MENTAL HEALTH AT UNIVERSITY: ACTIONS AND INTERVENTIONS AIMING STUDENTS

ABSTRACT:

Studies conducted by Fonaprace show high rates of illness in the student community, resulting in debates, investment in programs, and actions aimed at university students' mental health. Furthermore, in 2020 Brazil faced the situation imposed by the Covid-19 pandemic, negatively impacting mental health. This documental study sought to identify and analyze Ufal's mental health interventions for the student body. For this purpose, we mapped services and actions in mental health on the university's website and social networks, specifically aimed at the student body, from 2010 to 2020. We chose The Institutional Management Reports and available information/news as the analytical corpus. We collected data from December 2020 to April 2021 using the descriptors "mental health," "psychic suffering," "psychological illness," and "quality of life." We carried out the analysis of documents through Content Analysis, through which emerged two categories that expressed the research findings: "mental health care" at Ufal: from the policy of permanence to the permanence of actions"; and "articulating together... ": inter-sector "[...\ a way to go". The mental health interventions at Ufal are recent, still scarce, and driven by democratization policies. The student assistance sector develops most actions, which are based on a prevention perspective. There are challenges regarding interdisciplinarity and inter-sector coordination, as actions were fragmented and with little institutional articulation.

Keywords:
mental health; higher education; student

RESUMO:

Pesquisas realizadas pelo Fonaprace apontam índices elevados de adoecimento da comunidade estudantil, resultando no debate e no investimento em programas e ações voltadas para a saúde mental do estudante universitário. Somado a isso, em 2020, o Brasil se deparou com a conjuntura imposta pela pandemia da Covid-19, ocasionando impacto negativo na saúde mental. Este estudo, de caráter documental, buscou identificar e analisar as intervenções em saúde mental da Ufal, direcionadas para o corpo estudantil. Para tanto, foi realizado mapeamento dos serviços e as ações em saúde mental, no site e redes sociais da universidade, voltadas especificamente para o corpo discente, compreendidas no período de 2010 até 2020. Elegeram-se como corpus analítico os Relatórios de Gestão Institucional e as informações/notícias disponíveis. A coleta de dados ocorreu de dezembro de 2020 a abril de 2021, utilizando os descritores “saúde mental”, “sofrimento psíquico”, “adoecimento psíquico” e “qualidade de vida”. A análise dos documentos, realizada por meio da Análise de Conteúdo, permitiu a emergência de duas categorias que expressaram os resultados da pesquisa: “assistência à saúde mental” na Ufal: da política de permanência à permanência de ações” e “articular junto...”: intersetorialidade “[...]um caminho a percorrer”. As intervenções em saúde mental realizadas na Ufal são recentes, ainda escassas e foram impulsionadas pelas políticas de democratização, sugerindo serem desenvolvidas, em sua maioria, pelo setor de assistência estudantil, numa perspectiva de prevenção. Desafios se apresentam quanto à interdisciplinaridade e à intersetorialidade, uma vez que as ações apresentaram-se fragmentadas e com pouca articulação institucional.

Palavras-chave:
saúde mental; ensino superior; estudante

RESUMEN:

Investigaciones realizadas por Fonaprace muestran altos índices de enfermedad en la comunidad estudiantil, generando debate e inversión en programas y acciones direccionadas a la salud mental de los universitarios. Además, en 2020, Brasil enfrentó la situación impuesta por la pandemia de la Covid-19, provocando un impacto negativo en la salud mental. Este estudio documental buscó identificar y analizar las intervenciones de salud mental de UFAL direccionadas al estudiantado. Para ello, se mapearon servicios y acciones en salud mental en el sitio y las redes sociales de la universidad, dirigidos específicamente al estudiantado, desde 2010 hasta 2020. Se eligió como corpus de análisis los Informes de Gestión Institucional e informaciones/noticias disponibles. La recolección de datos ocurrió de diciembre de 2020 hasta abril de 2021, utilizando los descriptores “salud mental”, “sufrimiento psíquico”, “enfermedad psicológica” y “calidad de vida”. El análisis de los documentos se realizó a través del Análisis de Contenido y permitió el surgimiento de dos categorías que expresaron los resultados de la investigación: “la atención a la salud mental” en UFAL: de la política de permanencia a la permanencia de las acciones” y “articular juntos…”: intersectorialidad “[...] un camino por recorrer”. Las intervenciones en salud mental realizadas en UFAL son recientes, aún escasas y fueron impulsadas por políticas de democratización, lo que sugiere que en su mayoría son desarrolladas por el sector asistencial estudiantil en una perspectiva de prevención. Surgen desafíos en términos de interdisciplinariedad e intersectorialidad, ya que las acciones se encontraban fragmentadas y con poca articulación institucional.

Palabras clave:
salud mental; educación superior; estudiante

INTRODUCTION

The transition from school life to university life is, for many young people, the achievement of their own independence, but it can also be seen as a critical period of adaptation (COSTA; MOREIRA, 2016), composed of experiences that require a posture of accountability and sociability (ASSIS; OLIVEIRA, 2010). Studies with college students record symptoms of stress, anxiety and depression ( PADOVANI et al.., 2014 ) and suggest that work overload, associated with the lack of free time and support networks are stress generators in this population ( YOSETAKE et al.., 2018 ). Gonçalves et al. (2018), in a study conducted with medical students at the Federal University of Alagoas (Ufal), identified that the majority scored significantly for symptoms of depression, with 32.2% presenting moderate to severe symptoms. These data are in line with Leitão (2017), when she states that there is a growing concern about the mental health of young people, given evidence of emotional distress, such as anxiety, depression, and suicidal tendencies in this population.

For Hahn, Ferraz and Giglio (1999) concern with the mental health and well-being of college students has been presented in Brazil since the 1950s, with a considerable increase in publications after 1975. However, the services directed to the health of the university student were precarious and focused on physical health (FIGUEIREDO; OLIVEIRA, 1995), lacking actions promoting community mental health with a multidisciplinary approach that enables articulated performance of professionals in the area of health and education (HAHN; FERRAZ; GIGLIO, 1999, p. 82).

In the 1950s, no evidence was found that there was, in Brazilian federal universities, a student assistance policy or a mental health policy aimed at university students, even if they had instances called student deans' offices. The actions of student assistance were maintained according to budget availability, interest and conception of each Federal Institution of Higher Education (Ifes) (LEITE, 2015). However, discussions about policies to promote and support students took place among the student pro-rectors, culminating in the creation of the National Forum of Community and Student Affairs (Fórum Nacional de Pró-Reitores de Assuntos Comunitários e Estudantis, Fonaprace) in 1987, which would be in charge of discussing, developing and proposing to the Ministry of Education (MEC) the Policy of Promotion and Support to Students (FONAPRACE, 2012).

Thus, in 1994, Fonaprace conducted the first student profile survey, which aimed to determine the socioeconomic and cultural profile of students in order to subsidize the formulation and implementation of social policies that would provide permanence in the institution. Even though the research did not present data on the mental health of the student body, psychotherapy appeared as an assistance program offered by some institutions (FONAPRACE, 1996). In the research done in 2004, it was observed that 36.9% of the students presented significant difficulty or emotional crisis during the last year; 27.3% sought psychological assistance, and 5.5% sought psychiatric assistance at some point in their lives. Psychotherapy also appeared as an assistance program offered by the institutions. The results suggest a greater concern on the part of the pro-rectors with the student's mental health, since from the second survey on, there has been a greater interest in the knowledge of this problem, perceived by statements like "students present emotional difficulties" (FONAPRACE, 2004, p. 62).

In 2011, a new survey conducted by Fonaprace states that "emotional difficulties affect academic performance" (FONAPRACE, 2011, p. 40), informing that 47.7% of respondent students had emotional crisis in the last year. In addition, 29% have sought psychological care; 11% have taken psychotropic medication; 10% have sought psycho-pedagogical care; and 9% have sought psychiatric care. The survey concluded that there was a significant increase in percentages of both students who have experienced emotional crisis and those who have sought psychiatric and psychological treatment (FONAPRACE, 2011, p. 41). In the following surveys, conducted in 2014 and in 2018, is observed the addition of new data investigating mental health, among which are death ideation and suicidal thinking¹. In a comparative analysis between the latest surveys, Fonaprace stated that the percentage of students with death ideation was 6.1%, while suicidal thinking affected 4% and warns for attention to mental health indicators (FONAPRACE, 2019, p. 84).

It is important to highlight that, during the historical series of surveys conducted by Fonaprace, specifically between the second (2004) and the third survey (2011), policies and programs focused on student permanence were implemented by federal government. These are, therefore, fruit of the struggles of Fonaprace and the student movement (DUTRA; SANTOS, 2017), which enabled important changes in the profile of the university student, observed in the surveys that followed policies implementation. Among the policies and programs, we highlight the Support Program for Restructuring and Expansion Plans of Federal Universities (Programa de Apoio a Planos de Reestruturação e Expansão das Universidades Federais - Reuni) and the National Program for Student Assistance (Programa Nacional de Assistência Estudantil - Pnaes), proposals aimed at Brazilian federal institutions (universities and federal institutes) and that boosted investment in actions focused on student mental health.

Reuni was established in 2007, through Decree No. 6069, with the aim of expanding access and permanence in higher education by better use of physical structure and human resources available in federal universities (BRASIL, 2007). The expansion of inclusion policy and student assistance figured as one of its guidelines. In the same year, Pnaes was launched with a view to guaranteeing student access, permanence, and conclusion, as well as to guarantee resources exclusively for student assistance. In the proposal, mental health and psycho-pedagogical monitoring were presented as thematic lines, and, to this end, it was necessary to hold public competitions for technical-administrative servers, such as social workers, psychologists and nutritionists (ANDIFES, 2007, unpaginated). In this direction, the Ordinance No. 39 of 2007 of the MEC was launched, which established Pnaes, sanctioned as Decree Law (No. 7234) only in July 2010, consolidating itself as a government program.

According to Leite (2015), Pnaes brought form and expression to the assistance to university students, since, as already mentioned, student assistance in the Ifes was conditioned to the interest and budgetary resources of each institution. Pnaes was a social policy that aimed to achieve equality among students in higher education (GONÇALVES, 2011) and, to this end, pointed out ten strategic areas that should be developed in the Ifes: student housing; transportation; food; health care; digital inclusion; culture; sports; daycare; pedagogical support; access, participation and learning of students with disabilities; global developmental disorders; and high abilities and giftedness (BRASIL, 2010). Nevertheless, Decree No. 7.234 did not present specifications on mental health, but, from it, it was observed investment in student assistance, both in financial and human resources, as well as the discussion of new propositions for the mental health of university students was expanded.

As an example, in 2018, this theme became the agenda of one Fonaprace's Regional Meetings. One of them, organized and hosted at the Federal University of Paraná (UFPR), aimed to reflect on how student assistance is inserted in the context of mental health. In September of the same year, depression and suicide in universities were debated in the II Regional Southeast Meeting of Fonaprace, emphasizing the health promotion model in detriment of the biomedical care model² . In these meetings, working groups aiming to discuss promotion and prevention actions, as well as student support and follow-up were held (TOKARSKI, 2018; MENDES, 2018). The participation of Fonaprace and student assistance professionals in the debate, strengthening and increase of actions aimed at mental health at the university is reinforced (FONAPRACE, 2019).

In addition, in 2020, Brazil was faced with the situation imposed by the Covid-19 pandemic, making it impossible for young people to maintain their usual ways of life, which caused a negative impact on the mental health of college students (OLIVEIRA et al., 2021). According to Schmidt et al. (2020), social distancing, the main measure used to reduce the spread of the virus, could cause the appearance of psychological symptoms, such as: fear of being affected by the disease; loneliness, hopelessness, anguish, feeling of abandonment, sleep alterations and suicidal ideation. This scenario potentiated the emergence of stress, anxiety and depression (SCHMIDT et al., 2020; MAIA; DIAS, 2020; SILVA; ROSA, 2021), requiring protective measures, especially by the Education bodies.

Considering the growing rates of mental illness in the student community, the debate and investment in programs and actions aimed at mental health, associated with pandemic of Covid-19, we wonder: how has the mental health support to Ufal university students been presented, especially by student assistance? Which services and interventions were and are developed from the insertion of Pnaes? How have these interventions been presented? Aiming to answer these questions, this study sought to identify and analyze the mental health interventions of Ufal, focused on the student segment, through documentary research.

Ufal, an university institution located in the Northeast region of Brazil, was founded in 1961 and currently consists of four campuses distributed throughout the capital, metropolitan region and the interior of Alagoas: Campus A. C. Simões, located in the capital, Maceió; Campus de Engenharia e Ciências Agrárias - Ceca, located in Rio Largo; Campus Arapiraca and its units in Viçosa, Palmeira dos Índios and Penedo, located in the Agreste of Alagoas; Campus do Sertão, which has its headquarters in Delmiro Gouveia and a teaching unit in Santana do Ipanema. The study identified and analyzed the interventions in mental health aimed at the student public, in the period between 2010 and 2020. It also sought to contribute to the discussions related to the theme and offer elements to expand the support network for university students.

METHODOLOGY

Qualitative research sought to identify and analyze the interventions in mental health at Ufal directed to the student body. For this, it was performed a mapping of services and actions in mental health, developed by Ufal, specifically aimed at the student body, from 2010 to 2020³ . This was a documentary research, which had as field of study the Ufal website and the Instagram social network of the Dean of Students (Proest), and as analytical corpus, the Institutional Management Reports and the information / news available.

Data collection occurred from December 2020 to April 2021, using as descriptors "mental health", "psychological suffering", "psychological illness" and "quality of life". The inclusion criteria were: the presence of one of the descriptors mentioned; being an interventional action, aimed at the university's student body. In total, 85 documents were found (6 Institutional Management Reports/79 news items). The floating reading (BARDIN, 2011) allowed us to identify that much of the information available in the documents were not about interventions, and were not directed to the student body of the Ufal. In the end, 35 documents (4 Institutional Management Reports/31 news) were evaluated and interpreted in the light of academic literature review.

The data constituted in the documentary assessment were analyzed using the technique of content analysis, set of techniques of communication analysis that aims to perform an inference of knowledge relating to the conditions of production or reception, inference that might use both quantitative and no quantitative indicators (BARDIN, 2011, p. 44). For this, it was resorted to the use of systematic and objective procedures to describe the content of the messages, obtaining as a result the development of two categories discussed below.

RESULTS AND DISCUSSION

Considering the research questions and objectives, as well as the analysis of the material in light of the scientific literature, the results pointed to the presence of two categories of analysis: "Mental health care" at Ufal: from permanence policy to permanent actions, and "articulate together...": intersectoriality "[...\ a path to follow".

"Mental health assistance" at Ufal: from permanence policy to permanent actions

Brazilian federal universities have undergone transformations over the past two decades, with repercussions in the modification of the assisted student body, in their human and physical resources, and, depending on the demands presented, in the necessary themes for support and intervention. Among these themes is the mental health of college students. This category considered the influence of democratization policies, especially the Pnaes, for the emergence and expansion of interventions, as well as points out those that stood out in the findings and were permanent over the years.

According to the results found, interventions in mental health aimed at university students at Ufal are scarce and recent. Dating from 2014, the "psychological care", performed by Proest, appears without specifications. Moreover, new interventions are only pointed out again in the documents two years later. It was recognized that health care provided in the National Plan for Student Assistance has a long way to go (UFAL, 2014, p. 116). Such notes suggest that it is an action not yet consolidated, with a history of late emergence, if we consider 2010 as the year of launching of Pnaes. Similar results were found in research conducted in other institutions. In 2010, Assis and Oliveira identified that at the Federal University of Mato Grosso (UFMT) there were no actions aimed at psychosocial care of students. In 2013, Osse pointed out that, even though there were services that provided support to the student body, the University of Brasilia (UnB) did not have an exclusive service for students. Silveira (2012) identified that, of the 14 Ifes created or federalized between 2003 and 2010, only 3 developed some type of mental health intervention.

It was only at the end of 2014 that, according to Gomes and Oliveira (2019a), there was the entry of the psychologist in Proest of Ufal, through public tender. In this direction, although Gomes and Oliveira (2019a) report the experience of the psychological reception originating in 2015, our findings showed systematic of this activity only from 2016 and over the following years, with, according to reports, an increasing number of students assisted and services provided. As an example, the Institutional Management Report of Ufal, for the year 2019, pointed out that there were 1,066 psychological consultations and 71 referrals to psychiatry assistance and public network, in a universe of 343 students served by the Psychological Reception Service (UFAL, 2019, p. 127). The Report shows an increase in the number of attendances, compared to the year 2017, when 206 students were attended and 436 attendances were recorded.

Such expansion may be related to the increase in the team of psychologists at Proest, which now has professionals in the capital and in the interior, also having as a consequence a greater diversity of activities performed. In 2019, these professionals organized and/or participated in events and campaigns (White January, Yellow September, Lilac August, etc.), in a perspective of mental health promotion with collective, interdisciplinary and intersectoral actions (UFAL, 2019, p. 127), in addition to performing group interventions (reflection groups and conversation groups), guidance and discussion of cases with other Ufal servers, referrals to the public health network and preparation of the second edition of the Guide to Psychosocial Care in Mental Health.

However, in 2020 there was a reduction in activities, as our results indicate. This decline coincided with the period of the Covid-19 pandemic, which paralyzed services, including education sector. Unable to be physically present to combat the proliferation of the virus, new ways of being present needed to be thought up by education sector in view of the demands that presented themselves, such as mental health support. Thus, in April 2020, Proest's Psychology department started to offer psychological support in a virtual format. Moreover, throughout the year, two booklets were published focusing on mental health care during the pandemic, and a live broadcast and conversation rounds were held, also in virtual format. These specific actions sought, mainly, to help students with the challenges imposed by the pandemic.

In addition to the interventions carried out by Proest, we found, in the years leading up to the Covid-19 pandemic, activities developed by other sectors and students concerned with mental health at the university, such as: (1) Nutrition Faculty with the extension project Room of Care, alternative therapies in 2016; (2) Pro-Rectory of People Management (Progep), which developed in 2017 and 2019 debates, lectures and roundtable on mental health, mainly through campaigns such as "White January", "World Health Day" and "Yellow September"; (3) Education Center, with the Theatre of the Oppressed in Mental Health in Maceió in 2017; (4) Nursing Faculty, holding a roundtable on Yellow September in 2017; and (5) students debating about mental health in an event in 2019. It is important to highlight that, even though there is a School Clinic of Psychology at the university, we did not identify activities in this sector.

Considering that the concern with the mental health of college students had its origins in the 1950s (HAHN; FERRAZ; GIGLIO, 1999), and the concern and discussion on the topic of mental health have gained more attention in recent times ( LEITÃO, 2017; PENHA, OLIVEIRA; MENDES, 2020 ), the path presented by Ufal in the implementation of interventions aimed at the mental health of college students seems to follow the implementation of redemocratization policies in the Brazilian Ifes, especially Reuni and Pnaes. These findings are similar to results of studies already conducted ( MOURA, 2015; OLIVEIRA; SILVA, 2018; GOMES, 2020 ).

In this scenario, it is worth highlighting the actions taken by student assistance. It is from it that most of the interventions in the context of Ufal start, with expansion over the years. Although in Decree No. 7.234 the specifications on mental health are not clear, in 2016 the Brazilian student assistance had 201 psychologists ( CÊPEDA, 2018 ), with a greater entry of diverse professionals in the Executive Branch, by public competition, in 2014, according to the Ministry of Economy ( BRASIL, 2018). In a brief search conducted on the website of the Permanent Commission of Vestibular (Copeve), the Ufal body responsible for the selective processes of the institution, we identified the holding of public competition for clinical and organizational psychologist that same year. Such data indicate that the increase in student assistance actions at Ufal, focused on mental health, coincides with the institutional investment in strengthening the team of Psychology professionals in the sector. According to Moura and Fachi (2016), the student assistance concerns a place recently occupied by Psychology.

From the interventions made, we found that some of them remained present in the years observed, as described below: the psychological reception and referral to the network of psychosocial care, both performed by Proest; and the implementation of campaigns, of national and international nature, both by Proest and by other sectors, especially Progep. These interventions seem to mark, in general, how Ufal has acted in the continued assistance to students' mental health.

The psychological reception, carried out by Proest, was defined as

qualified technical listening to the demands brought by the student to the service, in order to guide him/her on the coping strategies that he/she may develop to deal with the situation experienced at that moment (UFAL, 2019, p. 127). (Note: translated by the authors).

When reporting on the experience of psychological welcoming at Ufal, Gomes and Oliveira (2019, p. 112) pointed out that the practice was developed in 2015 as an activity of Psychology to meet the needs of mental health care of university students, as well as delimit the role of Psychology in student assistance. According to the interview given by Proest psychologists in 2020, after the listening, performed in two or three meetings, the professional should refer each situation.

In this direction, the referral to the Psychosocial Care Network (RAPS) was shown to be related to such practice, but difficulties were presented when referencing it (UFAL, 2019). As a way of referencing the RAPS, the Guide to Psychosocial Care in Mental Health was elaborated and launched in 2017. It was an informative and fundamental support instrument in activities of psychosocial nature carried out by student assistance professionals (UFAL, 2017, p. 94) that contained data on the services of the RAPS, especially those services that had mental health professionals, such as psychologists and psychiatrists. Updated in 2019, the proposal aimed to guide the student to the realization of psychotherapeutic treatment in the Health Network. It is observed, on the part of student assistance professionals at Ufal, the defense of the treatment of mental health issues referenced in the RAPS, a perspective advocated in other studies (BLEICHER; OLIVEIRA, 2016; GOMES; OLIVEIRA, 2019 a, 2019b).

As for the campaigns, "White January", "World Health Day" (celebrated on April 7th), "Lilac August", "Yellow September" (celebrated on the 10th of that month), and "World Mental Health Day" (held on October 10th) were present, some of them posted on the university's website, as shown in figure 1.

Figure 1
Campaigns promoted by Ufal.

The campaigns were carried out by various sectors, through rounds of conversation, debates, roundtables, lectures, but were not maintained over the years. However, the "Yellow September" was present in our findings since 2016, continuously maintained until the year 2019, being held by various sectors or articulated among them. According to Araújo (2020), this campaign has been worked in many Ifes as a way to confront suicide. According to Fonaprace (2019, p. 84), the Ifes have expanded their actions in mental health with the adherence to the campaigns called 'White January' and 'Yellow September', which aim to raise awareness of the academic community about mental illness, psychological suffering, and suicide.

The actions taken, such as lectures and individual psychological assistance, focus on the students, favoring information and help in achieving individual changes. In this sense, they neglect a critical reflection about the university scenario that generates institutional transformations. Thus, it affirms an individualistic perspective in dealing with mental health and psychological suffering, to the detriment of a psychosocial approach. On the other hand, collective practices, groups and conversation rounds present possibilities of expanding actions, including the experiences and perceptions of students concerning the university environment, with repercussions on institutional policies.

The interventions mentioned can be classified as preventive, since they are mainly oriented towards avoiding illness, reducing incidence and prevalence, being structured through guidance and dissemination of information (CZERESNIA, 2003). In smaller numbers, interventions with a broader proposal and with a focus on health and general well-being appeared in the results: sports activities held by the Physical Education Institute of the institution and by Proest (one of the areas of Pnaes is sports); actions by student initiative, such as sports activities, carpooling, diaper room and nap room, as well as open spaces in events for discussion about mental health.

For Contini (2010), the psychologist who works in the educational context should overcome the preventive practice, focusing mainly on health promotion. However, the author warns that promoting health in education is not only the role of Psychology, the area in which most of the interventions carried out by Ufal were concentrated. Still, given the complexity of the human phenomenon, it is necessary to dialogue with other areas of knowledge, both in the production of new knowledge, as in professional practice (CONTINI, 2010, p. 48). In this direction, the emphasis of actions in mental health in education should be on the transformation of living and working conditions that conform the underlying structure of health problems, demanding an intersectoral approach (CZERESNIA, 2003, p. 4), being intersectorality a challenge posed to the institutional context and student assistance as we will see below.

"Articulate together[...\": intersectorality; "[...\A way to go"

According to the 2014 Management Report, it was pointed out, by Proest, the importance of articulating with Progep projects and actions aimed at improving the quality of life of the student community (UFAL, 2014, p.184). Articulate, according to the dictionary of the Portuguese language ( GEIZER, 2012, p. 75 ), means establish relations between parts, uniting, create, plan, combine, promote. Such concept brings us to the term intersectoriality, a perspective that aims to overcome fragmentations between the various areas, allowing the establishment of dialogues, shared between institutions, governments and people, and acting in the formation of policies that can impact the health of the population (OLSCHOWSKY et al., 2014, p. 592).

Ufal is composed by various sectors such as pro-rectories, academic units, administrative sectors that, in everyday life, interact and dialogue with various actors: students, servers (teachers, technicians and outsourced employees) and the external community. Although this study has focused on interventions with students, it is understood the importance of collective actions, planned and articulated by sectors and actors of the university community, considering the context in which they are inserted. For Perez, Brun and Rodrigues (2019, p. 358) mental health in the university context should not be solved individually, there being the need for engagement of students, teachers and professionals who work in higher education, in addition to the health professionals themselves.

The findings of this study reveal the scarcity of articulated actions by different sectors at Ufal. The data point out that, although it is intended on the path of intersectoriality from referrals referred to RAPS, the discussion of cases, the participation of psychologists from student assistance in activities as facilitators or speakers in academic events focused on the themes of student assistance (UFAL, 2019, p. 127), in addition to the realization of two "Yellow September" campaigns (2018 and 2019) with the participation of various sectors of the institution, challenges are presented, since we did not found projects, in partnership, with a focus on student mental health and that considered the institutional reality, including there the other actors of the university scene. We agree with Oliveira and Silva (2018) when they state that the challenges are related to the recent professional performance of psychologists in this context, as well as to the discussions about mental health among young people that have been gaining more attention recently (LEITAO, 2017; FONAPRACE, 2019).

In addition, information on various activities suggests a lack of coordination between sectors, especially between student assistance and employee assistance sectors. In 2017, Proest carried out a campaign on the university's institutional media about depression, on World Health Day. A similar activity was carried out by Progep, which offered it to the entire academic community. In the same year, this sector carried out activities in Yellow September, starting with a round table discussion, while Proest held a round of conversation about suicide in May. In 2018, articulated with sectors such as the School of Medicine, the Institute of Psychology, and the University Hospital, Proest held the Yellow September. During the disclosure of this event, it was pointed out that the Faculty of Nursing would also hold roundtable on the theme. The academic unit of Palmeira dos Índios also held activities on the theme in the same year. It is observed, therefore, the prevalence of isolated efforts from various sectors, which could have their scope expanded through intersectoral actions.

The interventions suggest segregation between student and worker health actions in the university context (BLEICHER; OLIVEIRA, 2016). This may be related to the fact that, regarding the actions developed in the health area, there is no clear definition or sufficient criteria, especially due to the idiosyncratic and complex aspect present in the determinants of health (PENHA; OLIVEIRA; MENDES, 2020, p. 389). New challenges are presented in view of the advances made regarding the mental health of college students. However, old challenges are still present, such as the need to articulate with Progep projects and actions aimed at improving the quality of life of the student community pointed out in 2014. It is advocated that mental health in the university context be planned and developed in an institutional perspective, not relying only on Pnaes (ARAÚJO, 2020) or the student assistance sectors of the Ifes. At the same time, it should articulate different areas and, consequently, different social policies, aiming to ensure a broad standard of social protection (IMPERATORI, 2017, p. 295), for example, through articulated actions in the areas of culture, pedagogical support, and sports, areas that appeared little or not at all in our findings.

The potential and challenges of intersectoriality refer to the discussion on interdisciplinarity in the field of mental health, advocated since the Psychiatric Reform movement and the psychosocial care policy in Brazil. In this context, mental health was considered in the sociocultural field, demanding interdisciplinary and intersectoral assistance, created with the substitutive services, especially the Psychosocial Care Centers (CAPS) (LEAL; ANTONI, 2013). In this conception, people are considered in their entirety, requiring networks and public policies articulated between the various sectors of society and government. Such perspective calls for the planning of institutional policies that take into account the complexity of the mental health issue in the university, aiming to overcome the fragmentation of efforts, so that better results can be achieved. Partnership actions among the several areas of knowledge and institutional sectors, involving sports, art and culture, are particularly relevant.

Thus, the old challenges pointed out and the new challenges - if we consider the plural and dynamic context that education is and where it is inserted - intersect, creating obstacles, but also possibilities, demanding financial, human, and creative capital from institutions and professionals who work in mental health and in the fight against dropout in higher education.

CONCLUDING REMARKS

This study aimed to identify and analyze the interventions in mental health aimed at the students, carried out by Ufal in the period between 2010 and 2020. Through documentary research, which had as field of study the university's website and social networks, and as analytical corpus the Institutional Management Reports and the available information/news, 35 documents (4 Institutional Management Reports/31 news) were identified and analyzed. The analysis of the documents, referenced in Bardin (2011), allowed the development of two categories of analysis "Mental health care" at Ufal: from permanence policy to permanent actions and "articulate together...": intersectoriality "[...\ a path to follow".

The results indicated that interventions in student mental health at Ufal are scarce and recent, with a more systematic beginning in 2016. The democratization policies, especially Reuni and Pnaes, boosted these actions, especially by the entry of psychologists in student assistance from 2014. In this sense, the interventions suggest, for the most part, to be developed by the student assistance sector, from a prevention perspective. Among the activities, psychological welcoming, referrals to RAPS, and national or international campaigns, the latter carried out by different sectors, prevail in number and time.

Challenges are presented as to interdisciplinarity and intersectoriality, since, even though articulation was sought, actions were fragmented with little institutional articulation, and there were no projects or programs with the participation of several institutional actors. It is understood that the mental health of the university student does not call only for Psychology, which, as we observed, tends to develop most of the activities, or for student assistance, for being considered a reference sector for the student. These are parts of the process and should stimulate (in the sense of provoke), support and, in a collective action, enable intersectoriality through different approaches to the same phenomenon, favouring an understanding of the totality of the phenomenon studied and observed (CONTINI, 2010, p. 50).

Finally, we highlight the limits of this research, conducted with institutional documents and information from the institution's website, published on the Internet, a field that may not reach the totality of actions effectively carried out throughout the investigated period. In this direction, we reinforce the importance of future research that can expand the results pointed out here, in order to support or refute them, as well as to enable contextualized interventions concerned with the institutional demands.

Preprint

DOI: https://preprints.scielo.org/index.php/scielo/preprint/view/4343

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• 1
  The terms "death ideation" and "suicidal thinking" appear as distinct items in the FONAPRACE material. However, no definitions of the terms were presented.
• 2
  The biomedical model is based on the conception of health as the absence of disease, limiting itself to the biological in order to respond to health-disease processes. Thus, it has a curative perspective. The health promotion model, on the other hand, works with the expanded concept of health, with emphasis on the perspective of care (MARCONDES, 2004).
• 3
  The choice of the beginning of the period is justified because it is the specific year when Decree 7.234 was issued.
• 4
  Images taken from Ufal's website: www.ufal.br

• The translation of this article into English was funded by the Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG, through the program of supporting the publication of institutional scientific journals.

Publication Dates

• Publication in this collection
  16 June 2023
• Date of issue
  2023

History

• Received
  07 July 2022
• Accepted
  28 Feb 2023