It was more than three decades before Brazil was able to implement a more humanized mental health model. But all this advance, which had as its main milestone the Psychiatric Reform in 2001, has now given way to retrogression. This is what evaluates Leonardo Pinho, president of the National Council of Human Rights (CNDH) and vice president of the Brazilian Association of Mental Health (Abrasme). During a seminar held at the UFBA Institute of Collective Health on February 22, he spoke about the main implications of the new mental health policy that is being designed in the country.
Leonardo Pinho’s criticism comes shortly after the release of a technical note published by the Ministry of Health earlier this month, which predicts controversial changes in the treatment of mental health in Brazil. Among the main items, the document highlights the financing for the purchase of electroshock devices, incentive to therapeutic communities, increase of psychiatric beds and the possibility of hospitalization of children and adolescents.
Ordinances and Decrees
Although it generated surprise and many discussions, the note did not bring any news to the president of CNDH. According to him, the document only concludes a set of ordinances and decrees that had been implemented in the country since 2017. “These decrees and ordinances made the national mental health policy go back more than 30 years,” says Leonardo Pinho.
Psychiatric hospitals, for example, already had their return expected in Ordinance 3,588, published by the Ministry of Health in 2017, when they joined the Psychosocial Care Network (Raps). The network, composed of various services and equipment, such as the Psychosocial Care Centers (Caps), has as its original objective to develop the psychosocial rehabilitation of the people attended.
“It is important to highlight that the Psychiatric Reform was never opposed to hospitalizations. It was a device to be used at a very specific moment in the therapeutic project. ”For him, the risk lies precisely in bringing hospitalization to the center of mental health. “What we need is for Raps and its devices to be better funded and expanded to make less use of beds.”
The bed industry
Data presented by the CNDH president reveal that the mental health budget in 2018 was not distributed satisfactorily in Brazil. Of the 320 million total, two thirds went to the private network, consisting of psychiatric hospitals, asylums and therapeutic communities. Thus, only a third of the funds actually went to Raps’ other public equipment. “That is, public resources to irrigate a private health model.”, Criticizes Pinho.
The dispute over SUS resources seems to win an important chapter in 2018, with the publication of Ordinance 2434, which increased by 60% the daily rates paid to hospitals that perform hospitalizations for more than 90 days. According to the president of the Council, the Ministry of Health ordinance increased the permanence of these patients in the units. “It returns to that view that people can be removed from social life and placed in places of detention, as more money is being received for this,” he says.
Illegality X Mobilization
For Leonardo Pinho, all the measures announced and implemented in the last two years, stamped with the publication of the technical note in 2019, make it clear that this is the creation of a new mental health policy. Therefore, they would first need to go through the National Health Council Plenary. “The law is clear: social participation is not a government option, it is a must when it comes to implementing and creating new policies.”
Also according to the president of CNDH, there are already recommendations from the National Health Council to revoke these ordinances. But so far, the Ministry of Health only informs that the technical note is in internal consultation in SEI (Electronic Information System) to receive contributions from ministry officials and other agencies, such as Conass (National Council of Health Secretaries). ) and Conasems (National Council of Municipal Health Secretariats).
For Leonardo Pinho, the moment is mobilization. “We need to build a democratic front to defend human rights and a health-promoting idea that transforms lives,” he concludes.
To watch the full lecture with Leonardo Pinho, visit this link.