Temporary housing as a mental health intervention for the needs of children and adolescents users of alcohol and other drugs: Hybridity between care and protection

Abstract

This article discusses temporary housing for children and adolescents as a modality of health care. Using the framework of French Institutional Analysis, the research was based on interviews with practitioners, participant observation and analysis of individual records so as to understand the trajectory of the cases and the implications of the temporary and volunteer nature of this service. The hybridity of this home and its acceptance of other possible life norms generate tension with custodial and stigmatizing practices in the Brazilian health and social assistance services available to children and adolescents.

Keywords

childhood and adolescence drugs hybridity mental health

Introduction

Since the advent of the Brazilian Unified Health System (Sistema Único de Saúde – SUS; Brasil, 1990a), the public health system¹ offers many services for children and adolescents, striving to insure their rights, their liberty and autonomy. This perspective can also be found on mental health actions, where a public policy² was established grounded on an intersectorial approach, with a territory and community base, in accordance with an enlarged concept of health.

In parallel, with the implementation of the Child and Adolescent Statute (Estatuto da Criança e do Adolescente – ECA; Brasil, 1990), the acknowledgement of children and youth as citizens with rights and as an absolute priority regarding social protection led to the development of a broad system for the defence and assurance of rights with significant changes in their lives.

In spite of this reordering, there are many challenges for working with children and youths who live in the circuits between the street, the system of care and the judiciary. This was indicated in the 2003 assessment made by the Health Ministry (Brasil, 2003), which showed the insufficiency of services and the frailty of health policies for problems related to drug use, and resulted in many proposals for tackling these problems (Brasil, 2009, 2010a).

One of the effects of the frailty of the network of services, pointed out in various research, is the increase in psychiatric admissions of children and adolescents, particularly those who use drugs and live in the streets (Almeida, 2012; Joia, 2014; Scisleski, 2006). The situation gets worse when admission to hospital is the result of a court order: compulsory admissions tend to be long and recurrent, and reduce complexity to a medical perspective that reinforces the asylum-like, coercive function of psychiatric hospitals and weakens other public services (Blikstein, 2012; Cunda, 2011; Joia, 2014; Scisleski, 2006, 2010).

On the other hand, many children and adolescents have been refused at the Social Assistance Services for Institutional Reception (SAICA),³ based on the assumption of a supposed risk associated with mingling with this public or with the excuse of the need for intensive care and protection.

By appearing both as defenceless or dangerous (Assis, 2012; Orestes, 2013), they become institutional wastes as a result of the abandonment and lack of commitment produced by these very institutions (De Leonardis, 1998). This situation has provoked debates about the creation of specialized shelters, including those for mental disorder (Almeida, 2012; Couto, 2004).

Considering these problems, in this article, we describe a service created for temporary housing drug users, the Juvenile Hosting Units (from the Portuguese Unidade de Acolhimento Infanto-Juvenil – UAI). The stories of children and adolescents in these units evince the tensions in mental health and social assistance services with respect to their possibilities for coping with the demands of drug users as well as tensions that arise at the interface between policies oriented by rights and controlling, repressive modalities that are justified by appealing to protection and care.

This analysis was part of a research developed for a master’s degree.⁴ It was conducted at a Juvenile Hosting Unit, UAI and at the Juvenile Psychosocial Community Centre (Centros de Atenção Psicossocial – CAPSi), both located in the same territory in the city of São Paulo. Empirical research was carried out in 2014 through participant observation concerning the UAI’s routine, interviews with practitioners and investigation of individual records of adolescents who had been or were housed during the period of research.⁵

The adoption of the methodological approach of the French Institutional Analysis (IA) denotes an ethical–political posture in the conduction of the research in which the researcher is not seen as somebody who studies about something, that speaks for someone, striving to know in order to transform reality. On the contrary, the researcher intervenes, adopting the position of someone who investigates with the subject or group and speaks to them. Therefore, it is a form of intervention research given that, as it works ‘on the level of the events, it must always safeguard the possibility of innovative human experience; and the researcher must be open to follow and be surprised by it’ (Paulon, 2005: 21).

The perspective that was assumed gives priority to ‘the knowledge derived from daily living in the field (not the “know-how” of rules, but the “how it was done” of practice)’ (Lourau, 1993: 77), acknowledging the temporality of research and the implication of the researcher in the knowledge produced. The field diary was the main tool for this exercise.

Hence, the importance of the concept of implication, forged in the context of IA, relates to the interplay of relations that contribute to the production of knowledge, in which the researcher is necessarily implicated. There is no possibility of neutrality in research, since the observer/researcher is part of the observation field, therefore altering it by his/her presence. It is a question of analysing implications of the process of research, that is, the conditions for carrying out the research (Lourau, 1993).

For the analysis of the place the UAI occupies in the practices that perform juvenile care policies in the town of São Paulo, the concept of analyser was used (Lourau, 1993) – an event that gives visibility to the power play present in a given situation that allows questioning some naturalizations. This concept guided the choice and arrangement of the fragments of conversations, scenes and cases extracted from the field diary.

In this manner, we propose to demonstrate the risks of a ‘circuitous functioning’ (Rotelli et al., 1990: 23) of the services, when one-off, selective and fragmented actions promote both chronicity and/or emergency situations.

In contrast, we will attempt point to the potency of the UAI in producing different modes of care by reaffirming its hybrid character and by recognizing children and adolescents as political subjects that can refuse the tutelage and control that characterize the policies directed to them.

The Hosting Unity as a care strategy

Institutional hosting as a care strategy in mental health has been adopted since the beginning of the years 2000. Two pioneer experiences – Casas do Meio do Caminho⁶ (Halfway Houses) in Recife, capital of Pernambuco (PE), and the República Terapêutica (Therapeutic Housing) in São Bernardo do Campo, a city in the metropolitan area of São Paulo – worked with the perspective of Harm Reduction,⁷ a clinical–political strategy which is contrary to hegemonic forms of treatment used for the drug-user population. This way of positioning required the invention of new modalities of care in order to face the compulsory and segregationist which are characteristic of this field.

In 2009, when the Emergency Plan for Expansion of Alcohol and Drugs Treatment and Prevention (Brasil, 2009) was launched, temporary housing was indicated as an alternative for the mental health care for the most vulnerable population groups: children, adolescents and juvenile drug users who lived in the streets. Subsequently, these units were named as Hosting Unit (Unidade de Acolhimento – UA) (Brasil, 2010, 2012).

These units are available for adults (Adult Hosting Unit, Unidade de Acolhimento Adulto – UAA) or juvenile (UAI) users with ‘needs resulting from the use of crack, alcohol and other drugs […] who are vulnerable socially and family-wise and require therapeutic and protective follow-up’, and rely upon a reference to a Psychosocial Community Centre (CAPSi⁸) (Brasil, 2012: online, accessed 01 July 2015).

Therefore, the UAI is a node in the Network of Psychosocial Services (Rede de Atenção Psicossocial – RAPS) that can be activated by the CAPS when the use of drugs requires intensive care in an open environment. Because these cases are complex, the actions undertaken by the CAPS and other local health services must be coordinated with other services, such as the Reference Centre for Social Assistance (Centro de Referência de Assistência Social – CRAS) and the Specialized Reference Centre for Social Assistance (Centro de Referência Especializado de Assistência Social – CREAS); schools, for promoting access and the right to education; policies regarding Leisure and Sports facilities and so on. (Brasil, 2012). The potency resulting of its residential and open character is to favour territorial liaisons for producing care, as well as insuring interactions with family and community.

It is important to emphasize the fact that this modality of care expresses the mixture of actions and technologies that are inherent to the field of mental health and social assistance policies, as it uses institutional hosting⁹ as therapeutic and protective strategies. However, in spite of its similitude with the SAICA the Juvenile Hosting Unit, UAI, is different because its main objective is mental health care, even if social protection is also one of its aims. It does not, therefore, substitute the SAICA: they have complementary objectives of intensive care (the UAI) and social assistance (the SAICA).

It should also be said that temporary housing appears as an alternative of care in a context of discursive re-alignment in the policies on drugs as health policies assume a more active role in this area. However, 3 years after they were founded, and more than a decade after the first experiences, it is worth noticing that there is only a small number of hosting units in the country: 34 UAA and 26 UAI (with 770 vacancies in total), according to the website Observatório Crack, é possível vencer (n.d., Crack Observatory, crack can be beat, www.brasil.gov.br/observatoriocrack/index.html – accessed 02 May 2015). Considering that historically drugs have been dealt with through a prohibitionist bias, punitive and medically oriented, it is not difficult to suppose that this network of services is still oriented by an updated version of these rationalities.

The São Paulo Juvenile Hosting Unit (UAI): challenges and paradoxes of care

The opening of São Paulo’s UAI happened during the Operação Sufoco (Operation Tight Spot), prompted by the city’s government in 2012. This operation was an anwser to the demands of urban gentrification,¹⁰ and it merged police repression with health and social assistance actions aimed at homeless people and crack-users that dwelled in the town centre (Joia, 2014).

Many sectors that were contrary to this operation rallied, with large media coverage, and created the conditions to develop other methods for understanding and answering to the drug question, as stated by a health professional: ‘The interesting thing is that it was their action [the Operação Sufoco] that produced this space [the UAI] as an answer, and an unusual one’ (interview with health professional, 2014). It was an unusual answer because it came up in a context in which the hegemonic response would have been psychiatric admission or other modes of treatment proposing isolation and abstinence.

In São Paulo, the UAI is staffed by two university trained health professionals that share the function of coordination, and a team of community carers, working in shifts on a daily basis.

Because it was the first service in this modality,¹¹ it is situated in a place close to where children and adolescents who live on the streets dwell. It has a housing capacity of up to ten users. It occupies facilities in a residential borough, in order to favour community conviviality, with spaces organized in a house-like manner – living-room, kitchen, bedrooms, bathrooms and toilets, backyard – with no resemblance to in-patient or psychiatric institutions. There is a monthly allowance for buying food and other daily use products, for the use of public transportation and for the maintenance of the facilities.

For those who are accepted, privacy is guaranteed and they have individual lockers in their rooms for keeping their belongings. They are invited to take part in meetings for the definition of conviviality rules, and to help in the tasks of housekeeping and daily living activities. They have free access to the house up to ten o’clock in the evening and are oriented to not bring into the house illicit substances, in accordance to an established rule, and they can receive visits of their families.

The daily routine of the adolescents involves participation in activities such as therapeutic workshops and groups offered at the CAPSi and regular attendance to school; health care in offered by one of the public services; there are leisure activities (outings, parties organization, etc.) and visits to their families (particularly on weekends).

Between March 2012 and September 2014 a total of 55 adolescents ranging from 13 to 18 years where accepted at the UAI. The majority was male (67%), living on the streets (77%), with a history of use of psycho-active substances (91%) and one or more passages through SAICA (68%).

The majority of the cases sent to the UAI stayed for less than 3 months. One might suppose, at first, that this reflects the guidelines present in the document¹² that rules its functioning: it specifies that acceptance and inclusion of the youngster should respect the voluntary, transitory character of the service, which means that they can refuse this type of care and that the staff must have the ability to listen and negotiate their care plan.

However, a closer look reveals that the short time of stay does not seem to be a result of the voluntary, transient character of UAI. In the opinion of some of the staff that were interviewed, the adolescents for whom it was not possible to maintain hosting as a care strategy were those who had not been referred by the CAPSi; they did not have a transition plan that could induce the creation of bonds and meanings for the adolescent and for the professionals that were involved.¹³

Two situations contribute to this situation: hosting determined by judicial order that does not respect the normative, clinical criteria for the inclusion of adolescents in the UAI; and the lack of other units of juvenile hosting in town, which impairs the territory logic which is fundamental for integral care.

On the other hand, in some cases, housing was prolonged, in spite of the transitory characteristic indicated in the normative document: 18 per cent of the adolescents remained in the service for over a year. The case of adolescents who had been diagnosed with mental disorders and did not use drugs, a considerable number among those hosted in the unit,¹⁴ is emblematic of this tendency and reveal a paradox: if the UAI is the destination of a residual demand that the services cannot attend to (therefore responding to the logic of institutional selectivity), it is also a legitimate attempt to break the cycle of hospital admissions.

Let us see what is revealed by the institutional paths of some adolescents that stayed at the UAI:

Cauê was admitted into hospital many times as a child and as a adolescent, by request of his family that, according to the interviews of professionals and patient records, could not deal with his attacks. Although he never used drugs, he was referred by a CAPS situated in another territory in town as an attempt to interrupt this cycle of hospital admission […]. (Oliveira, 2015)

Carla was first admitted into a psychiatric unit when she was 12 years-old. After discharge, she was monitored at a CAPSi. […] The admission to a psychiatric unit inside a general hospital (on the east region of town) lasted for about two years whilst she waited for a bed in another unit. By determination of the judge, she was referred to the UAI in June 2013, even though she did not have a history of drug abuse. The UAI was seen as a place where she could be hosted and cared for properly. Carla stayed two years in the psychiatric ward of a hospital, but she didn’t really need this long admission. She stayed there two years because there was nowhere to refer her. The judge did not have where to send her. Then the Special Therapeutic Housing was inaugurated [the first name of the UAI in São Paulo]. (Oliveira, 2015)

The stories of Cauê and Carla call into question the challenges of tending to crises in the sphere of mental health policies. Their life paths are analysers of the social assistance protection services potency for producing care in the situations of mental suffering. Their stories of psychiatric admissions since childhood are emblematic of the persistence of such practices in spite of Law number 10.216/2001, that established the network of territorial care – instituting the active utopia of mental health integrality, without the need for psychiatric hospitals as ‘back up’ (Oliveira, 2015: 102).

They also show the need for spaces that combine housing and care in mental health, but that do not take the format of asylums. The lack of such spaces can also be seen in the use of the term ‘Special Therapeutic Housing’ as another way of naming UAI. In the Psychiatric Reform, Therapeutic Residences are services that substitute psychiatric hospitals, which were central in the process of de-institutionalizing madness in Brazil (Brasil, 2001).

Another point to be emphasized concerns court orders which denote a paradoxical movement: on the one hand, it is an attempt to guarantee the right of these adolescents to community conviviality by referring them to an UAI; on the other hand, it does not propitiate the development of strategies that favour family conviviality and their permanency in their own territories, as can be seen in this example:

When she became 14, Carla began to question why she was housed so far from her family. She went by herself to the Court House to try to speak to the judge about this situation and to ask to be transferred to a place closer to where her parents lived. The answer she was given by the Court’s psychosocial team was that there were no vacancies. […] The professional team of another SAICA, after hearing reports of assaulting the service staff and of auto-aggression, decided that she ‘had no conditions of living with other people’ and asked, through the judiciary, her admission into a psychiatric hospital […]. (Oliveira, 2015)

Carla was submitted to institutional circuits since her early childhood, which culminated in her psychiatric admission thus signalling the lack of spaces able to support singular modes of existence. This adolescent refused many times the fate reserved for her, as when she had the initiative of asking the Court officers to be transferred to a SAICA closer to her parents’ house. It is the expression of a desire to be able to live a degree of freedom; of being able to participate of the choices about her own life, which is nevertheless denied. It is a situation that is also emblematic of the little space attributed to political rights and to the right that children and adolescents have to participate.

The following excerpt shows clearly the tensions that run through UAI’s routine resulting both: from the difficulty of working as a network and from judicial presence in sanitary and socio assistance matters. Both of them are gears that work together in order to activate circuits of exclusion or inclusion:

The adolescent [a 16 years old] is followed by CAPSi since he was 12. He shows up at the service sporadically, ‘in emergency situations’, under the effect of drugs or when threatened in the streets […]. He and his siblings had a history of institutional sheltering in infancy […]. He also had a history of psychiatric admissions due to drug abuse. CAPSi made attempts of referring the adolescent to housing services, but ‘the shelters couldn’t bear’ his stay, due to his ‘aggressive’ behaviour. And he also opposed the sheltering attempts. […] Around 2013, he was referred to UAI but, soon after, went back to the streets and restarted using crack. He stayed away from the UAI and from the CAPSi for a long period. […] Subsequently, in his contacts with the CAPSi he said that he did not want to stay at the UAI, but afterwards he asked if he could go back to the house – in this occasion, he reported having received threats in the streets. His case was followed by the Child and Youth Court. In November 2013, the judge asked the CAPSi for an assessment about the ‘need of compulsory admission to hospital […]. If the assessment showed the need for admission, the adolescent would have to be immediately directed to the indicated place until medical discharge, in order to treat his drug addiction. His discharge was prohibited without court consent. If the CAPSi assessed that there was no need for compulsory admission, it would have to present a therapeutic project within 5 (five) days, specifying the place (institution) and the form of treatment that would assure his removal from the use of drugs’. [highlighted by the authors]. In reply, the CAPSi presented a plan of care that they had been sketching with the adolescent, which consisted in his being housed at the UAI and referred to other services that would be part of the therapeutic project, such as the Primary Care Centre and the ‘Centro Integrado de Educação de Jovens e Adultos’ (Integrated Centre for Youngsters and Adult Education) […]. (Oliveira, 2015)

However, it is worth noting the adolescent’s movement when he positions himself differently in face of the offers of institutional housing. This movement seems to signal the effects of the UAI’s mode of care and protection – which are achieved in a relationship that exercises some degrees of liberty.

A peculiarity in the UAI’s mode of implementing hosting – marked by voluntariness and by transitoriness – is that may position the adolescent into a sort of subjectivating hybridity (no longer a boy in the streets, not yet a boy at school, family or city), because it escapes the homogenizing subjectivation process and opens up to different types of existence (Lancetti, 1996).

UAI’s voluntary and transitory character, therefore, does not cancel out the responsibility for care; on the contrary, it gives emphasis to the need for implementing collective actions, permanently agreed upon and integrated to other public services.

Hybridity

As soon as it was inaugurated, the UAI started to absorb a contingent of youngsters that amassed many episodes of institutionalization and who did not ‘fit’ the institutions to which they were sent. The demands addressed to the UAI revealed not only situations in which there was a need for intensive care in health, but also an institutional selectivity and tendency to exclude of certain cases, in particular those who involved drugs use or criminal practices and/or mental health problems or intellectual impairment, which represent obstacles for intersectorial care:

What comes to us are the kids that are refused on shelters, refused at home, refused in life! Those are the ones who come to us. So, what is our profile: and what are the possibilities of ways out for those refused in life? These are the things we have to think about. (Interview with technical staff, 2014)

The refused ones, ‘pilgrims of nowhere’ (Couto, 2004: 62), previously called by De Leonardis (1998) ‘institutional wastes’, form a heterogeneous population with demands that cannot be reduced to predefined, unvarying institutional answers, which make those who do not fit the services objects of compulsory, coercive practices of tutelage. This shows the circuit functioning, marked by a fragmented, discontinuous attention that many times submits the adolescents to the streets’ mortifying circuit (Joia, 2014):

Here at the city centre what happens is a type of subtle institutionalization, outside the walls. Adolescents are captured by this bunch of services that, deep-down, control their circulation, producing a perverse institutionalization. (Oliveira, 2015)

From this testimony we can infer that the streets, circled by many services, facilities and interventions directed to those who make the streets their place of living, refuge or even battle field, often become part of them, participating in the children and adolescent’s ‘circulation control’ – in a trans institutional manner of functioning. From places of liberty, streets become transformed, occupied by control devices (Joia, 2014).

However, this movement also highlights the UAI’s singular ways of functioning: it takes the configuration of a hybrid device due to the diversity of the demands and subjects that it receives. In order to produce care and protection, it is necessary to relativize norms and protocols:

[…] the houses were founded in São Paulo ‘breaking up’ with the logic of the decree. The house is hybrid, so much so that it does not care only cases of drug addiction, but also cases of mental health. (Oliveira, 2015)

Its hybridity enhances the challenges of the network of care, an essential notion linked to the idea of rotation – as opposed to its fragmentation or dispersion (Fuganti, 2009). The network should not operate as a summation of facilities, as an ‘extended governability control’ of well established, crystallized relationships that prevent the user’s demand to come up in their singular existential transit. Instead, it should function as a ‘mode of production of existential connexions between individuals and collectives, in different contexts of groupings and manners of living socially’ (Merhy et al., 2014: 153). In order to tune into the singularity of the users’ demands, it is necessary to assume them as drivers of their own trajectories of care, refusing identity productions that substitute subjects by stigmas, diagnostics or categories that define the therapeutic bets (Merhy et al., 2014: 155).

It is worth here to clarify some points around the idea of hybrid functioning of the temporary housing service and of its hybridization effects on the modes of care and of the subjects cared for. As analysed by Almeida (2012), there is a type of hybridity that operates through the conjunction of heterogeneous technologies in order to form an institutional apparatus whose objective is to contain and homogenize subjectivities; they work according to the logic of the specialized service (Rotelli et al., 2001).

However, there is another hybrid mode of functioning that marks the experience of the temporary housing service at São Paulo: it works through the integration of a diversity of strategies that makes it a space that strengthens the potential for care which, in turn, favours hosting adolescents with a variety of demands.

It is a place where there is an absence of regularity nor normality. We refer to the hybridity that is the trademark of multilingualism, of the mixture of vocabularies, of the connexion of different, heteroclite, disparate elements. This is where the hybridity comes from: a place for the anomalous, meaning what escapes ‘from the normative of average forms and therefore is able to produce other forms of life, other forms of existence’ (Lobo, 2004: 204).

Canguilhem (2012 [1966]) offers an important clue when he reminds us that the word anomalous, etymologically, refers to what is irregular, rough; it is a purely descriptive concept; it does not attribute any value. It is not a disease in the sense of what has deviated quantitatively of the normal, considered the ideal condition, but a state of mutation that expresses other possible forms of life. Canguilhem (2012 [1966]) refused to take the concept of normal from the arithmetical scale, of statistic frequency or from the ideal type. He invites us to think of normativiness as an ethical–political clue that speaks about the creative capacity imposed by the condition of being alive.

Hence, a hybridity that potentiates shifts in the position of subjects that are objects of hegemonic tutelage and acknowledging them not only as citizens with rights, but as citizens who are political, able to refuse tutelage and to enunciate their choices; in short, able to ‘create for themselves new norms of life’ (Canguilhem, 2012 [1966]: 166).

Other shifts can be seen, related to the ways of producing care and protection, which forge a mode of care in which the different services that integrate the network do not operate in the logic of the circuit (in a segmented, disjointed way), but in a hybrid fashion that has the potential of agencying continuities and of strengthening the potency of caring (Fuganti, 2009).

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

References

Almeida

NMC

(2012) Labirintos e mosaicos: institucionalização da infância com deficiência. PhD Thesis, Pontifícia Universidade Católica do Rio de Janeiro – PUC-RJ, Rio de Janeiro, Brazil.

Assis

DAD

(2012) Risco social e saúde mental como argumentos para o encarceramento de crianças e adolescentes. Master Dissertation, Universidade Bandeirante de São Paulo/Anhanguera, São Paulo, Brazil.

Blikstein

(2012) Destinos de crianças: estudo sobre as internações de crianças e adolescentes em hospital público psiquiátrico. Master Dissertation, Pontifícia Universidade Católica de São Paulo – PUC-SP, São Paulo, Brazil.

Brasil (1990) Lei n. 8069 de 13 de julho de 1990. Dispõe sobre o Estatuto da Criança e do Adolescente e dá outras providências. Available at: http://www.planalto.gov.br/ccivil_03/LEIS/L8069.htm (accessed 10 July 2015).

Brasil (1990a) Lei n. 8080, de 19 de setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da Saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências. Available at: http://www.planalto.gov.br/ccivil_03/Leis/L8080.htm (accessed 10 July 2015).

Brasil (2001) Lei n. 10.216, de 06 de abril de 2001: dispõe sobre a proteção e os direitos das pessoas portadoras de transtornos mentais e redireciona o modelo assistencial em saúde mental. Available at: http://www.planalto.gov.br/ccivil_03/leis/LEIS_2001/L10216.htm (accessed 15 July 2015).

Brasil (2003) Política do Ministério da Saúde para a Atenção Integral do Usuário de Álcool e outras Drogas. Brasília, Brazil: Ministério da Saúde.

Brasil (2009) Portaria n. 1.190, de 04 de junho de 2009: institui o Plano Emergencial de Ampliação de Acesso ao Tratamento e Prevenção em Álcool e Outras Drogas. Brasília, Brazil: Ministério da Saúde.

Brasil (2010) Decreto n. 7.179, de 21 de maio de 2010: institui o Plano Integrado de Enfrentamento ao Crack e outras drogas. Available at: http://www.planalto.gov.br/ccivil_03/_Ato2007-2010/2010/Decreto/D7179.htm (accessed 1 July 2015).

10.

Brasil (2010a) Portaria GM/MS nº 4.279, de 30/12/2010. Estabelece diretrizes para a organização da Rede de Atenção à Saúde no âmbito do Sistema Único de Saúde (SUS). Available at: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2010/anexos/anexos_prt4279_30_12_2010.pdf (accessed 8 July 2015).

11.

Brasil (2011) Decreto nº 7.508, 28 de junho de 2011. Regulamenta a Lei nº 8.080, de 19 de setembro de 1990, para dispor sobre a organização do Sistema Único de Saúde – SUS, o planejamento da saúde, a assistência à saúde e a articulação interfederativa, e dá outras providências. Available at: http://www.planalto.gov.br/ccivil_03/_ato2011-2014/2011/decreto/D7508.htm (accessed 10 July 2015).

12.

Brasil (2012) Portaria nº 121 de 25 de Janeiro de 2012: institui a Unidade de Acolhimento para pessoas com necessidades decorrentes do uso de Crack, Álcool e Outras Drogas no componente de atenção residencial de caráter transitório da Rede de Atenção Psicossocial. Available at: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2012/prt0121_25_01_2012.html (accessed 1 July 2015).

13.

Canguilhem

(2012 [1966]) O normal e o patológico. Rio de Janeiro, Brazil: Forense Universitária.

14.

Couto

(2004) Por uma política pública de saúde mental para crianças e adolescentes. In: Ferreira

(ed.) A Criança e Saúde Mental: Enlaces entre a Clínica e a Política. Belo Horizonte, Brazil: Autêntica, Fumec, pp. 61–74.

15.

Cunda

(2011) As tramas empedradas de uma psicopatologia juvenil. Master Dissertation, Universidade Federal do Rio Grande do Sul – UFRGS, Porto Alegre, Brazil.

16.

De Leonardis

(1998) Estatuto y figuras de la peligrosidad social. Entre psiquiatria reformada y sistema penal: notas sociológicas. Revista de Ciencias Penales 4: 429–449.

17.

Fuganti

(2009) Biopolítica e produção de saúde: um outro humanismo? Interface 13(1): 667–679.

18.

Joia

(2014) As tóxicas tramas da abstinência: compulsoriedades nas internações psiquiátricas de crianças e adolescentes em situação de vulnerabilidade social. Master Dissertation, Pontifícia Universidade Católica de São Paulo – PUC-SP, São Paulo, Brazil.

19.

Lancetti

(1996) Como construímos o Projeto Meninas e Meninos de Santos. In: Lanceti

(ed.) Assistência Social e Cidadania. São Paulo, Brazil: HUCITEC, pp. 17–36.

20.

Lobo

(2004) Pragmática e subjetivação por uma ética impiedosa do acontecimento. Psicologia em Estudo 9(2): 195–205.

21.

Lourau

(1993) Análise Institucional e práticas de pesquisa. Rio de Janeiro, Brazil: UERJ.

22.

Merhy

Gomes

MPC

Silva

. (2014) Redes vivas: multiplicidades gerando as existências, sinais da rua. Implicações para a produção do cuidado e produção do conhecimento em saúde. Divulgacão em Saude para Debate 52: 153–164.

23.

Ministério do Desenvolvimento Social e Combate a Fome (Brasil) (2009) Orientações Técnicas: Serviços de Acolhimento para Crianças e Adolescentes. Brasília, Brazil: Conanda.

24.

Observatório Crack, é possível vencer (n.d.) Available at: http://www.brasil.gov.br/observatoriocrack/index.html (accessed 2 Mai 2015).

25.

Oliveira

(2015) ‘Os recusados’. Uma experiência de moradia transitória infanto-juvenil no campo da Saúde Mental. Master Dissertation, Pontifícia Universidade Católica de São Paulo – PUC-SP, São Paulo, Brazil.

26.

Orestes

(2013) Processos classificatórios na recepção, triagem e encaminhamento de crianças e adolescentes aos abrigos: permanências e mudanças após a Ação Civil Pública. Dissertação de Mestrado, Pontifícia Universidade Católica de São Paulo – PUC-SP, São Paulo, Brazil.

27.

Paulon

(2005) A análise de implicação com ferramenta na pesquisa-intervenção. Psicologia & Sociedade 17(3): 18–25.

28.

Rameh-de-Albuquerque

(2008) Casas do Meio do Caminho: um relato da experiência de Recife na busca da atenção integral à saúde dos usuários de álcool, fumo e outras drogas. Master Dissertation, Fundação Oswaldo Cruz – FIOCRUZ, Rio de Janeiro, Brazil.

29.

Rotelli

Leonardis

O de

Mauri

(1990) Desinstitucionalização, uma outra via: a reforma psiquiátrica italiana no contexto da Europa Ocidental e dos “Países Avançados”. In: Nicácio

MFS

(ed.) Desinstitucionalização. São Paulo, Brazil: Hucitec, pp. 17–59.

30.

Scisleski

(2006) ‘Entre se quiser, saia se puder’ – O percurso de jovens pelas redes sociais e a internação psiquiátrica. Master Dissertation, Universidade Federal do Rio Grande do Sul – UFRGS, Porto Alegre, Brazil.

31.

Scisleski

(2010) Governando vidas matáveis: as relações entre a saúde e a justiça dirigidas a jovens em conflito com a lei. PhD Thesis, Pontifícia Universidade Católica do Rio Grande do Sul – UFRGS, Porto Alegre, Brazil.

32.

Souza

(2007) Redução de danos no Brasil: clínica e política em movimento. Master Dissertation, Universidade Federal Fluminense – UFF, Niterói, Brazil.