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Conteúdo (article):

Coproduzindo autonomia dos adolescentes no cuidado em saúde mental a partir da Oficina Photovoice
Co-producing adolescent autonomy in mental health care through the Photovoice Workshop


1Fabiane Machado Pavani. Universidade Federal do Rio Grande do Sul. fabiane.pavani@ufrgs.br https://orcid.org/0000-0002-3858-8036
2Agnes Olschowsky. Universidade Federal do Rio Grande do Sul
agnes@enf.ufrgs.br https://orcid.org/0000-0003-1386-8477
3Christine Wetzel. Universidade Federal do Rio Grande do Sul. chriswetzel1961@gmail.com https://orcid.org/0000-0002-9125-0421
4Kethruyn Guedes Ferreira. Universidade Federal do Rio Grande do Sul. kethruyn_ferreira@hotmail.com https://orcid.org/0009-0003-5349-6978


RESUMO

Objetivo: analisar o método photovoice como ferramenta de cuidado em saúde mental de adolescentes na perspectiva da coprodução de autonomia, em um Centro de Atenção Psicossocial infantojuvenil (CAPSi). Método: pesquisa fundamentada no paradigma construtivista, com abordagem qualitativa e participativa, mediante o percurso teórico-metodológico do photovoice. Na coleta e dados foram utilizadas notas de campo e Círculos de Cultura. Participaram quatro adolescentes usuários do CAPSi. A análise ocorreu simultaneamente à coleta, pelo Método comparativo Constante. Resultados: a oficina possibilitou uma coleção de fotografias e suas narrativas representaram criações, experiências, encontros, reflexões e movimentos sobre o que os adolescentes têm a dizer acerca da coprodução de autonomia em suas vidas e seu cuidado em saúde mental. Envolveu um trabalho artesanal com os adolescentes, que puderam comunicar o que não era possível expressar em palavras. Conclusões: o photovoice além de ser um método de pesquisa, com os adolescentes e não sobre eles, também demonstrou ser uma ferramenta possível no cuidado em saúde mental, pois criou espaço para que os adolescentes expressassem suas necessidades, desejos e escolhas de ser e fazer, o que se pode compreender também como coprodução de autonomia no cuidado em saúde mental.

Palavras-chaves: adolescentes, saúde mental, autonomia pessoal.

ABSTRACT

Objective: to analyze the photovoice method as a mental health care tool for adolescents from the perspective of co-production of autonomy, in a Child and Adolescent Psychosocial Care Center (CAPSi). Method: research based on the constructivist paradigm, with a qualitative and participatory approach, through the theoretical-methodological path of photovoice. Field notes and Culture Circles were used to collect data. Four adolescents from the CAPSi participated. The analysis occurred simultaneously with the collection, using the Constant Comparative Method. Results: the workshop provided a collection of photographs and their narratives represented creations, experiences, meetings, reflections, and movements about what adolescents have to say about the co-production of autonomy in their lives and their mental health care. It involved an artisan working with the teenagers, who were able to communicate what was not possible to express in words. Conclusions:the photovoice besides a research method, with adolescents and not about them, also demonstrated to be a possible tool in mental health care, as it created space for adolescents to express their needs, desires, and choices of being and doing, which can also be understood as co-production of autonomy in mental health care.

Keywords: adolescents, mental health, personal autonomy

INTRODUCTION
The construction and implementation of psychosocial care, as a model of mental health care, focuses on sensitive and critical care, restoring the dignity and citizenship of people suffering from mental problems and/or disorders, with a view to guaranteeing respect for human rights and their leading role. By assuming this, the need is recognized to ensure this approach to children and adolescents in the field of mental health, as well as the exercise of citizenship and social inclusion as subjects of rights1-2.
Among the parameters that lead to this model of care, it is important to work on how to encourage adolescents\' autonomy in their care, since the search for self-appropriation and their desires and expectations are expected developments in these phases, as well as dialogues with care and a better quality of life. Emphasizing autonomy in mental health care can foster different ways of being and living in the world. From this, it is understood that this is one of the decisive characteristics in transforming the idea of insanity and the person suffering from mental illness in society2-3.
Care that favors the development of autonomy goes against the logic of protective care, justified by the attribution of the person\'s inability to perform actions and functions, in other words, to live fully4. This supposed incapacity is attributed to the diagnosis of mental disorder, which is historically limiting, because the signs and symptoms of the condition prevail, while there is an “erasure” of the person, their subjectivity and their singularity5-6.
Autonomy may be understood as an ability that is created and expressed in the individual and collective spheres, which involves the relationship with others as well as the relationship with oneself. It is assumed that it is not possible to “grant” autonomy to people, as it is created from a simultaneous individual and collective conception. Therefore, autonomy is the result of a relational process, marked by countless contextual variables, including family and the social environment of each person, which corroborates the idea that autonomy occurs in co-production7.
In working with adolescents in the areas of health, education, housing, work and culture, among others, the co-production and exercise of autonomy is a constituted right. However, there is a challenging construct of how to produce and encourage adolescents to exercise their autonomy in these situations, especially in the field of psychosocial care for children and adolescents2,8.
Occasional experiences have been observed of investment in mental health care practices that include adolescents as actors involved in their own care. Studies point to the need to understand young people\'s own perceptions of their life trajectories and modes of subjectivation, so that they can express themselves and be heard when they talk about themselves and their expectations related to their treatment9.
In order to do this, it is necessary to include them in self-care, based on the concept that they are capable of speaking, voicing their opinions, contributing to decisions, as well as understanding, interpreting and developing skills and competences with a view to co-production and the exercise of autonomy in mental health care.
This involves treating the adolescents as citizens, creating spaces where they belong and their voices are heard, where the adult\'s words do not prevail. This way of looking at things can be an essential tool for co-producing and exercising adolescents\' autonomy in mental health care4,9.
With this in mind, the aim of this article is to analyze the photovoice method as a mental health care tool for adolescents from the perspective of co-producing autonomy in a Psychosocial Care Center for Children and Adolescents (CAPSi).
This research is justified by the urgent need to strengthen mental health care for adolescents, considering their views, voices, subjectivities and contexts. It can also help build the theoretical consistency needed to broaden the discussion on autonomy and share sensitive approaches both to research with adolescents and to child and adolescent mental health care practices.

Methods

This research is based on the constructivist paradigm, with a qualitative and participatory approach, through the theoretical-methodological path of the photovoice method.
Photovoice is a participatory qualitative research approach developed by Caroline Wang and colleagues in 1990. It produces an interface between images and words, using the action of photographing and discussing the images as a means of reflecting on issues, concerns and problems experienced by a community or group of people10.
The method is based on three pillars: feminist theory, documentary photography and Paulo Freire\'s education for critical consciousness. The latter stands out for its essential contribution to the construct of collective critical reflection on reality and the “problem situations” experienced, in other words, it consists of the process of questioning oneself about the problem, which, in fact, is what each person experiences, and acting on it, which corresponds to the reality to be transformed by the people themselves11.
Thus, the research is participatory, as participants are invited to identify and select aspects related to their context and experiences to be represented as “data” through the action of photographing them. As a result, spaces are created for the \'voice\' of the participants, their priorities and knowledge, building powerful avenues for the empowerment of population groups, including those who have historically been socially marginalized10,12-13.
The fieldwork took place between July and September 2022 at a CAPSi located in the city of Porto Alegre, Rio Grande do Sul, Brazil. For 12 years, the service has been caring for children and adolescents from the north and northeast regions of the city, through individual and collective care.
The study population consisted of adolescents being cared for at the CAPSi. Adolescents between the ages of 12 and 19 were included in the study, regardless of their sex, gender or length of time at the facility, and who took part in the photography workshop that was set up during the research process. Those who found it difficult to verbalize their thoughts and feelings did not take part. After applying these criteria, four teenagers took part in the research.
Field notes and 14 Culture Circles were used to gather information. The field notes were made up of the fieldwork annotations by the main researcher and artifacts produced during the period, such as the adolescents\' writings and photos taken along the way. The Culture Circles included weekly conversation sessions with the teenagers, in which their images (photos) were selected and shared. Each teenager presented their observations, the reasons for taking the photos, and provided additional meanings about these images through metaphors, narratives and symbolism.
The information was produced over a 14-week period, in accordance with the stages of the photovoice method10 adapted for this study: getting to know the field; identifying the participants; introducing photovoice and holding discussions about equipment and related exercises; presenting the object of study; capturing images, identifying and discussing their perceptions; collecting images about autonomy and sharing strategies.
\'Getting to know the field\' was characterized by meetings with the CAPSi coordinators and staff, to present the research and evaluate its implementation. At this stage, the team suggested setting up a workshop with the adolescents, with the aim of explaining, establishing a bond and trust with the researcher and experiencing the action of photographing without yet starting the research.
The construction of the photography workshop (Photovoice Workshop) was essential for the \'identification of participants\' stage, in which the aim was to identify with the team the users indicated to take part in the workshop. As a result, all the teenagers taking part in the photography workshop were invited to a presentation about the research, and at the end of the explanation, they were invited to take part. Of the eight teenagers taking part in the workshop, four agreed to take part in this study.
The stages \'introduction to photovoice and holding discussions about equipment and photography exercises\', \'presentation of the object of study\', \'capturing images, identifying and discussing perceptions\' and \'the collection of images on autonomy and sharing strategies\' consisted of weekly sessions and were organized using the culture circles on a weekly basis.
The first five workshop sessions were dedicated to presenting and discussing the photovoice method and its theoretical and technical concepts. During the culture circles, the participants were instructed on how to handle the cameras to capture the images they wanted and how to use them to express themselves, including discussion of the ethical issues, responsibility and authority that are attributed to the participants in their role as photographers. Agreements and rules of coexistence were drawn up together, as well as planning of the days on which the images would be taken, the collective discussions and the place and time of the sessions.
From the sixth to the tenth meeting, the images captured were discussed, along with the perceptions, conditions and aspects that contributed and related to the adolescent\'s autonomy. For this purpose, the culture circles used guiding questions such as: “What would you like to say about this image? Why did you choose this image? Who was there when you took the picture? What did you think about while you were taking this picture?”. Throughout each week, the teenagers borrowed the cameras and took pictures. At the next session, the photos taken were selected, shared and discussed in the workshop, so that the author could present their perception and the reasons for capturing that image.
Finally, the \'collection of images on autonomy and sharing strategies\' stage consisted of four final sessions. There were discussions about interest and strategies for sharing the images, which resulted in moments dedicated to planning and holding a photographic exhibition. A total of 221 photographs were produced, of which 40 were selected for the exhibition, which took place in December 2022 on the CAPSi premises. Subsequently, the exhibition was also held at the municipality\'s Antimanicomial Movement in May 2023.
The data were analyzed at the time of collection, using the Constant Comparative Method14. The themes that emerged in the process were grouped into three categories: adolescence and its trajectories; the everyday routine of adolescent relationships and the co-production of autonomy; photovoice and the co-production of autonomy.
This article uses the results that made up the category ‘photovoice and the co-production of autonomy’. This category was made up of topics related to strategies for engaging adolescents in scientific research, photovoice as a way of promoting spaces for adolescents\' voices and the photovoice workshop at the CAPSi as a tool in mental health care.
The study was approved by the Research Ethics Committee of the sponsoring institution (CAEE: 59064222.6.0000.5347) and the co-participating institution (CAEE:59064222.6.3001.5530). The adolescent participants signed the Free and Informed Consent Form, as did their parents and/or guardians. The confidentiality of the adolescents was guaranteed by replacing their names with the letter \'A\', for adolescent, followed by a number.
With regard to the photographs used, it was made clear in the terms referred to above that they were the property of the participants, who granted the copyright for exclusive use in this research. Thus, authorship and ownership of the captured images were guaranteed to their photographers and each participant received their printed photographs. All the empirical material was stored digitally and will be preserved for five years on a pen-drive, under the researcher\'s responsibility. After this period, it will be deleted.

Results

The first workshop sessions were dedicated to familiarizing the teenagers with the photovoice method, which allowed them to become acquainted with the world of images and photography, taking into account their previous experiences.

Before, I studied at school X and I don\'t know what we did, but I used to mess around with a camera, but only rarely, once a week. It was very little. It was there that I came into contact with digital cameras (A1).

It\'s very small, isn\'t it? If you look at it, it doesn\'t look like a camera! My godmother has one of these cameras, because she\'s a photographer too (A2).

In this approximation, a dynamic was used with photos from magazines, in which the group talked and made comparisons between the sizes of the images, the colors, the content, the type of lighting and also whether the photographer was the author. The main elements that make up photography were then discussed, such as light, angles, framing, lens, focus and the photographer\'s positioning.
In addition, historical aspects of photography were introduced, for example, when the process of capturing images began, drawing a parallel with painting. Ways of capturing images were discussed; in order to show the evolution of the equipment used, images of old cameras and even current digital cameras were shown.
At this point, the adolescents began to recognize the reasons that led them to take part in the photovoice workshop, among other collective activities offered by the CAPSi.

They said that their reference coaches had presented the workshop as an alternative in which they could participate if they were interested and available. They were very interested in the idea of taking photographs, in learning a little about the world of photography, and some said it was an opportunity to develop initial skills that could help them in the future in the job market, as they wanted to be photographers (Field Notes, July 11, 2022).

With this in mind, it was proposed that each teenager choose a camera for themselves, identify it and use it while taking part in the workshop. This strategy encouraged and led them, for the first time in this space, to exercise their autonomy by choosing a specific camera, either because they liked a particular model or because it caught their eye. This simple action of choosing also proved to help build a bond between the teenagers and the workshop.
In turn, the weekly loan of the cameras created room for the exercise of autonomy, with a view to establishing negotiations, how to place and express oneself, which characterized the workshop as a safe space to talk about oneself, since the adolescents were able to talk about their fears, anxieties, wishes and desires. This helped them to remain engaged in the group, which also led to a shared running of the workshop.

I wanted to go with you to take pictures in other places [...] go to the Gasômetro, take some pictures. On Saturday, I\'d like to go out again to take other photos (A2). Do you want to keep these cameras you\'ve chosen or do you want to choose others? (researcher). Do you have these two, red and blue? Wow, what a fancy workshop, eh! (A1).

Note that the moments of negotiation enabled the teenagers to record images of other places in the city. Some of these spaces, for example, were places they did not visit frequently and/or wanted to visit (Figures 1 and 2).
Figure 1
Figure 2

One of the concerns along the way was that the teenagers wanted to use their own equipment to take pictures, such as cell phones. The use of these devices for photography, however, was not an issue during the workshop, because even though cell phones were available, they preferred to use cameras. The adolescents were actually able to compare how both types of device work. After handling the different cameras that were available, they concluded as follows:

My phone is useless, it\'s so useless that I can\'t take pictures (A2).
I want to work with this one. My phone is useless for taking photos (A1). Mine too! (A2).

Talking about the types of cameras, their handling and techniques was an aspect that enhanced learning and improvement, as it recalled what the adolescents already knew, connecting and making sense of the new information.

There must be a battery in here, I don\'t know how to open it, but I know there was a flash in there! I took a picture of her there. I did, and it was the flash. Wasn\'t it? (A1).
The flash, it\'s great, but it can ruin the photo you wanted to take... It can make your eye very red. Oh, without the flash! (A2).
Oh, that\'s a nice picture! Look at this one! It\'s very, very nice. Right? And I didn\'t even zoom in! I liked this one better, the colors (A3).

The teenagers\' frequent exercise was to identify their abilities, to get things right, make mistakes and always try again, in other words, to test themselves. The perception of common and individual difficulties pointed to the need to work with the group on their concerns and how to communicate their anxieties and fears. This was a way of helping them through dialog about the unknown and what these aspects represent in their realities, as can be seen in Figures 3 and 4 and their narratives.
Figure 3

Tests and tests. These were the test shots. This one I liked, it was more of a “love vibe” (A3).
Figure 4

This was the first photo I took on my own. I was going home. I was very tense when I left here. I don\'t know, and I\'m afraid people won\'t like me. I get shaky, I get flustered [...] and I was curious to know how to take the picture. I didn\'t know how to take the flash, but then I learned on my own (A4).

The photovoice workshop was not intended to train photographers, but rather to become a space for dialog through different forms of expression. The opportunity for adolescents to experience different experiences and, from the photos, to reflect and create other perspectives on their daily lives and mental health care.
Considering this, it was observed that the teenagers succeeded at each session in interacting more, asking for example: “So, what\'s new with you today?” (A2), from one week to the next. Similarly, they began to report whether or not they had managed to take photographs. This allowed them to reflect on the action of photographing as an action of choosing and deciding what to look at and capture:

I chose this one because of the sky. I love the sky like this, kind of like the sunset, so I have a lot of sunset photos on my phone (A1).
Now I\'m looking, I choose this other one because it\'s interesting. It\'s where my aunt lives, there\'s a place there, she lives in an apartment, then, if you walk a bit, there\'s a small farm. There, I said: “This is a good place to take a photo!". So I went and took a photo of the farm (A2).

The action of photographing something and being the author facilitated the adolescents\' ability to project ideas and identify tastes and desires. This gave rise to the feeling of being valued as someone unique, different from the others. The images captured mobilized the expression of thoughts and feelings:
Figure 5

How beautiful! Ai, ai. Phases of life, eh? Thank goodness everything changes. That\'s me. These are thoughts, these are decisions and words (A4).

In this respect, the different perspectives attributed to the photos taken and the conversations about them in each culture circle corroborated a movement of naming emotions, constructing senses and meanings, such as the example of being able to make choices, have responsibilities and reflect on them, which can favor the expansion of the co-production of adolescents\' autonomy.

We\'re nearing the end. I want to ask you how you felt about this activity? (researcher) Fine! (A1). I liked it (A2). One word that defines it is: expression (A3).
Was there anything you liked more? (researcher) Taking the camera and being able to take pictures with it! Because I like taking pictures, right, I take pictures of everything! (A1) Yeah, me too, because people were really curious when I photographed them: “Wow, you\'re good”. They said I should start taking pictures (A2).

Likewise, the action of sharing the images captured was a proposal for the group to mix lives, differences and stories, which resulted in a moment that was unique and rich, in the sense of helping the adolescents to find other ways of thinking and facing their difficulties, and thus be able to translate them in the repercussions of their daily actions and choices.

There were actually supposed to be 63 photos, but I had another look and removed some because I didn\'t think they were good: some my brother took with the camera and others I don\'t even remember (A4).
Ah, I thought it was some stones. This one is the stone on the ground, but it looks like a whale, a dolphin... It really gives the impression, along with that sky. So there are several of these things, which I think we try to look for where we can get the best results (A1).
Although it\'s a photograph, it doesn\'t look like one. It looks like something else. I thought it was a painting! (A2).

In the last stage of the research, the aim was to gather and visualize the printed collection of images, which formed a concrete/real image of the productions from the entire course. As a result, the group of adolescents were encouraged to think about and plan what they wished to do with the output from the workshop. One of the ideas was to share the images with people who weren\'t taking part in the workshop. Thus, the possibility of creating a photographic exhibition was prompted by the sequence of images (Figure 6) shown in their discussion.
Figure 6

What do you think about holding an exhibition? (professional). With all these “little eyes”? (A4). (laughter) And the name will be Visions (A3). Great (A4). Perspectives (A3). Or, literally, points of view (professional). That’s it, eyes (A3). We have various ideas, let’s think and create together (researcher).

In addition, all the teenagers agreed with the proposal of collective divulgation and also suggested an individual production such as the construction of a scrapbook, a birthday card with photos of family members and, finally, they suggested a visit to the Mercosul Biennial.
It should be noted that after each session, the researcher and the professionals who shared in running the workshop discussed and recorded information regarding the adolescents\' interaction with each other, with their peers and with the technical personnel. In most cases, there was a consensus that the adolescents\' participation in the workshop was helping them to talk about themselves, producing examples of exercising autonomy at home, at school and on the street, by talking about what they liked or disliked.
As the workshops took place, other professionals from the team began to contact the researcher to give feedback on the repercussions of taking part in the workshop on the individual care of the adolescents and assistance to their families. In this way, the CAPSi team also got to know the experiences that took place in that space, based on the adolescents\' reports, especially during individual consultations with psychiatrists, psychologists and other care modalities. This enabled the team to identify the workshop as important for certain cases/situations. At the end of the research, the team expressed interest in continuing the photography workshop using the photovoice method as a fixed activity at the CAPSi.

Discussion

Using the photovoice method to conduct the photography workshop at the CAPSi made it possible to compile a collection of photographs, and their narratives represented creations, experiences, encounters, reflections and movements about what adolescents have to say about themselves, their desires and expectations, their relationships, and the consequent co-production of autonomy as well as their mental health care. This process required new knowledge and proactive initiatives capable of generating collective awareness and a commitment to and strengthening of the co-production of autonomy.
This perception comes from the transformations in the field of psychosocial care, both from an ethical-political and theoretical-technical perspective, guided by the principle of protection, based on the premise that children and adolescents are subjects of rights, supported by the proposal of care in freedom13.
The option for the photovoice method was based on the idea of the participation and inclusion of the adolescents, with a concern for their involvement in the process of investigation, giving them the opportunity to think and act in the development and conduct of the research process.
In the field of research, the use of photography has become popular, especially in the area of health, due to its effectiveness as a way of studying the more subtle nuances of human life and analyzing social processes over time. Also contributing to this scenario is the advent of technologies, as well as the ease of access thereto, urging social researchers to tread new paths and adapt to a more interactive, modern and relational reality14,16.
The universe of images and photography relates to the act of photographing and the use of photographic production as a tool for promoting reflection, projecting one\'s voice and ideas and seeing oneself as a subject/citizen. In this way, the appropriation of technology and technique helps to identify subjectivities, in such a way that photos enable the study of aspects of life that cannot be observed through words alone17.
Images and the equipment used to capture them are not just a part of everyday life, they are everyday life. Therefore, the option of working with digital cameras, recording the images chosen by the adolescents, who had the power to decide what to show and the motivations for recording, also instilled the co-production of autonomy in their daily lives.
Other studies have pointed out certain difficulties during the research process using images, including access to cameras, which sometimes becomes one of the limiting factors in using the photovoice method in research18-19.
Nevertheless, this is a problem that can be solved: in the case of this study, the alternative was to have a rotation of cameras for use, as well as loans and donations. With this in mind, it was sought to acquire more equipment for this study than there were participants, which is what happened: a total of six digital cameras were made available for the stage of gathering information. It should be noted that five of them were donated and remain in the possession of the CAPSi team even after the end of the research, as a form of encouragement and aid for the maintenance and sustainability of the workshop in this field.
The loan of the camera to the adolescents was another aspect that helped in the co-production of autonomy, since the proposed action was to photograph primarily what happens outside the CAPSi space without the presence of the researcher or the professionals who work there, thereby ensuring their decision and choice of what to photograph, based on their desires and interests.
The construct of knowledge for the production of autonomy, which implies the exercise of curiosity, the critical ability to “take distance” from what you have to observe, to delimit, is directly proportional to the ability to generate comparisons and questions. In this respect, questions lead to critical reflection on one\'s own curiosity and the aim is to overcome the passive attitude towards what is new, which consists of just waiting for something or someone. As can be inferred, it is necessary to promote spontaneous curiosity11.
Once the cameras had been chosen, the adolescents first dispersed around the CAPSi building to take the shots, to test the photographic elements, to carry out the action of photographing and being photographed. It is not always easy to come into contact with something new, such as cameras, lighting, angles, editing, backdrops. Right and wrong, good and bad are experiences that the adolescents had while recording the images, everyday feelings that test our actions and decisions. In the research, workshops and circles, these feelings were encouraged as an opportunity for reflection in the search for autonomy.
This is because, considering the use of Culture Circles, strictly speaking, nothing is taught, everything is learned in reciprocal awareness. The coordinator\'s role is to share information requested by the participants and, above all, to provide favorable conditions for group dynamics11.
This is a condition that made it possible for the adolescents, during the photovoice workshops, while contemplating the scenes captured in the photographs, to share reflections and experiences from their daily lives and give them new meaning through dialog with the others.
In other words, to (re)exist critically in their world so that, when the time comes, they will know the words and be able to have their say. Looking for the moment to rediscover themselves through a reflexive rethinking of the very process in which they come to know themselves, understand their reality, their experiences and reconfigure their expectations and life context11.
It must be made clear that the intention is not to propose any dichotomy that results in a division between reflection and action, since both happen simultaneously. This facilitates emancipation, which can be seen as a way of strengthening the personal and collective power of people and groups subjected to long processes of oppression, discrimination and/or pain11.
In the experience reported, this emancipatory process was shared by all the members of the photovoice workshop, in the sense that the methodology made it possible to move away from places and roles that are sometimes crystallized in institutions. When an adolescent took the lead in deciding how he or she should be referred or led to the workshop, this upset the status quo established in institutions that operate from a perspective of separation between those who care and those who are cared for. The learning experience, in addition to producing photos, was to produce more democratic relationships, which favored the co-production of autonomy.
In turn, considering the reality to be transformed, as the use of the photovoice method aims to do, and the difficulties is a fundamental process for a critical awareness that triggers actions and attitudes of protagonism on the part of the adolescents about their realities12,17.
Thus, in a discussion group such as those held in the Culture Circles, individual statements become a collective construction that starts with the individual and returns to him, enhanced by the voice of the group. Sharing the images chosen by the adolescents collectively became an invitation to debate different points of view, which demonstrated the existence of time and space for reflection and also changes in the perception about themselves and the world.
As a result, the visual image is a potential tool for empowering socially marginalized population groups, enabling the creation and representation of the diversity of experiences as a group and/or community. In turn, discussions about images promote a reappraisal of reality, which can result in greater engagement by the participants in political practices aimed at transforming reality16.
The photovoice method reified dynamism in the construct of this research, shaping it in sync with the adolescents\' movements in a process of continuous evaluation, which also had repercussions on their daily lives, the service and the CAPSi team. It involved a kind of craftmanship that promoted interaction between the adolescents, the movement of testing themselves and communicating what they were still unable to express in words. This reaffirms the research process as a tool capable of supporting and guiding the practice of co-producing autonomy in mental health care for adolescents.

Final considerations

The construction of mental health care for adolescents that favors the co-production of autonomy is challenging, since it involves maintaining ethical-legal responsibility, given that they are still under 18 years of age, but it also implies that adolescents should be considered subjects of their own care. This encourages us to think about that place - perhaps a rarity - where adolescents can exercise the right to pursue their own wills and desires and thus exercise their autonomy, understanding that this occurs in relation to themselves and others.
With this in mind, it is considered that this research indicated the photovoice method as a mental health care tool with a view to favoring the co-production of autonomy by adolescents at the CAPSi, through the construction and implementation of a photography workshop (Photovoice Workshop).
The processes created using the photovoice method resulted in a joint construction that took into account, at the same time, the perceptions and realities of the professional services, and, equally, those of the adolescents involved in the process; likewise, it represented a flexible and adaptable route, in which the object of study itself changed during the course of the scientific investigation and the co-production of autonomy was visualized.
Therefore, it may be argued that the photovoice method is a form of research with adolescents and not about them, but also a powerful tool in mental health care for adolescents, since it jointly created space for them to express their needs, desires and choices of what to be and do, which can also be understood as the co-production of autonomy in mental health care.
It is appropriate to recognize as limitations of the study the difficulties of providing a space for adolescents to construct and exercise their autonomy and exempting them from the commitment to meet any expectations of the researcher and the professionals, as well as teaching how to handle the cameras and capture images without annulling the protagonism of the participants. This is a question of the tension between the place of the researcher/professionals and the way of carrying out interventions and research from a participatory perspective, faced with the task of caring for, teaching, guiding, protecting and guaranteeing the autonomy of the adolescents.

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