(Photo: Davide Contenti/ Picssr)
(Photo: Davide Contenti/ Picssr)

On the first day of last September, the Unified Health System (SUS) announced that it will again discuss the expansion of beds in psychiatric hospitals in the country. The initiative, which goes against the psychiatric reform in force for more than 15 years, was defended by representatives of municipal and state health departments and suggested by the National Council of State Health Secretaries (Conass), in a meeting with the Ministry of Health and the National Council of Municipal Health Secretaries (Conasems).

Since 1987, mental health sectors have been fighting for the end of asylums in the country. Not surprisingly: the largest of them, Hospital Colônia, in Barbacena (MG), killed more than 60 people and sold their bodies to medical schools in the country – the subject of the book “Holocausto Brasileiro”, by journalist Daniela Arbex. In addition, Brazil's first conviction for human rights violations was violence followed by death within a psychiatric institution, Casa de Reposo Guararapes, in Ceará. Violations of rights were found in asylums and patients with mental disorders were isolated for up to 30 years in these stages of atrocities.

In these three decades of anti-asylum struggle, the substitutive network emerged, formed by new public places aimed at the care of these people, with humane treatments that guarantee freedom, such as CAPS (Psychosocial Care Centers) and therapeutic residences. In addition, the Psychiatric Reform Law was enacted in 2001, which places hospitalization as a last resort and records the rights and protection of people with mental disorders.

Even so, even today, there are 159 asylums in Brazil. The movement, however, is the opposite: in the last 11 years the supply of psychiatric beds in the SUS has decreased by almost 40% and since 1989 almost 100 beds of this type have been closed.

“We have a history in the country of a psychiatric reform that responds to the international principles of good care in mental health”, explains Lumena Almeida, psychologist, former national secretary of Health Care, who was also Assistant Secretary of Health in São Bernardo do Campo and Secretary of Health of Mauá, in addition to working in the SUS for over 30 years.

In conversation with page B!, Lumena lists four reasons why the measure is considered a setback:

1) For many years, Brazil has been experimenting with care in freedom. And it has been showing that care in freedom is much more effective than closed care in a hospice, in a psychiatric hospital. It is no longer a bet, we experience it, we have cases of it. The national psychiatric reform policy is implemented in several municipalities.

2) National policy has been making a strong investment in the replacement network. If the Ministry assesses that there are problems in the care, in the CAPS, it has to qualify this care.

3) We have already managed to close 30 thousand beds for residents of psychiatric hospitals, people who were imprisoned for 26, 30 years, just because they had a diagnosis of mental disorder. Not even the maximum sentence in Brazil reaches that length. So Brazil was already paying off its historical debt with these people, building a housing network so that they could live in freedom. In other words, now going back to the psychiatric hospital as a space for care is going back, going the opposite way that the country has been doing to rescue the dignity of people who have lived in psychiatric hospitals for a large part of their lives.

4) All Brazilian municipalities that have implemented a quality network have dispensed with the bed in a psychiatric hospital. Because we showed that it is possible to take care with this network that is foreseen in the policy, which is CAPS, basic unit, street office, therapeutic residence, reception unit and bed in a general hospital. So there is no need for this bed, it no longer makes sense in the care process that was being implemented.

Possible paths

Lumena Almeida also brings ideas of paths that the federal government can take if it intends to promote the country's mental health policy, without hiding the reaction that the recent news generated:

It is with great astonishment that the sectors that for more than 30 years in Brazil have been working on psychiatric reform, on the national mental health policy, hear this speech from the Ministry of Health, the conass and Conasems. Every national policy to be implemented also has problems, weaknesses. For example, the Ministry of Health would help much more if it released the resource for all new services that were created and not yet financed by the Ministry in recent periods. This is an issue that would have to be discussed. Or that he would resume, for example, the Training Course, which is a training process that the Ministry of Health did with the mental health network, very powerful, in order to qualify care in the CAPS network. This is the role that the federal government has in order to qualify the policy. And not having a setback in the proposal, which is the expansion of psychiatric beds.

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