(In)visibility of mental health at the National Seminar on Nursing Education Guidelines


Aline Macêdo de QueirozI; Raíssa Millena Silva FlorencioII; Josicélia Dumêt FernandesIII; Elizabeth TeixeiraIV; Gilberto Tadeu Reis da SilvaV; Simone Coelho AmestoyVI

I PhD. Professor, Federal University of Pará. Brazil. E-mail: alinemacedo@ufpa.br
II PhD Student. Professor, Federal University of Bahia. Brazil. E-mail: raissaflorencio@yahoo.com.br
III PhD. Professor, Federal University of Bahia. Brazil. E-mail: dumet@ufba.br
IV PhD. Professor, State University of Amazonas and Lutera Manaus University Center. Brazil. E-mail: etfelipe@hotmail.com
V PhD. Professor, Federal University of Bahia. Brazil. E-mail: gilberto.tadeu@ufba.br
VI PhD. Professor, Federal University of Pelotas. Brazil. E-mail:simoneamestoy@hotmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2018.31292




Objective: to examine the scientific production divulged at the SENADEn® on mental health education and training after introduction of Brazil's National Mental Health Policy. Method: in this descriptive documentary study, data were collected from the SENADEn® Annals for the period 2002-2014. Abstracts were included when the title contained one of the descriptors: mental health, psychiatric nursing and/or psychiatry. Thematic content analysis was used. Copyright was respected and research ethics committee approval was unnecessary. Results: of the 21 abstracts selected, most cited descriptors, were drafted by three authors, and reported experiences from the higher education teaching and learning process. The studies were predominantly from Brazil's Southeast Region; published in 2012; and did not address the subject from a transdisciplinary perspective. Conclusion: the subject was found to be invisible in the Annals, which is incompatible with the Ministry of Health agenda priorities and with the need to establish education and training in mental health nursing in line with the psychosocial care paradigm.

Descriptors: Mental health; psychiatric nursing; nursing education; public health policies.




The National Seminar of Guidelines for Nursing Education (SENADEn ®- "Seminário Nacional de Diretrizes para a Educação em Enfermagem") is a privileged space for the design of strategies that enable education policies in nursing. It organizes itself in the context of the transformations in the political, social and economic field and aims at facilitating the discussion and definition of strategies for the education policies focused on technical and vocational training at the higher and secondary level in nursing.1

The event integrates the activities developed by the Brazilian Nursing Association (ABEn®- "Associação Brasileira de Enfermagem") which, since its creation, has been presenting significant leadership in the legal and political trajectory of nursing education.

After the approval of the Law for National Guidelines and Bases of Education (LDB – "Lei de Diretrizes e Bases da Educação Nacional") in 1996, and the advent of the National Curricular Guidelines for Undergraduate Nursing Courses (DCN/ENF – "Diretrizes Curriculares Nacionais dos Cursos de Graduação em Enfermagem"), the entity sought to guarantee a privileged space for the "education in nursing" axis in its agenda of national events, which motivated, among other actions, the creation of SENADEn®. The materialization of this event also confirms the commitment of ABEn® regarding the training of nurses qualified to work in the contemporary society, in harmony with the regional diversity and the specificities of the area1,2.

SENADEn®, especially after the approval of the Resolution of the National Council of Education/Higher Education Chamber CNE/CES No. 03/2001, which instituted the DCN/ENF3, has contributed to expand the discussions and define strategies, in addition to favoring the development of competencies and professional skills recommended by these Guidelines. These are actions that, in general, intend to consolidate the new parameters that guide the professional formation focused on the Unified Health System (SUS – "Sistema Único de Saúde").

In order to meet the DCN/ENF, it was necessary to include transversal contents, which are necessary for the nursing training and for the consolidation of the expanded concept of health, leading to the emergence of the issue of Mental Health as an important content for the comprehensiveness of health care4.

To address the scientific relevance of SENADEn® for nursing education as a space for the construction and dissemination of educational policies for the area, as well as the importance of discussing mental health and the training of professionals for the consolidation of the Psychiatric Reform, strengthen the relevance of the present study.

The study is also justified by the need to fill gaps in the literature on the subject and to guide the professionals of the area for a better insertion in the process of nurses' training.

For the development of the present study, the following research question was defined: what is the disclosed scientific production of SENADEn® about the nursing training in mental health after the institution of the National Mental Health Policy?

In order to reach the answers to the research question, the objective was to analyze the scientific production disclosed at SENADEn® on nursing education/training in mental health, after the institution of the National Mental Health Policy.



The National Mental Health Policy was instituted in parallel with the DCN/ENF and enacted by the Law No. 10,216/20015, which addresses the protection and rights of people with mental and behavioral disorders, redirecting the mental health care model, according to the psychosocial care paradigm. Thus, the provision of treatment in community-based services has become a priority6.

The III National Conference on Mental Health in 2001 emphasized the principle of comprehensiveness and care without exclusion. In the following year, the creation and operation of the Psychosocial Care Centers (CAPS – "Centros de Atenção Psicossocial") were standardized throughout the national territory.6 CAPS represents a service modality that directs the look to the subject in psychological distress and inserts them into a particular social group in order to compose and organize a care network.7

Later, in 2005, the General Guidelines for the Inclusion of Mental Health Actions in Primary Care were established, which highlighted the dialogue between mental health and primary care as an essential assumption for guaranteeing the rights of the individual,8 since every health problem is also a mental health problem. In addition, it is important to highlight that SUS has established the care strategy in the Health Care Networks and established as a priority the Psychosocial Care Network (RAPS – "Rede de Atenção Psicossocial") for people suffering from mental disorders, crack, alcohol and other drugs use.9

However, despite these important advances, the discussions about nursing teaching in mental health are also fundamental, because new movements and perspectives need to emerge to strengthen pedagogical practices and prepare students to meet the demands of the psychosocial care in health services.

In this sense, a study carried out with the objective of promoting discussions about the pedagogic process in the teaching of psychiatric nursing and mental health, as well as its interface with the principles of the psychiatric reform, concluded that it was not enough to indicate the technical and pedagogical aspects related to content, teaching and didactic procedures, being imperative to understand that the pedagogical practice is also based on political, ethical and relational competencies and that the nursing performance is key to transforming the ways of acting in health.4

Thus, these new pathways for the consolidation of the public policies instituted began to require the formation of professionals committed to the mental health care of the population, able to break with the hospital-centered paradigm, understanding the psychosocial determinants of madness, and developing new actions and ways of thinking and behaving, reinventing ways for dealing with the psychic suffering.4

However, the process of nurses' training still faces difficulties regarding the constitution of knowledge focused on the comprehensiveness of care, one of them being the development of practices based on a new perspective on mental health.10



Descriptive, documentary research that used data from the abstracts published in the Annals of the 7th to 14th SENADEn ®, carried out from 2002 to 2014. This time frame includes all the Annals released after the institution of the National Mental Health Policy.

The data collection occurred between the months of August and December 2015. The data from the Annals of the 11th SENADEn ® were made available on CD-ROM; those of the 12th and 13th in a pendrive; and those from the 14th were viewed online. The others were obtained on the Center for Studies and Research in Nursing (CEPEn – "Centro de Estudos e Pesquisas em Enfermagem") website, of the National ABEn®, which aims at encouraging the development and dissemination of nursing research, as well as to organize and preserve historical documents of the profession.

The inclusion criterion in this study was: abstracts that presented in the title at least one of the following descriptors: mental health, psychiatric nursing and/or psiquiatria. Those that did not approach nursing education/training in mental health were excluded. Figures were created to group the information on SENADEn's® edition and place, as well as quantity and origin of the authors, descriptors used, objective, methodology and level of training addressed. The subsequent steps included the process of thematic content analysis technique following the steps: the pre-analysis, the exhaustiveness rule, the exploration of the material and the treatment of the data, inferences and interpretations.11 The floating reading of the abstracts was carried out in the initial step, followed by the exhaustive reading, aiming to analyze the production about education/training in mental health. Finally, the registration units were coded according to the analogy of meanings, categories abstraction and presentation in figures.

According to the Law of Copyright No. 12,853, of August 14, 2013, the ethical aspects were met by the study, since it respected the copyrights of the collected researches.12 In addition, due to its scientific profile, the submission of the study to a Research Ethics Committee was not necessary.



Of the total of 4,174 abstracts published in the Annals of the eight analyzed editions of SENADEn® (from 2002 to 2014), 39 that met the pre-established inclusion criteria were initially identified. Of these, after applying the exclusion criterion, 21 were selected for analysis, the equivalent of 0.50% of the productions.

In the last two editions analyzed, it was possible to observe an increase in the number of abstracts on nursing education/training in mental health, according to Figure 1.

FIGURE 1: Number of Abstracts on Nursing education/training in Mental Health presented by SENADEn®. Brazil, 2016.

This result may be related to the inclusion of RAPS in 2011 as one of the priority actions of the Ministry of Health (MH), which made possible a greater financial investment for the creation of new mental healthcare devices and, consequently, it may have stimulated the scientific production on the adequacy of mental health training.

It is possible that this increase is also explained by the time required to evaluate the experiences started in 2006, after the implantation of the National Policy of Insertion of Mental Health in Primary Care, a fact that demanded from the educational institutions the creation of new formats of professional training for mental healthcare.

It is emphasized that the scientific production helps in the formation and acquisition of new knowledge and contributes to transform people's ways of thinking and acting. As an activity, it represents a complex social construction that requires daring and high investments.13

It is also worth highlighting that in one of the four principles of the "scientific ethos" it is emphasized that the results of research not only belong to the researcher, but also to society as a whole, being necessary to socialize and publish them.14

Therefore, it is not enough to produce, it is necessary to publish for the dissemination of information and, in this case, for the strengthening and visibility of nursing and mental health.

It should be highlighted that in the events, the constituent authorities of the invisible schools of the respective areas of specialization are also identified, as is the case in the mental health area, which justifies the submissions of the abstracts and their subsequent presentation. The abstracts that have been called "gray literature", nowadays with the resources of information and communication technologies, have been made available to the general public,15 which considerably increases the visibility of the production.

Of the 21 abstracts analyzed, only 12 presented descriptors. Although the use of the descriptor "mental health" in the title was criterion for inclusion of the abstract in the study, three of the 12 abstracts did not use it.

It is inferred that this situation arises from the fact that some editions of SENADEn® did not require the inclusion of descriptors in the abstracts. However, the descriptors are considered to guide the content of the work and should be chosen wisely, especially because researchers use this type of information to locate studies on specific topics. They must, therefore, be chosen carefully so that they can reliably express the content of the work.16

Descriptors are important elements for the visibility and retrieval of scientific articles in databases, so special attention should be given to their attribution; they are important terms for the indexation of the scientific production; and they guide the content of the work, faithfully reflecting its content. The choice of descriptors should provide greater visibility to the scientific production, favoring the search in the database.16

It is important to mention that the presentation of descriptors became a requirement for submissions from the 12thSENADEn ®. Thus, it is believed that this change will enable a deeper analysis of the publications on nursing education, as well as about their repercussions in the new professional performance scenarios.

In this study, the descriptors "psychiatry" and "psychiatric nursing", associated to the hospital-centered paradigm, were used less frequently than "mental health", which reflects some changes in the psychosocial care that favor the use of more inclusive terms and emphasize the subjectivity of the person. The greater use of the "nursing" descriptor is justified because it is a specific area of the seminar.

The abstracts analyzed had a variable number of authors (from one to six), but most of them were written by three authors. The 77 authors were from 12 states, as shown in Figure 2.

FIGURE 2: Number of Abstracts by States and Region. Brazil, 2016.

Regarding the number of abstracts by states and regions in the eight editions of SENADEn®, an uneven distribution was observed. The Central-West and South Regions did not publish any work, and the Southeast was responsible for most of the publications, especially the state of Rio de Janeiro.

It is important to mention that, historically, the Southeast was a pioneer in the fight for the Brazilian psychiatric reform, for enacting state laws inspired by the Project of the politician Paulo Delgado, activist of the anti-asylum movement and defender of the rights of the person in mental suffering. Rio de Janeiro, specifically, hosted the 1st National Conference on Mental Health, and the first CAPS was inaugurated in the capital of the state of São Paulo, both landmarks of consolidation of the psychosocial care.17

Although the state of Pará did not excel in the national scenario, in terms of the implementation of the National Mental Health Policy, it ranked second in the number of selected works. This result can be attributed to the achievement of the 13thSENADEn® in the city of Belém, capital of the state, because, in this event, three abstracts were analyzed in the present study. It is important to highlight that an exhibition was planned for this event addressing the theme "Innovations in the process of nurses' training in mental health", which was not performed, which resulted in the absence of the space for discussion on mental health, reinforcing the invisibility of the theme. This fact contributes negatively to the effectiveness of the new care practices and training supported in the psychosocial paradigm.

Higher education mental health nursing training was the subject of all abstracts, while secondary level technical vocational training was not addressed. The abstracts, according to their titles, objectives and methods are described in Figure 3. Regarding the objectives, most of the abstracts had the purpose of reporting experiences of the teaching/learning process of the curricular component in mental health or psychiatric nursing, and used as methodological modalities the experience and review report.

Figure 3: List of abstracts published at SENADEn®, in the period from 2002 to 2014, according to title and objective. Brazil, 2017.

Regarding the scope of the abstracts disclosed in the Annals, it was observed that mental health does not present itself as a trans-disciplinary approach, since such perspective was quoted in only one abstract. It should be highlighted that the pedagogical model for nursing training, in line with the DCN/ENF3, expresses the transversality of some contents that are necessary to the care practice in other phases of the course of people's lives.

Regardless of the area of study, the scenario of the production related to training at the technical-vocational level is of great concern, since it makes explicit the scarcity of scientific publication in the area of mental health.18

According to the findings, several studies referred to the scope of nursing graduation. A recent research sought to analyze the disciplines of Psychiatric Nursing and Mental Health in the curricular structures of the Nursing Undergraduate Courses in the national scenario.19 Another research deals with the identification of changes and innovations in the teaching of mental health and psychiatry.20 These results show the need to expand the studies in order to cover the technical level, considering that the performance of these professionals is of key importance, also remembering that it is the largest nursing workforce.

The scientific knowledge about mental health in the nursing training is in the empirical and documentary/theoretical field, with the production of secondary data. Productions based on field research on nursing knowledge, doing and acting are incipient - a reflection of the recent process of policy implementation and changes in training.

In this process of change in the training, one can perceive the existence of different social, emotional and/or cultural barriers, which corroborate to reinforce, along with common sense, the negative image of the person in mental suffering, because this individual is still considered socially as dispossessed of reason, aggressive, dangerous and unable to live in society.21 However, it is observed that teaching promotes a change in the beliefs and attitudes of nursing students; even so, this effect is modest, which suggests that it is necessary to focus on content that increases the literacy in the field of mental health in the curricula. It is in the need to socially reintegrate the sick ones, visible in the reduction of the attitude of social restraint, that this change is more accentuated, a positive effect of the clinical teaching, in which exposure and experience with the practice of psychiatric nursing increase the professional awareness, aiming at guaranteeing the patients' rights and freedom.22



The abstracts published in the Annals of SENADEn ®, in the period from 2002 to 2014, focusing on education/training of nursing in mental health, totaled 0.53% of the publications. This (in)visibility of the theme of education/training in nursing in mental health, in the aforementioned Annals, does not legitimize itself regarding the agenda of priorities of the MH, and is disjointed from the visible increase in investments in the area of mental health, and the growing need to consolidate education/training in nursing in mental health, based on the paradigm of the psychosocial care.

Most of the abstracts are from the Southeast Region, with greater socioeconomic development, which is also a region of great concentration of centers of research and technological innovation, considered references in the area of mental health, in addition to being the vanguard of the anti-asylum movement and of the implementation of actions inspired by the new care model.

The modalities of experience report and review stand out in the productions due to the need to disseminate the experiences developed in the process of transformation of the teaching and learning process and mental health care, based on the paradigm of psychosocial care. The study indicates the lack of abstracts with contents on education/training in mental health in the transversality and associated to the technical training of secondary level in SENADEn®, which reaffirms the (in)visibility of the theme and demands the development of new research on mental health and transformation of the training process.

The reality presented here portrays the complexity of the (in)visibility of the mental health representation in the training process, the teaching-service relationship in the new context of mental health and the role of nursing in the interdisciplinary work of the nurse's training, which refers to the need to strengthen the SENADEn ®, as a space for defining strategies for the formation and production of health of the population, subsidizing a reflection regarding the psychiatric reform, in its theoretical-practical conceptions.



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