MENTAL ILLNESS AMONG WORKERS IN INTENSIVE CARE UNITS OF THE BRAZILIAN PUBLIC HEALTH SYSTEM: INSTITUTIONAL INVISIBILITY, ETHICAL AND MORAL SUFFERING, AND LIMITS OF PUBLIC POLICIES FOR WORKER HEALTH PROTECTION

Abstract

Objective: To analyze the process of mental illness among Intensive Care Unit (ICU) workers in the Unified Health System (SUS), discussing the interface between institutional invisibility, ethical-moral suffering, and the effectiveness of current public protection policies. Methods: An integrative literature review was conducted in PubMed, SciELO, and VHL databases, using controlled descriptors (DeCS/MeSH) and a timeframe from 2023 to 2026. Forty-three articles were selected based on methodological rigor and thematic relevance. Results: Findings demonstrate that the prevalence of mental disorders is linked to overwork, precarious employment, and lack of psychological support. Institutional invisibility silences suffering, while ethical-moral suffering, resulting from resource scarcity, generates "moral trauma" and emotional detachment. Public policies (such as CEREST and PNH) show practical limits and federal disarticulation, failing to mitigate psychosocial risks. Discussion: Mental illness is a construction of managerial rationality that prioritizes metrics over subjectivity. Factors such as presenteeism, technostress, and intersectionalities (gender/race) worsen the scenario. Fiscal austerity and lack of psychological safety prevent talent retention and care sustainability. Conclusion: Mental illness is a structural pathology of the system. A paradigm shift toward management models based on cooperation and in-house support is urgent to ensure the integrity of those who provide care.