Abstract

Introduction

There is a long tradition of assistance-repression in the scope of caring for children and adolescents in Brazil, especially for those with law issues, making the objective of the socio-educational measure a challenge. This is due to the fact that between 1890 and 1989, the prevailing criminal codes differed from the guideline of the Statute of the Child and Adolescent (ECA)¹1 Brasil. Senado Federal. Crianças iam para a cadeia no Brasil até a década de 1920 [Internet]. Brasília; 2015 [citado 4 Jan 2021]. Disponível em: https://www12.senado.leg.br/noticias/materias/2015/07/07/criancas-iam-para-a-cadeia-no-brasil-ate-a-decada-de-1920
https://www12.senado.leg.br/noticias/mat... , which is based on the 1988 Federal Constitution. In addition to focusing on rights and not only on punishment, the ECA created a mechanism of accountability in the case of infractions committed by adolescents called “socio-educational measure”. The socio-educational measure is a systematized and individualized pedagogical action, which varies from a warning to internment, the most severe among them²2 Brasil. Sistema Nacional de Atendimento Socioeducativo - SINASE. Secretaria Especial dos Direitos Humanos. Conselho Nacional dos Direitos da Criança e do Adolescente (CONANDA). Brasília: Sinase; 2006.. Although internment lends itself as a necessary space for achieving legal and pedagogical objectives, it may generate countless phenomena due to its institutional nature. Among these are: loss of autonomy, and the repression of desires and individuality, as a result of the obligation, for example, to respect established schedules for engagement in activities³3 Gonçalves MV. “Eu nem sabia que podia entrar aqui”: promoção de cidadania cultural como experiência de ressignificação de identidade de jovens em conflito com a lei. Cad Bras Ter Ocup. 2016; 24(1):127-37.. Regarding this last item, the study of how a person engages in occupations and uses his or her time is relevant, because it influences individual performance and quality of life⁴4 Cha YJ. Correlation between Leisure Activity Time and Life Satisfaction: based on KOSTAT Time Use Survey Data. Occup Ther Int. 2018; 2018:5154819. Doi: https://doi.org/10.1155/2018/5154819.
https://doi.org/10.1155/2018/5154819... . This is because it is closely linked to what is being done, with whom, and where, in addition to the congruence between one’s environment, preferences, and behavior⁵5 Harvey AS. Quality of life and the use of time theory and measurement. J Occup Sci. 1993; 1(2):27-30..

This study aims to analyze these issues in juvenile detention centers, which can manifest, in their essence, the concept of a total institution⁶6 Pizzato C. Arquitetura socioeducativa: o espaço ressocializando pessoas, curando a sociedade. Porto Alegre: Corag; 2016., a place where all aspects of the inmates’ lives are developed in the same place and under the command of a single authority, and the daily activities are collective and scheduled⁷7 Borges PCCB. Perspectivas contemporâneas do cárcere. São Paulo: Editora Unesp; 2010.. The reduction in the ability of deprived persons to initiate and engage in occupations may result from the lack of opportunity to be oriented within the flow of time, a situation aggravated by little or no contact with the outside world⁸8 Whiteford G. Occupational deprivation and incarceration. J Occup Sci. 1997; 4(3):126-30.. In this situation, occupational choices are restricted and basic routine activities are unavailable, which may contribute to temporal disorientation and the constriction of occupational roles⁹9 Molineux ML, Whiteford GE. Prisons: from occupational deprivation to occupational enrichment. J Occup Sci. 1999; 6(3):124-30.. The difficulty of choice and opportunity to engage in occupations may negatively influence mental health and wellbeing, favoring occupational deprivation¹⁰10 Bradbury R. The role of occupational therapy in corrections settings [dissertação]. Ithaca (NY): Ithaca College; 2015.. This phenomenon may have as one of its causes the long-lasting exclusion from meaningful occupations, due to circumstances beyond the individual’s control, and may exist as a by-product of institutional policies¹¹11 Wilcock AA. A theory of occupation and health. Thorofare: Slack Inc; 1998.. The particular circumstances of deprivation of liberty are directly detrimental to the mental and physical health of adolescents in all situations of deprivation of liberty¹²12 Organização das Nações Unidas - ONU. Independent expert for the global study on children deprived of liberty. Genebra: ONU; 2019.. There is evidence of a high prevalence of mental disorders in populations of adolescents in detention for conflict with the law¹³13 Pinho SR, Dunningham W, Aguiar WM, Andrade Filho AS, Guimarães K, Guimarães K, et al. Morbidade psiquiátrica entre adolescentes em conflito com a lei. J Bras Psiquiatr. 2006; 55(2):126-30., and their prevalence is higher than in the free population of the same age group¹⁴14 Andrade RC, Assumpção Junior F, Teixeira IA, Fonseca, VAS. Prevalência de transtornos psiquiátricos em jovens infratores na cidade do Rio de Janeiro (RJ, Brasil): estudo de gênero e relação com a gravidade do delito. Cienc Saude Colet. 2011; 16(4):2179-88., even increasing up to ten times¹²12 Organização das Nações Unidas - ONU. Independent expert for the global study on children deprived of liberty. Genebra: ONU; 2019.. Furthermore, the cruelty and indignity that characterize the juvenile detention system may generate such suffering in the adolescents that, if escape is not possible, taking their own life sometimes seems to be a way out to end suffering¹⁵15 Brasil. Relatório Nacional sobre a situação de unidades socioeducativas de privação de liberdade. Rede Nacional de Defesa do Adolescente em Conflito com a Lei (Renade). Palmas: Secretaria Nacional dos Direitos da Criança e do Adolescente - SNDCA; 2017..

Methods

This was a qualitative, observational, cross-sectional study. The data analyzed came from a basic project entitled “Managements and practices related to crises and suffering in mental health in the Socio-Education Centers (Censes) of Paraná. The project was cleared by the Research Ethics Committee (opinion no. CAAE 02353018.3.3003.0101). All participants signed the Informed Consent Form (ICF). The study included workers over 18 years of age, without any apparent cognitive deficit and who agreed to participate in the research. The exclusion criteria involved workers unable to participate in the interviews, focus groups, especially because of evident cognitive deficit, who did not agree to take part in the research and/or those who refused to sign the ICF.

The present research was conducted in seven Censes, contemplating large and small units, six of them destined to the male public and one to female individuals, in three regions enumerated by the Department of Socio-Educational Care (DEASE), thus enabling a more diverse data collection. This was carried out between May and December 2019, after prior scheduling with each unit. The Censes refer to the care units that carry out the deprivation of liberty socio-educational measures and integrate the network of attention to adolescents in conflict with the law in the State of Paraná. The number of openings offered in them can vary between 20 and 90, depending on the characteristics of the population and regional demand¹⁶16 Paraná (Estado). Manual de fluxo, manejo, proteção e prevenção: Covid-19 e socioeducação [Internet]. Curitiba; 2021 [citado 12 Jan 2021]; Disponível em: http://www.justica.pr.gov.br/Socioeducacao
http://www.justica.pr.gov.br/Socioeducac... .

Three different data collection techniques were used in the qualitative research: focus groups, interviews, and participant observation.

Interviews: carried out individually, according to the availability of each worker so as not to disrupt the ongoing activities on that day/timetable. Eight semi-structured interviews were carried out with workers from the Censes, selected by the coordinator of the units. The interview script was about mental health crisis management practices and the work arrangements/processes that influenced this management. The average time for the interviews was 30 to 60 minutes, and they were audio-recorded and later transcribed in full. All the information that could incur in the identification of the participants was erased.

Focus Groups: the focus groups¹⁷17 Kitzinger J. Focus groups with users and providers of health care. In: Pope C, Mays N, organizadores. Qualitative research in health care. 2a ed. London: BMJ Books; 2000. p. 20-9. were conducted based on triggering questions related to the description by the workers of the adolescents’ routine, the workshops offered, and their possible effects on the health of the adolescents, mental suffering of the adolescents, and of the teams. Seven focus groups were held and the participation of different professional categories was suggested, with the intention of favoring a greater representativeness. The director of the units invited the participants, and those who were available and interested participated. The groups were conducted by the researchers of the research and lasted about an hour and a half each. The focus groups were held in quiet, reserved places, with audio and video recording. Seventy-nine workers participated in the focus groups, with a minimum of six, a maximum of 17, and an average of 11 participants per group. Of this total, 18 were psychologists, 8 pedagogues, 6 college professors, 4 nurses, 4 nursing technicians, 3 occupational therapists, 3 social workers, 2 administrative technicians, 2 nursing assistants, and 29 social-educational security agents. The number of participants was defined by saturation, when there is the suspension of inclusion of new participants once the data present, in the view of the researchers, repetition or redundancy (table 1).

Participant observation: the study conducted four moments of participant observation¹⁸18 Carlos F, Teixeira WOR, Oliveira K, Queiroz K. O método qualitativo norteando a pesquisa social. HOLOS. 2019; 5:e4752., aiming to get closer to the reality of the teams by means of the monitoring of training sessions directed to them and visits to the Censes. These trainings intended to discuss the teams’ management of mental health crises in the Censes. The researchers of the team carried out the trainings. Due to the dynamics of the institutional routine, the trainings occurred before the focal groups, and the discussions complemented the information later collected in them. During the participant observations and visits to the units, the descriptive records of comments were made through the use of field notes. In this way, we tried to describe the teams’ reports of experiences, reflections, as well as the facilities of the Censes visited.

Using this material as the basic element, narratives were built based on the hermeneutic approach of Ricoeur¹⁹19 Ricoeur P. Interpretação e ideologias. Rio de Janeiro: Francisco Alves; 1990., seeking their meanings from the phenomena emanating from the speeches, benefiting a greater coherence and depth of interpretation. During the reading of the excerpts, the vices of language were suppressed, making them more understandable, keeping, however, the essence of the workers’ statements, synthesizing them in order to have a more accurate analysis.

After the data analysis, an extensive reading was made of the narratives coming from both the interviews and the focus groups. The core argumentative nuclei were identified and, according to the thematic similarities, consolidated as follows²⁰20 Onocko-Campos RT, Furtado JP. Narrativas: utilização na pesquisa qualitativa em saúde. Rev Saude Publica. 2008; 42(6):1090-6.: a) The environment and its possible influences on mental health b) The procedures for the care of mental health crises and c) The institutionalization and the work processes.

One of the limitations of this study involved the impossibility of making more than one trip to the municipalities where the Censes were located. As a consequence, one single meeting was used for the execution of the focus groups and interviews. Moreover, the participant observations were also restricted to moments of team training and visits to the units. Another limitation, inherent to the research methodology, was that the data is based on the workers’ perceptions, and what was mentioned was not verified through other ways.

Results and discussion

In relation to the number of adolescents, the data collected point out that in 2018 there were 887 interned in nineteen Censes within the State of Paraná. Of this total, 390 were interned in the Censes where the research took place, representing 43% of the total public interned that year. The analysis of the argumentative nuclei revealed details about the physical structure of the units, offer of activities, regulations, human resources, work processes and possible influences on the daily life of the units.

The ambience and its possible influences on mental health

The excerpts below discuss the relation between the physical structure of the units and its repercussions on the mental health of the adolescents in the perception of the workers:

Other excerpts cited details such as the holes and the color of the walls of the units, as well as the lack of natural lighting in some spaces for safety reasons, recognizing such issues as inadequate and generators of suffering in the public served. During the participant observation carried out in one of the Censes, one of the lodgings visited had artificial lighting 24 hours a day due to the total darkness of that space. The team described that if the light bulb were turned off, it would be impossible to monitor the behavior of the adolescents via a camera installed in the room. The absence of light control and the use of colors that influence the ambiance of the units were factors already found in other studies and that negatively affect the experience of the adolescents²¹21 Oliveira EMD. Por uma arquitetura socioeducativa para adolescentes em conflito com a lei: uma abordagem simbólica da relação pessoa-ambiente [dissertação]. Florianópolis: Universidade Federal de Santa Catarina; 2008., being, also, contrary to the current regulations of the architectural parameters of the units²2 Brasil. Sistema Nacional de Atendimento Socioeducativo - SINASE. Secretaria Especial dos Direitos Humanos. Conselho Nacional dos Direitos da Criança e do Adolescente (CONANDA). Brasília: Sinase; 2006.. The inadequate physical structure was listed as prejudicial even to the services provided by the team:

Even though the physical structure may not be the only determining factor for the success or failure of the socio-educational measure, it is impossible to disregard its influence on the human being²²22 Instituto Latino Americano das Nações Unidas para Prevenção do Delito e Tratamento do Delinquente (ILANUD). Guia Teórico e Prático de Medidas Socioeducativas. Nova Iorque: UNICEF - Fundo das Nações Unidas para a Infância; 2004.. A detention unit is a highly complex facility, as it involves a place that must include spaces for the promotion of education, health, leisure, shelter, and security. Furthermore, the socio-educational units contain walls and surveillance systems, materializing the deprivation of freedom, without being a prison⁶6 Pizzato C. Arquitetura socioeducativa: o espaço ressocializando pessoas, curando a sociedade. Porto Alegre: Corag; 2016.. In this sense, according to the excerpt above, the word “cell” was sometimes used by the teams to describe the adolescents’ living quarters, signaling the dichotomous aspect of the socio-educational system, which proposes to socio-educate them, but in an environment with correctional characteristics, having in mind the sequence of fences, sentry boxes, walls, and restricted circulation lanes that impede free transit⁶6 Pizzato C. Arquitetura socioeducativa: o espaço ressocializando pessoas, curando a sociedade. Porto Alegre: Corag; 2016.. The teams described the size of the structure as influencing the care provided and access to the various daily activities. The teams attributed characteristics of relaxation and humanization to units with smaller structures and a smaller number of interned adolescents:

The structures of the social-educational units play a relevant role in the functioning of the activities offered by regulating the flows and ordering the control and security of various spaces⁶6 Pizzato C. Arquitetura socioeducativa: o espaço ressocializando pessoas, curando a sociedade. Porto Alegre: Corag; 2016.. Although Brazilian laws do not specify the parameters related to the physical structure for the fulfillment of the socio-educational measure, it requires that the offer of services be personalized, in small units and with reduced groups of adolescents²2 Brasil. Sistema Nacional de Atendimento Socioeducativo - SINASE. Secretaria Especial dos Direitos Humanos. Conselho Nacional dos Direitos da Criança e do Adolescente (CONANDA). Brasília: Sinase; 2006., with no more than forty adolescents per unit²³23 Brasil. Resolução nº. 46, de 29 de Outubro de 1996. Regulamenta a execução da medida sócio-educativa de internação prevista no Estatuto da Criança e do Adolescente, Lei nº 8069/90. Diário Oficial da União. 8 Jan 1997., architecturally designed to approximate a residential structure²³23 Brasil. Resolução nº. 46, de 29 de Outubro de 1996. Regulamenta a execução da medida sócio-educativa de internação prevista no Estatuto da Criança e do Adolescente, Lei nº 8069/90. Diário Oficial da União. 8 Jan 1997.. Following these lines, the goal is to enable better monitoring and social insertion, mitigating the harmful effects of deprivation of liberty that may involve affective deprivation, low self-esteem, distance from family and community life, and difficulties in understanding common daily relationships²2 Brasil. Sistema Nacional de Atendimento Socioeducativo - SINASE. Secretaria Especial dos Direitos Humanos. Conselho Nacional dos Direitos da Criança e do Adolescente (CONANDA). Brasília: Sinase; 2006.. However, it was observed that some units were not compliant with some of these norms²2 Brasil. Sistema Nacional de Atendimento Socioeducativo - SINASE. Secretaria Especial dos Direitos Humanos. Conselho Nacional dos Direitos da Criança e do Adolescente (CONANDA). Brasília: Sinase; 2006., by presenting structures, for example, in the form of complexes, with more than two floors or by underusing places such as soccer fields, ecumenical space, internal and collective dining halls due to the lack of human resources. In this way, the deficit of human resources seemed to affect the service provided to the adolescents, the use of the different spaces in the unit and, consequently, the offer of activities:

The negative effects of the deprivation of freedom on the mental health of the interned adolescents were perceived in numerous narratives. Other excerpts described that, beyond this deprivation, the non-engagement in activities generated mental suffering:

The excerpt above remarks how health and wellbeing can be negatively influenced by the restriction in the choice and opportunity of a person to engage in occupations, generating the phenomenon known as occupational deprivation¹⁰10 Bradbury R. The role of occupational therapy in corrections settings [dissertação]. Ithaca (NY): Ithaca College; 2015.. There is a state of difficult, if not impossible, engagement in meaningful occupations that have social, cultural, and personal relevance²⁴24 Whiteford G. Occupational deprivation: global challenge in the new millennium. Br J Occup Ther. 2000; 63(5):200-4.. The teams constantly discussed suicide planning in the adolescents’ discourse. It is recognized that suicide attempts and suicide in total institutions are influenced by a multiplicity of factors, occupational deprivation being one of them, a situation that clearly requires further investigation²⁴24 Whiteford G. Occupational deprivation: global challenge in the new millennium. Br J Occup Ther. 2000; 63(5):200-4.. A possible hypothesis to be construed may point out that the occupational deprivation of institutionalized adolescents or their engagement in activities that are not meaningful to them could accentuate the use of time for suicide planning. One of the teams described an episode in which a 12 year-old adolescent was left in his underwear, rubbed soap all over his body, and when they opened his room, he tried to escape from the unit, managing to pass by 5 social-educational agents before being restrained. So many other reports in this sense generated, therefore, reflections about the amount of time invested by the adolescents in escape and suicide attempts. Studies evidence the correlation of suicide with the context of deprivation of freedom of adolescents in several countries, such as Iran²⁵25 Mozaffari F, Hejazi M. The role of spiritual and psychological well-being in predicting high-risk behaviors of young prisoners in zanjan. J Res Relig Health. 2019; 5(3):32-44., Germany²⁶26 Radeloff D, Lempp T, Kettner M, Rauf A, Bennefeld-Kersten K, Freitag CM. Male suicide rates in German prisons and the role of citizenship. PLoS ONE. 2017; 12(6):1-11. and Australia²⁷27 Putnins AL. Correlates and predictors of self-reported suicide attempts among incarcerated youths. Int J Offender Ther Comp Criminol. 2005; 49(2):143-57.. This situation could result from the fact that, in a context of freedom deprivation, individual lose the right to choose how to occupy his or her time and engage in life roles for a predetermined period of time¹⁰10 Bradbury R. The role of occupational therapy in corrections settings [dissertação]. Ithaca (NY): Ithaca College; 2015., since total institutions present numerous barriers are generated to the performance of primary occupations of human existence, such as working, taking care of oneself, or resting²⁸28 Goffman E. Asylums: Essays on the social situations of mental patients and other inmates. Palatine: Anchor Books; 1961.. On the other hand, the teams signaled that the expressive and corporal activities seemed to have beneficial effects on the mental health of the public attended:

Additionally, the activities appeared to be directly influenced by the security rules of the units. These activities were pointed out as ensuring a safe environment, but at the same time, they were considered a risk, requiring constant control and vigilance:

The report of some teams pointed out the absence of meaning in some activities offered, showing the apparent inexistence of a space to listen to the interests of the adolescents. Such data refers to the concept of occupational alienation, in which there are prolonged experiences of disconnection, isolation, limited expression, or lack of meaning related to daily activities²⁹29 Townsend E, Wilcock AA. Occupational justice and Client-Centred Practice: a dialogue in progress. Can J Occup Ther. 2004; 71(2):75-87.. On the other hand, when the activities are designed based on the sociocultural universe, of identification, and belonging of young inmates, it is possible to have a wider range of training to promote their autonomy³⁰30 Morais AC, Malfitano APS. O terapeuta ocupacional como executor de medidas socioeducativas em meio aberto: discursos na construção de uma prática. Cad Bras Ter Ocup. 2016; 24(3):531-42., as well as the planning of a life project, strengthening in this way the sense of personal identity³¹31 Silva DCO, Ruzzi-Pereira A, Pereira PEP. Fatores protetivos à reincidência ao ato infracional – concepções de adolescentes em privação de liberdade. Cad Bras Ter Ocup. 2013; 21(3):553-61..

Some teams described “systems of progression” inside the Censes, which were directly related to the access of the adolescents to the countless activities. The progression systems were described by the teams through the use of terms like “advances”, “benefits” and “achievements” and could generate the offer of activities to the adolescents:

Access to such activities was through “evaluations” carried out by the teams, for example, evaluations with scores and court reports. Some teams signaled that the progression system was also used as a possible form of behavioral control of the adolescents:

The idea of rewarding or favoring adolescents through the provision of care or activities was addressed not only in the collective sense, but also as directed to the individual. One of the speeches analyzed drew attention by the fact that, apparently, the worker exemplified that an individual service to deal with a situation of aggressiveness arising from a mental disorder would not be possible, because it would somehow favor such an adolescent:

It is evident, in this way that the process of socio-education appeared to be a continuous assessment, the behavior of the adolescent being the generator of consequences in his/her experience in the Censes. The behavior would, therefore, cease to be a sign for reception and become an indicator of vigilance.

As a final note, in dealing with the engagement in occupations, according to the teams, family members verbalized that they would not visit the adolescents due, among other factors, to the need to get naked in front of a socio-educational agent. This situation exposed the limitations arising from the security routines of the units for the performance of co-occupations, in which the involvement of two or more people in an occupation³²32 Pierce D. Co-occupation: the challenges of defining concepts original to occupational science. J Occup Sci. 2009; 16(3):203-7. occurs, such as a family conversation.

The procedures for handling mental health crises

The mental health crises of the adolescents were expressed mainly through their suicide attempts. All the teams described that the main strategy to deal with this aspect was the removal of objects from the adolescents. It was observed that, according to the description of one of the teams, the removal of objects could extend to the clothing of the adolescents, with such conduct being questioned, even by the workers themselves:

According to the teams most suicide attempts were by hanging, including with items such as underwear (in the case of one adolescent who had both personal items and clothes removed). Other attempts involved, for example, self-mutilation by piercing with manufactured objects and ingestion of mattress foam. Moving the teenager to another room, increasing the number of individual consultations, and requesting the help of other teenagers to supervise the one with suicidal ideation were also strategies described by the teams to avoid suicide attempts. The teams also pointed out that suicide attempts could manifest themselves as possible articulations of the adolescents seeking transfers from the unit to get away from other adolescents, thus avoiding unpleasantness. The transfer from the social-educational unit to psychiatric hospitals was also described, given the apparent greater possibility of escape in those places. Besides this, the teams said that the adolescents compared the routine in the psychiatric hospital with the one in the unit, preferring the former because of the possibility of access to TV, free movement around the yard, and the existing hierarchy resulting from “good behavior”, manifested by the possibility of becoming “monitors”.

The teams also said that both the adolescents signaled the engagement in activities as a way to deal with the mental health crisis, and the teams themselves made use of this strategy:

It has been affirmed that the engagement in activities favors the expression of the anguish generated by the internment, contributing to reflections on the actions of adolescents and alternatives for coping with the reality experienced³³33 Almeida M. O jornal e o vídeo como meio de expressão de jovens internados na Unidade Educacional da FEBEM de Ribeirão Preto. Rev Ter Ocup. 2004; 15(1):33-8.. Another frequent strategy described by the teams for the management of the mental health crises of the adolescents involved the use of psychotropic drugs. This strategy was described as a form of behavioral control, having in mind that, according to the teams, conducting daily life in the unit without medication was “impractical:

Some statements suggested, however, alternatives to deal with the situations presented by the adolescents in another way that not only through drug therapy:

This finding agrees with descriptions in the literature about the use of sports activities as a way for adolescent inmates to release tensions and revisit concepts such as discipline and respect for rules and others⁶6 Pizzato C. Arquitetura socioeducativa: o espaço ressocializando pessoas, curando a sociedade. Porto Alegre: Corag; 2016..

Institutionalization and the work processes

The third and last semantic category is related to the work processes of the teams and their clear institutionalizing experience. The difficulties in communication among the workers, in access to information about the adolescents, as well as the scarcity of team meetings were among the more frequently reported issues.

Several teams reiterated complaints about the working conditions, involving, for example, aspects such as the physical structure and human resources. Regardless of what the complaints were, a commonly described factor involved the distance from management, a situation signaled as harmful to the cohesion and organization of workflows. On the other hand, communication between teams and management seemed to positively influence work processes:

Furthermore, there were reports of lack of human resources as an important influence upon the mental health of the workers. The teams talked about the feeling that, just like the adolescents, they also felt, in a certain way, institutionalized. When questioned about the impact on the workers’ health of experiencing the mental suffering of the adolescents, the teams alleged that such suffering accompanied them even when they left the units after a day of work. Not infrequently, the teams reported that they worry about the adolescents continuously. Many workers stated that this and other constant worries led them to self-medicate to sleep. In addition, the teams reported feeling helpless by the State, aggravating the mental suffering experienced:

The follow-up of situations of suicide attempts was described as an impacting aspect on the mental health of the teams. However, this situation was described as apparently inherent to the work in the socio-educational units:

Through the analysis of the statements of the teams, it was perceived that the Censes made them institutionalized. Environments with insufficient spaces for communication and listening between workers and management, extensive and continuous work protocols and a feeling of devaluation by the State were aspects described that contribute to this argument. The teams also pointed out that there was constant surveillance of their activities, coming from the management itself, but also from judgment and prejudice from society in general:

Through their own institutionalizing experiences, the teams seemed to replicate and normalize forms of authoritarianism in the daily lives of the adolescents themselves. However, since the social-educational units are spaces for re-socialization, a dichotomy seemed to be apparently generated: sometimes the teams talked about re-socializing postures, sometimes about the repressive postures of the units:

The perceptions related to the statements of the Censes’ teams resembled, in parts, those of prison environments. Although it was perceived that the teams differentiated the social-education units from prison environments, justifying such a difference essentially by the “possibility of activities”, the description of professional anguish due to the context of the Censes was recurrent. The teams described feeling constantly bothered by the adolescents “boring” or “drugged”, terms alluding to idleness. This aspect is similar to the descriptions of studies on prison environments, which essentially generate such a sensation to those imprisoned there¹⁰10 Bradbury R. The role of occupational therapy in corrections settings [dissertação]. Ithaca (NY): Ithaca College; 2015.^,3434 Falardeau M, Morin J, Bellemare J. The perspective of young prisoners on their occupations. J Occup Sci. 2015; 22(3):334-44.. It was perceived that the teams from the Censes lived a work process that was also institutionalized and reproduced the institutionalizing experience in the daily life of the adolescents. This daily routine did not seem to consider the real needs of the adolescents, since the needs of the teams themselves did not seem to be taken into consideration.

Final remarks

It was concluded that there was lack of standardization of the Censes, either in the structural sense, in the offer of certain activities, in some regulatory aspects and in the configuration of human resources. The smaller structure units had better staff communication and better crisis management practices for the adolescents, considering the existence of a better bond between the adolescents and the workers. Furthermore, occupational deprivation seemed to signal an increase in the adolescents’ suffering. On the other hand, access to a repertoire of activities, as long as they were meaningful to the public attended, seemed to promote mental health.

Mental health crises are frequent in environments of deprivation of freedom. These phenomena are often credited to a diagnosis, limiting their understanding to the sphere of only the characteristics of the adolescents who are there. This research leads to a reflection on how important the environment, the organization of the work process, and other elements of the deprivation of freedom itself are either as potentializers or mitigators of this issue. Such elements must be taken into consideration in the management and creation of strategies for this public in order to avoid the traditional phenomenon of medicalization.

Although emphasis was given in this research to the physical-material and human resource aspects of the units, we reiterate the necessary criticism of the macro-determinants involved in the work processes of the units, such as the existing socio-educational model itself, from a dynamic, historical, and ecological perspective. Finally, it was perceived that institutionalization was described by the teams as generating intense and constant mental suffering for both the adolescents and themselves. Therefore, the identification process generated by the effects of institutionalization was shown to be a preponderant factor when considering the health of the adolescents and the teams from the Censes researched.

References

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