O matriciamento em saúde mental como forma de dispersão de saber

Abstract

Introduction: Matrix support in mental health, as a technical-political device of the Brazilian Unified Health System, is grounded in the perspective of the horizontal dispersion of knowledge, articulating Primary Health Care and Psychosocial Care Centers within a logic of shared responsibility. In light of the Brazilian Health Reform and Psychiatric Reform, matrix support seeks to overcome the physician-centered and fragmented model, fostering comprehensive care, territorialization of practices, and strengthening local resolvability. However, the normative institutionalization of matrix support does not ensure its concrete implementation within territories, making critical analysis of its occurrence, organization, and professionals’ understanding within Primary Health Care necessary. Objectives: To evaluate the occurrence of the matrix support process in mental health within Primary Health Care in the Baixada Santista region, its organizational forms, and the understanding of the professionals involved regarding the theme. Method: This is a cross-sectional study with a mixed analytical approach, conducted with Primary Care professionals from the municipalities of Cubatão, Santos, and São Vicente. The estimated sample comprised 240 participants, based on probabilistic calculation with a 5% significance level and 80% statistical power. A self-administered questionnaire developed by the researcher was used, consisting of structured questions to construct the variables 'level of knowledge about matrix support' and 'perceived effectiveness of matrix support,' as well as semi-structured questions subjected to thematic analysis. Association tests between variables were performed, alongside qualitative analysis of narratives concerning participation in care, barriers, and perceptions related to mental health. Results: Heterogeneity was observed in the occurrence and organization of matrix support across units, with distinctions related to the organizational model. An association was identified between greater knowledge about matrix support and higher perceived effectiveness, suggesting a dynamic feedback relationship between knowledge and practice. Qualitative narratives indicated that participation in mental health care does not automatically derive from the formal existence of matrix support, but rather from the internalization of the comprehensive care model. Discourses marked by technical insecurity, persistence of biomedical references, and the presence of stigma emerged, in addition to reports of structural limitations and weaknesses in network articulation. Conclusion: Matrix support proved to be more than an organizational strategy, configuring itself as an ethical-political device capable of challenging traditional models of care. Its consolidation requires continuous investment in professional training, organizational regularity, and integration with Permanent Health Education policies. The interrelationship between knowledge and perceived effectiveness indicates that strengthening knowledge enhances practice, while effective experiences expand collective learning. Despite methodological limitations, the findings contribute to Public Health by reaffirming matrix support as a concrete expression of SUS principles and as an instrument for qualifying mental health care within Primary Health Care.