Singular therapeutic project in mental health: an integrative review

it is an Integrative Literature Review study conducted in July 2017. The following databases used to collect the data were LILACS, MEDLINE and BDENF. After applying the inclusion and exclusion criteria, 12 articles were selected.

Results:

there was divergence between what was recommended by the Ministry of Health for PTS elaboration with that described in the studies analyzed. Emphasis is placed on the low participation and co-responsibility between team/user in PTS elaboration, excessive referrals to specialized mental health services, fragmentation of knowledge within the multidisciplinary team, and difficulty sharing and discussing information about cases.

Final considerations:

it is pointed out the need to adapt PTS elaboration, and its respective steps, to the needs of each individual.

Descriptors:
Mental Health; Primary Health Care; Mental Health Services; Patient Care Planning; Integrality in Health

A^* * Article;	Title	Year/place of publication^ Brazil's Federation Unit.	Main Results
01	A construção de um projeto terapêutico singular com usuário e família: potencialidades e limitações	2012 Mato Grosso	• Embracement as a way of approaching users aiming at link building; • Importance of home visit to include family members in care.
02	A prática do apoio matricial e os seus efeitos na Atenção Primária à Saúde	2016 Espírito Santo	• Search for immediate answers aimed at healing, referring to the biomedical model; • Difficulty creating links with users; • Matrix support as a facilitator of qualified listening, co-responsibility for care, and reduction of unnecessary referrals.
03	Apoio matricial: dispositivo para resolução de casos clínicos de saúde mental na Atenção Primária à Saúde	2013 Ceará	• Team stigma in seeing mental health demands; • Importance of the link to the discussion of issues little explored; • Need to expand the therapeutic offer; • Team search in broadening the dialogue and listening; • Importance of matrix support for mental health care; • Importance of light technologies, affection clinics and co-responsibility.
04	Apoio matricial, projeto terapêutico singular e produção do cuidado em saúde mental	2015 Ceará	• Centered-medical work and intense influence of classical psychiatry geared towards medicalization, but difficulty of physicians in prescribing psychotropics; • Articulation with devices of the territory to compose PTS and punctual attempts of articulation in network; • Unpreparedness and impotence of professionals in dealing with clinical cases of mental health; • Lack of user participation in the elaboration of their PTS; • Need for permanent education for the Family Health Strategy (FHS) team; • Encouraging interdisciplinary work at FHS.
05	O projeto terapêutico nos CAPSs de Mato Grosso: uma análise documental	2009 Mato Grosso	• Performances on an authoritarian, repressive and punitive basis with emphasis on pre-established rules and norms; • User has the possibility of disconnection or suspension of the service if it exceeds the number of allowed faults; • Lack of family support; • Concern about identifying those responsible for users; • Lack of linkage and participation of users in PTS construction, considering that only one document brought the participation of users in the decisions of its therapeutic project.
06	O Projeto Terapêutico Singular e as práticas de saúde mental nos Núcleos de Apoio à Saúde da Família (NASF) em Guarulhos (SP), Brasil	2013 São Paulo	• Lack of physical space for extended meetings and basic communication technologies such as telephone and computer; • Lack of capacity to perform primary health care and mint health; • Absence of PHC physicians at meetings with the NASF; • Meetings guided by referral guides, without information from users and without preparation of the team to discuss the cases taken to the matriciamento; • Embarrassment, distrust and detachment between teams; • NASF team work overloads; • Lack of intersectoral involvement and networking; • Feeling of professional dassessment.
07	Os desafios da integralidade em um Centro de Atenção Psicossocial e a produção de projetos terapêuticos	2011 São Paulo	• Deficiency of records in medical records; • Lack of sharing of PTS information among team members; • Difficulty of night shift being present at case discussion meetings; • Need for interventions with family members and home visits; • Need for a less compartmentalized practice.
08	Projeto terapêutico de usuários de crack e álcool atendidos no centro de atenção psicossocial	2015 Ceará	• Individual and group approaches; • Performance of multidisciplinary team in the development of activities; • Risk of fragmentation of care and need for interdisciplinary action; • Assessment of therapeutic projects through consultations with the medical clinic; • Active search through home visits to redeem the link; • Incomplete information in records, with inadequate filling and unreadable letter.
09	Projeto terapêutico em Saúde Mental: práticas e processos nas dimensões constituintes da atenção psicossocial	2016 Ceará	• Participation of the team in decisions and planning of actions from the political guidelines of the Psychosocial Care Center (CAPS - Centro de Atenção Psicossocial); • Underestimation of sociocultural aspects; • Fragmentation of care evidenced by specialization in action organization and lack of knowledge interlocution; • Lack of user participation in the process of discussion and elaboration of its therapeutic project; • Lack of linkage and co-responsibility, evidencing the lack of interventions in the socio-affective field; • Preponderance of the biomedical model evidenced by the formatting of the supply of care strategies; • Challenge to ensure the construction of PTS that promotes psychosocial care and can cover the affective dimension.
10	Projeto terapêutico singular na produção do cuidado integral: uma construção coletiva	2011 Ceará	• PTS is based on the mutual effort between health-user-family worker; • Users interact at any moment in the process; • Prioritization of networking; • There are meetings to discuss the work process; • Consideration of the social spaces of users; • Hosting based on active listening and bonding; • Interconnection between ESF and CAPS to identify care needs of users; • PTS considers the opinions, dreams and purposes of the user's life, establishing a horizontal relationship between worker-user-family; • Responsibility for monitoring PTS does not lie solely with the Reference Technician (RT).
11	Projeto terapêutico singular no âmbito da saúde mental: uma experiência no curso de graduação em medicina	2014 São Paulo	• Semi-structured interview for bonding; • Follow-up of the case through meetings with sequential themes; • Challenge in enabling users a moment of listening and therapeutic orientation according to their own demands.
12	Projeto terapêutico singular para profissionais da estratégia de saúde da família	2016 Santa Catarina	• Difficulty organizing teamwork as an obstacle in the elaboration of PTS as routine; • Non-standardized records and parallel information hampering communication; • Lack of joint organization and planning of care actions for users and family; • Excess demand from users; • The need for a computerized interconnected system for recording information shared between CAPS and FHS.

CHARACTERISTICS		ARTICLES
CHARACTERISTICS		A1	A2	A3	A4	A5	A6	A7	A8	A9	A10	A11	A12
1^st STEP	Embracement and situational analysis of the case	X	X	X	X	X	X	X	X	X	X	X	X
1^st STEP	Comprehensiveness (physical, psychic and social aspects)	X	X	X	-	-	-	X	X	-	X	X	-
2^nd STEP	Actions	X	X	X	X	X	X	X	X	-	X	X	X
	Goals	-	X	-	-	-	-	-	X	-	X	X	X
	Discussion with subject about actions and/or goals	X	X	X	-	-	-	X	X	-	X	X	X
	Discussion with team about the PTS under study	X	X	X	-	-	-	X	X	X	X	X	X
3^rd STEP	Sharing responsibility in the teams	-	X	X	-	-	-	X	X	X	X	X	-
	Co-responsibility (team/user)	X	X	X	-	-	-	X	X	-	X	X	X
	Definition of PTS by RT	-	X	-	-	-	-	X	X	-	X	-	-
4^th STEP	PTS reassessment with subject and team	-	X	-	-	-	-	X	X	-	X	X	X

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[1] Corresponding Author: Juliana Ávila Baptista E-mail: julianabaptista89@gmail.com