental health policy for children and adolescents, focused on overcoming the historic care gap that marked the entire 20th century, for the care of this population (Couto; Delgado, 2015). The Child and Youth Psychosocial Care Centers (CAPSi) stand out as local proponents of this policy, based on the principles of universal accessibility, the notion of children and adolescents as subjects of rights, and the construction of territorialized care networks articulated intra and intersectorally (Brazil, 2005). Having noted important advances in this policy (Fernandes et al., 2020), one of its main challenges remains to implement the logic of mental health promotion (MHP) as a guide for psychosocial actions, whether in the scope of management apparatuses, within care processes, or in intersectoral deals.

Developed from the 1980s onwards, the notion of health promotion (HP) emerged as a critique of health modeling based on strictly recuperative initiatives, focused exclusively on the individual sphere, on the restricted role of the health sector and the primacy of the biomedical model of treatment (Buss, 2009). MHP is based on the notion of health promotion and recognizes the processes of health and illness based on their political and social intersections, highlighting the set of micro and macrostructural determinations that define the conditions of individuals and their communities as they reach greater or lesser health degrees (Heeman; Saxena; Moodia, 2004).

As Carvalho (2004) indicates, although the notion of PS refers to a reorganization of the political-assistance logic of health systems, this notion has become subject to different interpretations, depending on the basic political orientation that underlies it. If the centrality of the intersection of micro and macro determinants is recognized in their impacts on the population's health and disease processes, the attribution of responsibility of these determinants becomes variant. For an organization of public policies with a neoliberal matrix, this will mean, exclusively, to enable the population to make healthier life choices, locating in the individual the unique and exclusive center of agency concerning their health processes, in what was called the behaviorist matrix of HP. In contrast, for a progressive perspective, it will mean recognizing a process of mediation between the different levels of organicity - from the individual to the collective and from civil society (community) to the institutionality of the State - in which the expansion of health levels only becomes possible within these mediation dynamics in social space, based on the premise that the processes of subjectivization and individuation always take place within social dynamics. For this study, such a progressive perspective of HP is adopted.

Therefore, this article is affiliated with a MHP perspective whose aspect seeks to rescue, within the conceptions of health and their corresponding models of action, an understanding of the role that the set of shared normativity - as structuring normativity of the symbolic plots of intelligibility derived from productive social processes - operates in defining the modes of agency and relationship that make up the network of sociability that crosses individuals and communities in a given territory (Oliveira, 2021).

Once the multifaceted nature of the determinations of health and disease processes is emphasized, intersectorality emerges as one of the central elements in implementing a psychosocial care network guided by the logic of MHP. In the composition of an intersectorally agreed territorial agenda, articulating psychosocial care services in education, social assistance, and justice and defense of rights becomes essential (Couto; Delgado, 2015).

Concerning the specificities of the articulation between the field of mental health and education, MHP practices in schools are described in international literature as a model of proven efficiency (Kieling et al., 2011; Patel et al., 2007). However, even though it is possible to recognize the school context as a privileged location for MHP initiatives with children and adolescents, few Brazilian studies are dedicated to the peculiarities of the articulation between CAPSi and schools in their territories (Cid; Gasparini, 2016).

It is based on the premise that - in parallel with access barriers, precarious working and hiring conditions, lack of investment in health networks, and the absence of intersectoral strategies - one of the main obstacles to the development of an intersectoral agenda of psychosocial care within the school network concerns a fragile understanding of the psychosocial field about the particularities and challenges that are currently evident in the school environment. This factor ends up contributing to the establishment of a sectoral isolation framework.

Thus, this research aims to investigate what, in the perception of professionals from a municipal school in Rio de Janeiro, are the main challenges and potentialities that arise in the intersectoral articulation between the field of Psychosocial Care for children and adolescents and the school sector to produce MHP strategies. It is believed that by developing research that expands the scope of analysis on such challenges, it becomes possible to provide the field of child and youth psychosocial care with a greater foundation on the needs presented by schools concerning the perspectives of intersectoral and mental health promoting agenda.

Methodology

This is a qualitative-based study, part of a larger research developed for the first author's doctoral purposes, using a Focus Group (FG) to collect information. Six (6) teachers from a municipal school in the city of Rio de Janeiro participated, and 457 students were enrolled in the years corresponding to Elementary School II.

The FG was held in November 2020 via the Zoom platform, given the restrictions imposed by the COVID-19 pandemic, with a prior script of questions related to the specificities and challenges of mental health in the school context and the possibilities for developing MHP actions.

Participants were selected based on their attendance in the preparatory stages of the study, which involved the researcher holding four meetings with teachers to present the objectives and preliminary survey on mental health in everyday school life. Of the total of 29 active teachers at the school, six regularly participated in the preparatory meetings, having been eligible to join the FG. All stages were completed after the research's approval by the University's Ethics Committee hosting the doctorate and by the Municipal Department of Education of Rio de Janeiro (CAAE 20846819.9.0000.5263).

Field

The school studied is in a neighborhood in the city of Rio de Janeiro with approximately 170,000 inhabitants and a Social Development Index of 0.706 (18th best in the city, among 126 neighborhoods evaluated, according to data collected in 2000). The administrative region where the neighborhood is located occupies 18th place out of 159 positions, according to the 2022 Social Progress Index (IPS) ranking.

The neighborhood has an average per capita income of R$2,709.00, with 0.62% of households responsible for people aged 19 or younger; 0.58% of children are in child labor (IBGE, 2010) and, according to DATASUS, 4.8% of admissions to the public health network for children between 1 and 12 years old were determined to be suspected of physical aggression (DATASUS, 2014). Middle-class housing and 13 low-income communities coexist in the neighborhood.

Concerning the educational sector, the neighborhood has nine daycare centers and 13 municipal schools, two Integrated Public Education Centers (CIEP), and three Child Development Spaces (EDI). In the field of social assistance, it is covered by one basic Social Assistance Reference Center (CRAS) and one specialized one (CREAS). Regarding health network, this neighborhood makes up Programmatic Area 2.2, whose structure has two Family Clinics, eight Municipal Health Centers and two Polyclinics, one Reference Center for Occupational Health, one Municipal Rehabilitation Center, one Emergency Care Unit (UPA), two general hospitals, one pediatric hospital, in addition to reference mental health services, such as one CAPS II and one CAPSad II. It is worth pointing out that, until data collection, the region did not have a specific reference CAPSi for coverage of the area.

To present the studied school, data collected from the National Institute of Educational Studies and Research Anísio Teixeira (INEP) at the beginning of the research were used. The school in question had 457 students distributed in 16 classes, operating in two shifts, and is responsible for the final years of Elementary School (students aged 11 to 14). It had 48 employees, of which 29 made up the teaching staff. The historical series of its Basic Education Development Index (IDEB) indicators for the years 2015, 2017, and 2021 are, respectively, 4.9, 5.2, and 5.7, always equal to or above the goals established for the municipality, which registered, respectively, 4.6; 4.9; and 5.7.

Research subjects in the Focus Group

Participants were, on average, 45 years old (SD=4.9), had been teaching for 18 years (SD=5.1), and as teachers at the participating school for approximately 6.5 years (SD=4.2). Everyone signed the Free and Informed Consent Form (ICF) and the Authorization Term for Image and Voice Sound Use. The FG was recorded and transcribed in full, lasting 2 hours and 24 minutes. To ensure confidentiality in the presentation of results, participants will be written in the results as P1, P2, P3, P4, P5, and P6.

FG analysis

The material collected in the FG was subjected to thematic content analysis (Minayo, 1994), which “consists of discovering the 'cores of meaning' that make up communication and whose presence, or frequency of appearance, may mean something for the analytical objective chosen” (Bardin, 1997, p. 105).

Results

The results were organized into three central themes that expressed the most relevant issues in the teachers’ perception of the topic investigated: a) Violence and conflicts as challenges for promoting mental health in the school context; b) Main elements in school conflicts; and c) Possible ways to confront violence and conflicts.

Violence and conflicts as challenges for promoting mental health in the school context

The difficulty in managing conflicts and the presence of situations of violence in everyday school life were highlighted as the main factors that trigger suffering and physical and emotional overload in the school environment. It is worth pointing out that, in their responses, the participants were not restricted to reporting specific experiences of the school studied, but also reporting experiences they experienced in other school units in the municipality.

Statements such as those reproduced below clarify what is referred to as violence and conflicts:

A friend who is a teacher says that she can't give her students scissors to do their work because they cut themselves... and a boy asked to keep a soda in the freezer in the teachers' room; during recess, he took it and beat his classmate with the frozen soda... (P2 /FG - emphasis added)

He [student] got upset about a situation that happened in the classroom, and he thought that when he yelled at me - like, I can only imagine that, you know? - and he was aggressive... I was going to withdraw, keep quiet... and I didn't keep quiet, and then I think he became more and more nervous, more irritated, he lost control, to the point of threatening me... He said: “I I’ll tear you apart” (P3/FG - emphasis added).

According to the participants, the dynamics of violence are not restricted to specific cases but are a privileged form of social bond existing in the school community and its reference territories.

[...] I know that suddenly, someone in the middle of my class would shout, “Mathematics, excuse me!” [...] because, if they didn't shout, the others could go there and hit the person who did something and didn't shout. So, every time we had to go there and separate them because there was a beating in the middle of class, from someone who did something and didn't shout “mathematics, excuse me”, and we had to separate those who were lynching the poor guy (P2/ FG - emphasis added)

I went to work in [name of the neighborhood] and there were guys in front with rifles, right... and then, when I say 'the guys', regardless of whether they are from the police or whether they are drug dealers, you go through that... so what the [participating teacher] said “ah, the student arrived... her house was invaded at six o'clock in the morning”... so, it brings... they bring the traces of a violent city, a violent place, and really... I think that they are not used to being valued (P1/FG. Emphasis added).

The grammar of violence ends up writing a form of social bond that is established beyond situations of dissent or dispute, composing a network of relationships extended to the entire community and established between students, between them and their teachers, between families and the school.

Within this school organization marked by dynamics of violence, teachers recognize that they play the role of conflict managers, the main factor of emotional exhaustion. As observed by one participant, conflict management is carried out in different dimensions: on the one hand, in interpersonal conflicts structured through violence which, as already observed, involve different characters in school dynamics; on the other, in intrapersonal conflicts, related to the psychological suffering experienced by students.

People don't understand [...] but we spend all our time having to build reasoning together with the student, and, at the same time, say “so and so, sit down... so and so, stop it...”, “teacher, he did it, I don't know what…”. And so, it's constant conflict management... I think this is the biggest obstacle to our work, apart from all the demands that come from students, which also have their relationship with behavior, education, mental health... in short... all issues that they have, that we are there managing all the time [...] it's not just me getting there and dealing with thirty at once, right... I manage the internal conflicts of the thirty [...] and theirs some with others, with them with me [...] it's a tense business like that... (P3/FG. Emphasis added)

Main elements in school conflicts

When asked about the elements that would motivate conflicts at school, educators pointed to a kind of clash between cultures evident in the school space: it is a confrontation between different sociocultural perspectives where, on the one hand, there are students and their family members and, on the other, school professionals. Participants describe these different cultures based on two categories: the “community” culture, which concerns the sociocultural specificities of students/families in a cultural perspective typical of Rio’s communities and favelas, while, in parallel, the culture of “asphalt”, corresponding to the teachers’ perspective and which contemplates the sociocultural particularities specific to the urban middle classes. As one of the participants recognizes, the difficulty in establishing mediation channels between these different cultures contributes decisively to clashes and conflicts:

[...] one of the biggest conflicts we have at school are realities... the teacher is not part of the student's reality, and the student is not part of the teacher's reality most of the time... and then the relationship is complex (P3 /FG).

But where I worked at [name of community] the school was inside [name of community], we were the ones who went into it to teach them and... the parents, they sometimes wanted us to act accordingly with the rules of the community, several times we heard “ah, but you can't do that here, this is a favela, it works differently here” [...] and one thing we heard a lot was “ah, this student only does this because the school is in here, if he were in a school on the asphalt he wouldn't do it like that” [...] but it really is a serious point of conflict that there are different realities that clash so much, with the school in the middle practically... (P2/FG - emphasis added).

Simultaneously, educators recognize that the “asphalt” perspective tends to assume a normative position, subjugating the culture of the “community”, reproducing in the school space the processes of marginalization of so-called “peripheral populations” as it occurs in the wide social scenario. Although they recognize that the culture of the “community” has its elements - such as language codes, clothing, etc. -, they state that these tend to be suppressed at school. They also observe the scarcity of spaces for speech and social participation at school, a scarcity that, added to the lack of recognition and value of their culture, tends to generate in students a feeling of not belonging to the school context.

[We must] break this stereotype that we are not rich, that we are not stuck up, and that they are not all criminals... they are marginal in another sense, in the sense of being on the margin... they live on the margins of society… (P3/FG)

They, kind of, don't feel part of the school [...] for most of them, school is the place where they go, attend classes, eat, play ball and go home... they don't have an intimate relationship with the school (P2/FG - emphasis added)

The conflicts are anchored in the inability to promote mediation between the modes of intelligibility that make up, on the one hand, the perception of the student's experience and, on the other, those supported by the school institution, in the figure of school professionals. Therefore, there seems to be a kind of barrier that prevents the establishment of points of contact and permeability between the different “realities” present in the fabric of social bonds built in the school context.

Participants report that, within this process, they are also led to establish violent dynamics towards their students. This becomes evident when they acknowledge dealing with students based on a strict expectation of “problem student”, or through an attempt to assert an authority that seeks to legitimize itself through authoritarian practices.

It can be inferred that the different actors in the conflict make up the opposite poles of the same dynamic, which feeds back into each other in a circular manner. In this way, the only bond that is established is through conflict, a bond that has violence as its privileged form of communication. A process is thus established in which positions only change - who attacks and who defends themselves - through the feedback cycle of school violence, instead of understanding such dynamics from its general aspects and internal articulations. Within the scope of this split logic, the possibility of sharing then becomes compromised.

In this context, everyone - from teachers to students - ends up reproducing a repressive model of education:

We teachers somehow reproduce the education we had. This education, in general, is not for everyone [...] in general, it is a repressive education... it is an education that is often punitive, systematized and that doesn't give space, it doesn't give a voice to this student, to the staff, to the parents, and each other. [...] so, I think that this issue of the student's voice, of us being able to listen to each other, this listening process, it is very little developed, due to all these issues... ranging from historical matters back then, they go through social issues, political and ideological disputes, until we get to the physical, the furniture... I don't know if I even repeated myself... so I wanted to record this: how difficult it is for us to propose to students a class that is more debate, and conversation because they resist, they ask: “Is there nothing to copy?”, “What is the subject?”... What I put on the board when you speak and what you propose to him is an exchange and he wants to copy? So, we often have a copyist student, who is reinforced by the system and by the school, so it is an ultra-outdated, traditional, punitive school, and it is up to some initiatives to change this when this should be public policy (P4 /FG - emphasis added).

Possible ways to confront violence and conflicts

Throughout the FG, participants pointed out measures that would make it possible to mitigate violence in the school context. The first of these concerns the importance of becoming more sensitive to the dimension of otherness present in the social bonds of the school, in the dialectic between the cultures of “asphalt” and “community”. They recognized that overcoming contact barriers between the different perspectives present at the school - “asphalt” and “community” - involves opening channels that provide greater intimacy with the different one. Here, intimacy comprises an effort to be developed by the several actors in the school context, to allow them to be affected by a dimension of otherness that would then interrogate the modes of perception of the experience previously defended by the parties in conflict, relying, for this, on a relationship to teachers, with the establishment of policies for permanent training by the public education body.

I notice that the more intimacy and lovingness we have with the student, the less conflict there is... The worst conflicts that happened to me were with students that I had no intimacy with, students that I had little contact with or that I did not know. (P5/FG - emphasis added)

They also recognize the importance of creating, in partnership with students, collective agreements that are clear, generalizable, and constantly reviewed in a participatory manner. Educators observe that a collectively agreed set of rules would provide more outstanding organization and stability to the social relationships held at school and serve as a collectively agreed 'code of conduct' that would regulate the modes of interaction, encouraging mutual trust.

In the classroom, it’s like this: “Combined isn’t expensive” [...]. If we establish a relationship of trust with them and we make an agreement and fulfill the deal... and we are fair with those who did the right thing... with those who did what [...] with those who did not achieve the agreement and with whom fulfilled… I realize they tend to trust […] (P3/FG - emphasis added).

They also point out the importance of implementing and/or reinforcing spaces for speech and social participation at school, spaces involving students and their families. However, they recognize that, even if such spaces are offered, effective participation needs to be encouraged and stimulated, since, as already described, students and families do not participate in decision-making spaces due to the feeling of not belonging to the school.

Sometimes, when we talk to them, “Ah, would you like to decide about this?”, many say: “Ah, whatever... I don't know... I don't know... for me the way you doing it is fine”... because it's something that's not in their hearts... believing that it's theirs and that they must be consulted about it. (P2/FG - emphasis added).

Professors also highlighted another aspect of significant importance: the need to reinforce and expand intersectoral partnerships. This indicates that it is not possible for a single public sector, whatever it may be, to construct consistent responses to complex and multi-determined phenomena.

Traditionally, the education sector is the only social policy that, as it is universal for children and adolescents, accesses the portion of this population that is excluded from other public policies, so it ends up facing a series of repressed social demands in the field of health, social care, justice, social rights, and others. In turn, teachers report how demands are addressed to the school, referring to violations and/or lack of access to rights, economic fragility, and multiple forms of violence, among others. As the participants point out, there is an expectation in the social imagination that the school should produce the necessary responses to face such demands and needs. Thus, given the magnitude of the problems and the scarcity of intersectoral strategies to address them, educators tend to stick strictly to academic processes, since becoming intimate with students and families would correspond to coming across the processes of vulnerability that affect the lives of these people, against whom they can do little.

Even though educators are sensitive to the particularities of their students and willing to consider them - and although they have to face other structuring social violence, such as low wages and precarious working conditions - the daily encounter with violence and uninterrupted processes of vulnerability, situations in which they feel powerless, end up leading them to build defensive mechanisms of distancing themselves from the lives of students, as a possibility of sustaining the pedagogical task amid a scenario of precariousness and social crisis.

Many times, the teacher ends up playing the role of psychologist... doctor... how many times do girls ask me what the morning-after pill is like... and then... I have to stop to explain... so... you take over different roles... and this wears you out a lot... you are the psychiatrist... so you take on many tasks... and then [...] often without support... wear and tear and illness... the teacher it gets sick... we get sick [...] this issue of authority that sometimes we confuse and get a little hard on, because we... it's our defense... we have to defend ourselves... (P4/FG - emphasis added)

In summary, the possible ways to confront violence and conflicts in the school context would involve, according to the FG participants: a) making the school more sensitive to the perspective and culture of students and families, which means recognizing, as legitimate, realities that are distinct from those that are hegemonic in the social bond; b) construct, with the participation of students, school rules that are clearer and more applicable; c) develop and/or expand, within the school, collective and participatory spaces for debate and deliberation; d) promote the expansion of intersectoral actions and partnerships.

Discussion

The theme of violence emerges as the main psychosocial challenge in the researched school field, a factor that corroborates the specialized literature on the topic (Aquino, 1999; Sposito, 2001) and official data sources (IBGE, 2016; UNICEF, 2018). Data from IBGE’s National School Health Survey (PeNSE, 2015), collected from students in the ninth year of Elementary School, show that 14.8% of them reported having stopped going to school for at least one day in the 30 days previous to the survey because they did not feel safe on the journey between their homes and the school, while 9.5% stopped attending because they did not feel safe in the school environment itself. Regarding violence within the school, 23.4% of students report having participated in fights and/or physical attacks at least once in the 12 months before data collection, while, in the same period, 12.3% declared to have been injured in such attacks. Therefore, the recognition of the different determinants that affect school violence, as well as the potential mechanisms for overcoming it, emerge as challenges in the daily lives of schools and their communities (UNICEF, 2018).

In the educators’ perception at the school studied, violent acts are manifested from the clash of antagonistic social perspectives - between “community” and “asphalt” - and seem to reproduce, in a fractal structure, the violence that marks specific modes of sociability in Brazil. For one aspect of Brazilian sociological thought (Silva, 2004; Misse, 2008), violence can be recognized as a matrix of sociability that traverses national history - from its formative slavery roots to its application as a model of social conflict management - belonging to the process of marginalization and repression to which social groups that do not find possible affiliation within the capitalist economic-productive system are subjected.

The Slovenian philosopher Slavoj Zizek (2014) proposes an argument that contributes to this discussion. For him, it is necessary to overcome an understanding of violence from the strict point of view of the subjects who perpetrate the violent act. As he observes, every violent act, perpetrated by a specific subject - what he calls the pole of subjective violence - must be recognized in an inseparable articulation with what he calls the objective pole of violence, as a modality of structural and systemic violence, veiled, without a determined agent, which acts on such subjects through mechanisms of coercion that support veiled relationships of domination and exploitation.

In the context of the studied school, subjective violence of students/family members can be taken as a direct response to objective/systemic violence arising from the silencing of their voices (here represented by the culture of “community”), which ends up perpetuating tacit movements of marginalization and normalization of any social perspective that is not developed by the hegemonic social grammar (in this case, that of “asphalt”). The repression of a voice deprived of the symbolic possibilities of expression would, in this way, end up returning in the form of subjective counter-violence in the school space, where existing social conflicts between the hegemonic sectors of society and their attempts, through education, would be staged, to format students according to hegemonic normative perspectives.

If violence emerges as a preponderant factor in the field of relationships at school, distinguishing violence and conflict as distinct phenomena can help to construct more effective ways to confront them. As Tognetta and Vinha (2007) point out, although education professionals tend to recognize conflict only in its negative aspect, as a phenomenon to be eradicated (in general, through authoritarian and coercive measures), it is possible to recognize its productive and inventive dimension, as inventiveness that originates from the encounter with the dimension of otherness present in the multiplicity of cultures and perspectives.

So, far from supporting an ideal of resolving violence through the achievement of a supposed conciliatory harmony - through the advent of an idealized “single language” between “asphalt” and “community” - it becomes fundamental to take the conflict in its propositional and dialectics, a route through which, as we understand, it may be possible to build channels of intimacy between distinct cultural grammars (asphalt and community). This intimacy is established through the encounter with a dimension of otherness that, far from confirming particular and reiterative ways of perceiving experience, proposes, through the encounter, even with that which seems strange, new ways of intelligibility of sensitive experience. Here, we agree with Freud (1919/2006), when he recognizes that intimacy and strangeness, far from involving an antinomic articulation, refer to a specific dialectic in which the recreation of our ways of interpreting the world only develops from the encounter with a dimension of otherness that interrogates such assumptions, opening the way to new forms of perceiving experience. In other words, it is through the construction of channels of intimacy with the estrangement typical of the encounter between the cultures of “asphalt” and “community” that new modes of intelligibility of experience can be established, giving rise to conflict in its propositional aspect.

The construction of these channels of intimacy requires, in turn, a radicalization of the participatory and democratic proposition within the school, which must open up spaces for the redistribution of deliberative power, until then grouped in the figures of principals and teachers. From this perspective, it is essential that a set of rules be drawn up and revised collectively and collaboratively, involving all members of the school community, as a mechanism capable of introducing recognition of the dimension of otherness intrinsic to social relations, as well as the incorporation of tensions specific to the composition of diverse desires and interests that make up this shared space. As a proposal for the democratization of participatory processes and mediation mechanisms for school conflicts, it is worth pointing out that specific experiences researched - such as, for example, restorative practices (Grossi et al., 2009; Balaguer, 2014) and peacebuilding circles (Brum et al., 2022) - have shown promise in addressing such challenges, deserving an expansion of studies that measure their impacts on the school environment.

This entire complex process will not be possible without intersectoral collaboration, that is, if it is taken as the exclusive responsibility of the school. As observed in the speech of the educators, they also find themselves violated for occupying in a solitary manner the place from which the State's social actions and policies “access” such children and their families. The importance of violence and its impacts on the mental health of children and adolescents must, therefore, be a priority in an intersectoral agenda to be built between the field of psychosocial care (with CAPSi as a strategic device) and education, involving, in its unfolding, the broader spectrum of social policies, to contemplate not only the impacts experienced at the individual/local level, but also those that refer to the structuring aspects that cross the life contexts of individuals and their communities.

As the report “Education that Protects Against Violence”, prepared by UNICEF (2018), points out, implementing a public policy to combat school violence must include different factors and initiatives organized based on various scales of action. According to this same report, the following are recommended as priority areas: 1) Generate and use evidence based on an effective descriptive and informative database of the scenario of actions and policies; 2) Develop public policies and programs to guarantee the effectiveness of legislation and standards relating to the protection of children and adolescents; 3) Promote intersectorality for the prevention of violence and safety inside and outside the school environment; 4) Break the cycle of production and reproduction of violence in schools; 5) Strengthen the capacities of the school, the community and the protection network to prevent and respond to violence against children and adolescents; 6) Reframe the curriculum and pedagogical project to confront the culture of violence and school failure.

From the perspective of the field of Psychosocial Care, the consolidation of an expanded and decidedly intersectoral care proposal involves, in an inseparable way, the implementation of the perspective of mental health promotion - and its basic premises of promoting autonomy, citizenship, and social participation, along with the social determinants of health - as a privileged epistemic and ethical axis for the conception and organization of mental health actions within the scope of psychosocial care networks. To this extent, one could promote within school dynamics the transposition of the conflictual dimension from its violent aspect to its propositional face while enhancing empowerment initiatives and increasing social participation, through encouraging critical reflection on such social processes.

Promoting mental health is also about engendering, together with subjects and their communities, a process of interrogating socially shared normativities that colonize the forms of perception of experience and determine possible modes of agency and relationship (Oliveira, 2021). When it is possible to sustain a space of tension between distinct normativities (such as the examples of “asphalt” and “community”), it allows for the installation of a counter-hegemonic vector of forces that deconstructs the character of naturalness that previously invested such hegemonic normativities of truth value. From this perspective, spaces may be created where, within social relations, new and creative ways of describing experience may eventually emerge, to engender, albeit potentially, other forms of social relations (Oliveira, 2021). It is precisely under such parameters that effective social participation becomes preponderant, with the promotion of autonomy as the privileged axis of a network of territorial relations that, more democratic and inclusive, end up being structured along lines that promote mental health.

Thus, it becomes possible to recognize the importance of purposeful action, supported by the field of psychosocial care for children and adolescents, aimed at building an intersectoral agenda with schools. However, it is also worth recognizing that the nature of the problems highlighted here - with emphasis on the issue of school violence - calls on the field of Psychosocial Care to review its action model within the intersectoral network. As Oliveira (2021) points out, it is possible to recognize that although psychosocial care services have been designed to operate from a clinical-political logic aligned with the principles of collective health and health promotion, it has been realized that in their daily work processes, such teams end up perceiving themselves as supporting a set of practices that are specific to the organizational model referenced to recovery from illness: they end up privileging action strategies based on a strictly individual perspective, with emphasis on central care organized around personal care, restricted to internal dynamics at CAPSi, covering only those subjects who directly demand clinical care, to the detriment of health promotion actions that reach a broader contingent of the community. This care model ends up linking intersectoral relationship modes - such as those developed between CAPSi and the school sector -based on specific actions, restricted to the clinical cases of particular users, triggered only on demand, without understanding action planning at a macro-community (Couto; Delgado, 2015).

As an effect, this logic also leads to a tendency towards sectoral isolation, resulting in a set of practices marked by a lack of knowledge of the flows specific to different networks, the prevalence of therapeutic projects, and distinct (or even antagonistic) lines of action, and the difficulty in sustaining of agreements and pacts in collective actions (Taño; Matsukura, 2019). In this way, intersectoral integration - which, under such parameters, ends up being recognized as “an additional job to be done” in parallel to individual care - takes on a secondary role in the work processes of CAPSi, already overloaded by individual demands. This overload comes, in large part, from this same lack of intersectoral collaboration. Therefore, if this model has already proved to be insufficient to meet the CAPSi's care demands, it seems unfeasible to develop effectively shared and co-participatory intersectoral actions.

In turn, effective intersectoral articulation - which proves powerful in taking responsibility for macrostructural psychosocial demands, such as school violence - requires that the epistemic and ethical logic of MHP permeates the teams' work processes. This logic does not require the abandonment of actions offered at the individual level; instead, it proposes the adoption of lines of action that promote mediation between the individual (and their derived particularities) and the broader social body, taking the space of territories as key elements to this process.

After all, it is precisely on the path of recognition and the derived proposal of interference in the set of determinations that cross the lives of individuals and their communities, as they then determine their modes of health and illness - that is, in recognizing this intertwining of such macro and micro determinants - based on the principle of an intervention that encompasses an agenda planned, implemented and evaluated at an intersectoral level. Finally, it is in this sense that recognizing such determinants present in the dynamics of relationships that make up the school space contributes sensitively to the production of psychosocial intervention strategies and models guided by MHP, contemplating, in a mediated way, everyone in their modes of relationship to the collective of the social body.

Final considerations

Given the central question of this study, which referred to the investigation into the main challenges and potentialities posed to the intersectoral articulation between the field of Psychosocial Care for children and young people and the school sector to produce MHP strategies, it is concluded, within the specific restrictions of the scope field of this research, that violence presents itself as the main psychosocial challenge within the school.

Faced with this challenge, such MHP strategies in schools must include the development of measures such as: 1) the creation of channels of intimacy between students/families and professionals, to overcome the barriers of contact between the different cultures in the school; 2) increase social participation initiatives within the school, involving students and families in the process, to encourage the circulation of counter-hegemonic norms within broader social dynamics, thus interrogating the tendencies of normative colonization in the social bond; 3) intersectoral collaboration between the services of the psychosocial care network, with emphasis on CAPSi, education and other sectors of social policies, which today appear to develop their actions in a fragmented manner, without sharing initiatives concerning planning, implementation, and evaluation of the intersectoral agenda in the territories.¹

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• 1
  B. D. C. de Oliveira: research design and implementation, data collection and analysis, writing and final review of the article. M. C. V. Couto and P. G. G. Delgado: research design, technical advice on the research, writing and final review of the article. G. Sadigurschi and G. P. G. Sardinha: implementation, data collection and analysis, writing of the article.

Editor:

Rossano Lima

Publication Dates

• Publication in this collection
  04 Oct 2024
• Date of issue
  2024

History

• Received
  17 June 2023
• Reviewed
  15 Dec 2023
• Accepted
  20 Feb 2024