Competências médicas para o cuidado em saúde mental na atenção primária à saúde: análise a partir da formação do médico de família e comunidade

Abstract

This study aims to understand the challenges faced by Family and Community Physicians in the care of people with mental health needs in Primary Health Care (PHC) and, based on these findings, to propose the construction of a technical report focused on developing clinical and relational competencies. The research adopts a qualitative approach, grounded in the theoretical-methodological frameworks of the Knowledge to Action (KTA) model and the Theoretical Domains Framework (TDF). Data collection was conducted through Focus Groups (FG) with residents and preceptors from Family and Community Medicine residency programs at the Federal University of Mato Grosso do Sul (UFMS) and the Municipal Health Secretariat of Campo Grande – MS, Brazil. Thematic Analysis (TA), articulated with the TDF domains, was used for data interpretation. Sixteen professionals participated, with diverse profiles regarding academic background, professional experience, and previous training. The analysis identified eighteen meaning units organized into two main categories: (1) mental health care in PHC and (2) the structure of the care network and its challenges. The first category highlighted aspects such as therapeutic bond, communication, interdisciplinarity, and training gaps. The second category pointed to structural barriers, limited access to specialized services, and the role of social determinants in the illness process. The discussion demonstrated that mental health care in PHC requires relational (listening, bonding, communication) and collaborative competencies, often challenged by traditional biomedical training, technical insecurity, and organizational constraints. It is concluded that intentional training pathways integrating theory, supervised practice, and teamwork must be established to strengthen resoluteness, integrality, and coordination of care. As a result, a technical report (with a structure similar to a competency framework) was developed, supported by national and international references, with applicability to Family Health Strategy training, continuing education, clinical supervision, and care planning (PTS). The product has potential formative, clinical, and organizational impacts. The study acknowledges limitations regarding its institutional and temporal scope and suggests further evaluation of the implementation and interprofessional expansion of the product.