Suicídio e políticas públicas de saúde : estudo etnográfico com atores e documentos acerca da efetivação de políticas de prevenção do suicídio

Abstract

This thesis presents a study on suicide and the set of public policies for suicide prevention, based on the field of epidemiological surveillance of self-inflicted violence, resulting from multi-sited ethnographic field research. It starts from discomforts arising from the author's daily work, generating alterities developed by an involved public health specialist and anthropologist. From an anthropological approach, it has the general objective of understanding the dynamics of construction and institutionalization of suicide prevention policies in Brazil. It moves between local and national instances that connect in the web of construction and implementation of public policies. Its research material is the set of documents related to suicide prevention policies and other health policies, on the one hand, and, on the other hand, the interlocutors, including people in situation of suicide, local suicide prevention working groups and managers directly or indirectly linked to the processes of idealization and construction, deployment and implementation and operationalization of the respective policies, with experience at local or national level. Given the complexity of the subject, suicide must be understood as a process that does not end with the attempt and death and reverberates in the family/close environment and in the broader social context, beyond the person. In public health, suicide emerges as a problem based on public policies aimed at violence (National Policy for Reducing Morbidity and Mortality from Accidents and Violence; National Policy for Preventing Self-Mutilation and Suicide, for example), characterized as self-inflicted violence, constituting an arena of struggle and power for its definition and confrontation. In this regard, historically, public health policies have not addressed the issue of suicide directly, as they have been scattered across different areas of knowledge and lack consensus on the flow of health care. When suicide prevention guidelines and standards are available, they fluctuate in accordance with public policies and management, do not consider its complexity, and are limited to biomedical and individualizing explanations, without prioritizing financial resources in the implementation of health actions at the different levels of the Unified Health System. Facing this challenge, it is necessary to continue the political resistance to find the arena for prevention and to hope that lives will not be shortened by suicide.