The potential of the Therapeutic Accompaniment as an instrument of madness demystification: an experience report

Background/Objectives: The Therapeutic Accompaniment (TA) started even before the psychiatric reform. With the creation of day hospitals in the 1940's and the beginnings of psychopharmacology in the 1950's, a „psychiatric assistant“ who could make the bridge between „madness“ and the outside world was much needed. We assume that accompaniment is therapeutic and serves as a catalyser between the person and the environment. Accompaniment can be delivered in individual or group settings. In Porto Alegre, the group intervention took place at a Basic Health Unit, and the individual approach at the patient's neighbourhood both in suburban areas of the city where TA activities are limited due to the patients’ low income. Objectives of this presentation are to report on the experiences of psychology undergraduate students with delivering TA in the public health system.

Methods: During one year, three chronic psychiatric patients with schizophrenia or bipolar disorder who did not sufficiently respond to pharmacological treatment were offered weekly TA sessions. Students’ diary notes of were subjected to a content analysis in order to explore ideas, descriptions, contents and feelings. Diary notes were categorised into three sections: (1) Registration (place where the objective information was written); (2) Reflexion – (ideas, feelings, and other ruminations); and (3) Intervention Planning – (techniques and activities).

Results: The TA could be characterized as positive tool on the process of integration between the District Metal Health Staff and the Health Units at the primary care level. TA’ practice reaches the cultural level in a way that cannot be achieved by clinical practice. TA also helped improving the clients’ relationships with their families, home visits being one of the activities. We could identify integral health assistance as one important policy of the Brazilian Integrated Health Care system (SUS). With this broader view, TA becomes an ally to other therapeutics to go beyond the subjectivity construction. Furthermore, we identified the potential of AT intervention to clarify the horizon of the Psychiatric Reform and its desired deinstitutionalization as the community has the opportunity to broaden social borders.

Discussion/Conclusions: As students of health areas, our so-called „knowledge“ occasionally can be termed ‘manicomial ideology’ which avoids dealing with the social stigma of isolation and mental illness. We should be aware that accompanying patients is also accompanying the Psychiatry Reform at a basic cultural level – family and their close networks. As we did not know the health unit and the neighbourhood surroundings, we are not just companions but also accompanied in the discovery of the patient's objective world. This turns the concrete patient's subjectivity in a constant interface between the patient's private and public instance. Nevertheless, some patients abandoned the companions’ service, leading us to think that in AT there are many questions that cannot be answered with this work.

Funding: None declared.

Keywords: Patient-centered integrated care, therapeutic accompaniment, primary health care.