Between Norm and Practice: Mismatches in the Implementation of Psychosocial Care in Schools

Elfride Foesch; Kellen Jacobsen Follador

DOI: 10.22167/2675-6528-202602855

Article derived from a Course Conclusion Work (TCC), with content based on the student’s original work and adapted to the editorial format of the E&S Magazine with the support of the ResumeAI tool, an artificial intelligence solution developed by Instituto Pecege for textual synthesis and organization.

Summary

Mental health in childhood and adolescence, especially in the school context, is fundamental for the development of learning. We sought to demonstrate whether the implementation of the National Policy for Psychosocial Care in schools, under Law No. 14.819/2024, was effectively applied in this context. The research was based on data obtained from the National Monitoring, conducted by the Parliamentary Front for Mental Health in partnership with the Institute for Studies on Public Health Policies. It was characterized as documentary, with a qualitative approach and a descriptive-analytical design, using Bardin’s Content Analysis as the method. The study was structured with an emphasis on analysis by federative unit, covering state and municipal levels, with a focus on the state of Ceará and the municipality of Fortaleza. The results showed significant differences in the implementation of the policy, with a predominance of actions linked to the School Health Program (PSE), indicating limited formalization of monitoring and oversight instruments by government agencies. In Ceará, adherence to national curricular guidelines was observed; however, inconsistencies were found in the regulation and execution of psychosocial care actions. It was concluded that strengthening intersectoral policies, expanding multiprofessional action, and implementing indicators based on scientific evidence, especially in the field of neuroscience, are fundamental for the effectiveness of psychosocial care in the Brazilian school context.

Keywords: psychosocial attention; childhood and adolescence; educational neuroscience; public policies; school mental health.

1. Introduction

The increase in cases of psychological distress among children and adolescents has generated growing attention from the scientific community. Studies indicate that stress experiences, especially linked to emotional insecurity, can contribute to mental illness during this phase of life. Diamond (2013) and Shonkoff et al. (2012) emphasize that this distress can compromise the development of neural circuits, affecting executive functions, self-regulation, and other essential skills for learning.

From the perspective of neuroscience, the environment in which the child lives and studies directly influences brain development. Experiences of emotional support, secure relationships, and a welcoming school environment are crucial for the development of skills such as attention, emotional control, and learning, as indicated by Shonkoff et al. (2012) and Diamond (2013). The absence of this support, on the other hand, can negatively impact these functions. Thus, attention to mental health in schools transcends a social issue, becoming a necessity for healthy brain development.

In this scenario, the school environment emerges as a fundamental space for the promotion of mental health and for the implementation of public policies for psychosocial care, as highlighted by the WHO (2021). Childhood and adolescence are critical periods of psychic development, and difficulties faced in this phase can generate significant impacts throughout life. Historically, educational and emotional problems have been addressed in an individualized manner, with a focus on clinical and, at times, medicalizing interventions, holding the student responsible and ignoring the broader context (Lima et al., 2024; Ribeiro, 2025).

The advancement of psychosocial approaches has broadened the understanding of mental health, recognizing the school’s role in creating environments conducive to human development. Margaretha et al. (2023) indicate that this shift aligns with international guidelines that view the school as a strategic space for mental health. In Brazil, Law nº 13.935/2019, which provides for multidisciplinary teams in schools, and Law nº 14.819/2024, which establishes the National Policy for Psychosocial Care in School Communities, represent advances. However, Lima et al. (2024) point out challenges in effective implementation, such as lack of infrastructure, scarcity of qualified professionals, and financial limitations.

Despite regulatory milestones, a gap persists between what is legally foreseen and practice. Studies, such as Ribeiro (2025), reveal that medicalization is still frequent in the school context, evidencing the pathologization of difficulties that may have pedagogical and social roots. The school, however, is a privileged place for promoting well-being and early identification of needs. Faria and Rodrigues (2020) suggest that integrated actions in the school environment, incorporated into pedagogical practices, are more effective in overcoming the fragmentation of interventions.

Given this panorama, it becomes essential to understand how public mental health policies in schools are being implemented and what their effects are. This study is justified by the need to analyze the implementation of these policies in different territorial contexts, seeking to verify the alignment between the proposed guidelines and their execution. The analysis considers the national and state levels, focusing on the state of Ceará and the municipality of Fortaleza, in order to identify convergences, challenges, and gaps. Furthermore, it aims to contribute to the improvement of evidence-based strategies, strengthening the effectiveness of mental health policies in the school context (Ribeiro, 2025).

2. Material and Methods

The research conducted was characterized as documentary, with a qualitative approach and a descriptive-analytical design. The study was based on the analysis of official documents and existing secondary data on the implementation of the National Psychosocial Care Policy in Brazilian schools. Content Analysis, as proposed by Bardin (2011), was employed as the central method for understanding and interpreting the information, seeking to comprehend the policy’s application in the school context.

The neuroscience perspective was used as a theoretical basis to support the understanding that the learning and development process of students is influenced by emotional well-being and brain function. This approach aided in analyzing how public policies impact the development of attention, behavior, and social relationships in the school environment, as pointed out by OECD (2015) and Who (2021).

The data sources were organized into four main dimensions. In the normative dimension, Law No. 13.935/2019, which provides for the provision of psychological and social services in schools, and Law No. 14.819/2024, which establishes the National Policy for Psychosocial Care in School Communities (Brazil, 2019, 2024), were analyzed. These documents allowed the identification of the legal framework for psychosocial action in the educational environment.

In the monitoring dimension, the national report prepared by the Mixed Parliamentary Front for the Promotion of Mental Health in partnership with the Institute of Studies for Health Policies (IEPS), with data from 2025 (MIXED PARLIAMENTARY FRONT; IEPS, 2025), was used. This document provided information on the follow-up and implementation of psychosocial care measures in the Brazilian states. For the local planning and management dimension, official documents from the state of Ceará and the Municipal Health Plan of Fortaleza, referring to the period from 2022 to 2025, were analyzed.

Finally, in the guiding dimension, documents from the World Health Organization (WHO, 2021) and UNESCO (2021) were consulted. These materials present international recommendations and guidelines related to the promotion of mental health and well-being of children and adolescents in the school environment. Such documents served as a reference to contextualize the policies and actions analyzed in the Brazilian scenario.

The documents were selected based on criteria of relevance, coherence, and quality. Priority was given to materials that directly addressed mental health in the school context, public policies, intersectoral actions, and promotion and prevention strategies in the educational environment. The reliability of the sources was ensured by the inclusion of documents from governmental bodies, international organizations, and recognized research institutions (Who, 2021).

The period of analysis of the documents covered the years from 2008 to 2025. This interval was defined to include important milestones in public mental health policies in Brazil and recent materials on the subject, allowing for an understanding of the evolution and development of these policies over time. Different types of documents were used, such as laws, reports, institutional materials, and academic works, for a multifaceted analysis.

The procedures for data collection and organization began with a complete, organized, and critical reading of the selected documents. This stage aimed to deepen the understanding of the content and identify relevant elements for the research, extracting explicit and implicit information. Subsequently, an organizational matrix was constructed based on the three main dimensions of the research, facilitating data structuring and the identification of policy application patterns in different contexts.

The data analysis was performed through thematic Content Analysis, according to Bardin’s precepts (2011). First, a pre-analysis was carried out, which consisted of careful and repeated reading of the documents to familiarize with the material and define points of interest and indicators. Then, in the analysis stage, the most important excerpts from the documents were separated into units of record and grouped into categories of similar meanings, which allowed identifying patterns and relationships between the information.

The territorial scope of the study included the national level, with a focus on the state of Ceará and the municipality of Fortaleza. The selection of Ceará was intentional, considering its location in the Northeast region, the availability of official documents from 2008 to 2025, and the existence of information to analyze the dimensions of regulation, programs, actions, and monitoring and evaluation mechanisms. Fortaleza was chosen because it is the state capital and due to the accessibility of municipal official documents, allowing for an in-depth analysis of the expression of national and state guidelines in the local context.

For support in the elaboration of the work, the Generative Artificial Intelligence tool ChatGPT, developed by OpenAI, was used, in accordance with the guidelines of CNPq Ordinance No. 2,664, of March 6, 2026. The tool assisted in the organization of ideas, in the revision and improvement of textual clarity, as well as in the structuring of tables and graphs. However, the choice of documents, the analysis of information, and the interpretation of results were entirely carried out by the author, who assumed responsibility for the final content.

3. Results and Discussion

The analysis of the implementation of the National Policy for Psychosocial Care in School Communities, under Law nº 14.819/2024, revealed a complex and multifaceted scenario, with advances and challenges at different federal levels. The results, obtained through Bardin’s Content Analysis (2011) of normative and monitoring documents, allowed for the identification of patterns, similarities, and gaps in how the policy is structured and applied. The research prioritized understanding the reality in the state of Ceará and the municipality of Fortaleza, offering an in-depth view of local dynamics.

Initially, an overview of the national-level implementation, based on the National Monitoring of the Parliamentary Front for Mental Health and the Institute for Studies on Public Health Policies (PARLIAMENTARY FRONT; IEPS, 2025), showed that most federative units still lack specific state regulation for psychosocial care in schools. It was found that actions are predominantly linked to existing programs, such as the School Health Program (PSE), and that monitoring mechanisms are often limited or based on general systems, such as SISAB.

The absence of specific regulation in many states, including Ceará, indicates a fragility in the institutionalization of the policy, making it dependent on federal guidelines and broader initiatives. This centralization at the federal level can hinder the adaptation of actions to local realities and the creation of more specific strategies for school mental health. The predominance of the PSE, although important for intersectoral articulation, also suggests that the psychosocial care policy does not operate independently, which can limit its scope and specificity (Lima et al., 2024).

Regarding operationalization, promotion and prevention actions are often focused on one-off projects, lacking continuity and a more consolidated multiprofessional approach. The presence of psychologists and social workers in schools, although provided for in federal legislation such as Law No. 13.935/2019, is still unequal and limited in many contexts. This fragmentation of actions and the discontinuity of local initiatives represent an obstacle to the effectiveness of psychosocial care, as pointed out by Faria and Rodrigues (2020).

The institutional capacity for data production and evaluation also proved to be a critical point. Although informational systems and specific studies exist, the formalization of follow-up and monitoring instruments by governmental bodies is limited. The low dissemination of data and poorly structured evaluation hinder policy tracking and evidence-based decision-making, compromising the continuous improvement of actions (Minayo, 2014).

Contextualizing within the state of Ceará, the research revealed that, despite adherence to national curriculum guidelines, the state lacks specific state regulation for psychosocial care in schools. The identified actions are mostly linked to broader programs in the health and education areas, such as PSE, and use SISAB for information related to primary care. This dependence on general programs and the absence of specific state guidelines may compromise the continuity and consolidation of practices (UNICEF, 2021).

The analysis of documents from Ceará indicated that, although institutional initiatives exist, there are weaknesses in the organization of school psychosocial care. Many actions are related to primary health care and health promotion, with articulation between health and education, but they still lack greater integration and systematization. This means that the existence of programs does not automatically translate into a consolidated and specific state policy for school communities.

The performance of multidisciplinary teams in Ceará, although recognized as important for identifying needs and developing promotion actions, lacks standardization and specific protocols. This gap can lead to differences in the implementation of practices among municipalities, reinforcing the need for continuous professional training and the strengthening of support networks (Patel et al., 2018; Ribeiro, 2025).

From the perspective of neuroscience, the limitations in the organization of psychosocial school attention in Ceará are particularly concerning. Situations of stress and emotional suffering can directly interfere with essential cognitive functions, such as attention, memory, and self-regulation, negatively impacting students’ development and learning (Diamond, 2013; Shonkoff et al., 2012). Therefore, the fragility in policy implementation is not just an administrative issue, but a factor that affects students’ brain development.

Deepening the analysis in the municipality of Fortaleza, the capital of Ceará, a more organized structure was observed in the health area, with defined planning, established goals, and the presence of the Psychosocial Care Network (RAPS) working together with Primary Health Care (Brasil, 2011). This institutional capacity, as highlighted by the WHO (2021), allows for the identification of both positive points and difficulties in the implementation of psychosocial care in the school context.

Fortaleza demonstrated to have specific sectors and teams responsible for organizing services, indicating a good administrative and technical structure that facilitates the implementation of public policies. This condition allows the municipality to execute more organized and continuous actions in the area of mental health. However, even with this structure, mental health in the school context is still not monitored in a specific and systematic way, evidencing gaps in the organization and consolidation of policies directly aimed at children and adolescents in the school environment (WHO, 2021).

Regarding monitoring, Fortaleza uses indicators and tools to track public policies, demonstrating an installed technical evaluation capacity (UNICEF, 2021). However, the absence of specific indicators for school mental health hinders a clear assessment of the impact of actions in schools and the precise identification of problems, limiting the improvement of strategies (Patel et al., 2018). This evaluative fragility is a characteristic that extends across different management levels (OECD, 2020).

The analysis by thematic categories, as proposed by Bardin (2011), allowed for a more structured understanding of the findings. In the category of Normative Regulation, the absence of a specific state norm in Ceará, contrasting with the dependence on federal laws, reveals institutional fragility and a centralization of policy at the federal level. Although Fortaleza has a robust administrative structure, this does not replace the need for specific regulation that standardizes and strengthens actions (Lotta, 2019).

In the category of Structured Programs and Actions, it was found that psychosocial care initiatives in schools occur mainly via PSE, but discontinuously and dependent on local actions, resulting in unequal access. Multiprofessional work, although planned, is unequal due to structural limitations. In Fortaleza, integration with APS and RAPS is stronger, but actions are still broad and do not constitute a specific policy for school mental health (Faria and Rodrigues, 2020).

Regarding the Monitoring and Evaluation category, Ceará uses general instruments such as PeNSE and PPA, but lacks specific systems for school mental health, which limits precise evaluation and evidence-based decision-making (WHO, 2021; OECD, 2020). Fortaleza, despite a more organized structure for monitoring, also faces the absence of specific indicators for mental health in the school environment, pointing to a persistent evaluative fragility.

The results show that the implementation of the National Policy for Psychosocial Care in schools occurs amidst significant advances and limitations. Although institutional structures and actions are in place, they are not always accompanied by clear norms, systematic organization, and continuous evaluation processes. To consolidate psychosocial care in schools, it is essential to ensure its integration, continuity, and adaptation to the needs of the educational context, especially through the creation of more specific state norms, the organization of multidisciplinary teams, and improved articulation between sectors (UNESCO, 2023).

4. Conclusion

This study sought to analyze the implementation of the National Policy for Psychosocial Care in School Communities, established by Law No. 14.819/2024, in different territorial contexts, focusing on the national, state (Ceará), and municipal (Fortaleza) levels. It was found that, at the national level, the policy still lacks specific state regulation in most federative units, with actions predominantly linked to the School Health Program (PSE) and limited monitoring mechanisms. In Ceará, adherence to national curricular guidelines was observed, but with inconsistencies in the regulation and execution of psychosocial care actions, revealing weaknesses in institutionalization and systematic organization. In Fortaleza, although a more organized health structure was identified, with planning and specific teams, psychosocial care in the school context was not accompanied by its own indicators, which generated an evaluative weakness. The analysis showed that limitations in the organization and continuity of actions directly impact students’ brain development and learning, underscoring the importance of the neuroscience perspective for the effectiveness of these policies.

The main contribution of this work lies in elucidating the discrepancies between what is normatively foreseen and the practice of psychosocial care in schools, offering subsidies for the improvement of evidence-based strategies. However, the study has limitations inherent to its documentary nature, depending on the availability and detail of public data, which restricts the generalization of results to all federative units. The recent enactment of Law nº 14.819/2024 also implies that its effects and implementation methods may not be fully recorded in the analyzed documents. For future studies, it is suggested to expand the research with direct data collection from students, teachers, and managers, in order to deepen the understanding of the policy’s practical application. It is also recommended to strengthen intersectoral policies, expand multiprofessional action, and implement specific indicators based on scientific evidence, especially in the field of neuroscience, to consolidate psychosocial care in the Brazilian school environment.

Bibliographic References

Aqui está a lista bibliográfica final, conforme as regras estabelecidas:

Diamond, A. 2013. Executive functions. Annual Review of Psychology, v. 64, p. 135–168, DOI: https://doi.org/10.1146/annurev-psych-113011-143750

Lima, M. E.; Gomes, N. S.; Diógenes, J. V. B.; Canuto, I. M. M.; Silva, C. T. A.; Moreira Filho, J. E. 2024

Shonkoff, J. P.; Garner, A. S.; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. 2012. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 129(1): e224-e231. DOI: https://doi.org/10.1542/peds.2011-2663.

World Health Organization (WHO). 2021. Guidelines on mental health promotive and preventive interventions for adolescents. WHO, Geneva, Suíça. Disponível em: https://www.who.int/publications/i/item/9789240025558. Acesso em: 7 abr. 2026.

Article originating from a Final Coursework on Neuroscience and Learning in Education

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