Opinion – Saúde em Público: Mental health is a matter of life and death

Genivaldo de Jesus Santos, 38, died of asphyxiation in May, the victim of an action by the Federal Highway Police (PRF) in the city of Umbaúba, in the interior of Sergipe. Police officers immobilized and locked Genivaldo in a corporation vehicle and threw a gas bomb inside the vehicle. Genivaldo had schizophrenia and was approached by unprepared professionals.

Welcoming or approaching someone with some kind of mental disorder may not be that simple for most people. Often, prejudice and stigma with this group, and others who are vulnerable, affect contact and the way in which this first reception will be done. Dealing with mental suffering properly and carefully is also a challenge for public policies, being a task for professionals from different sectors, such as public security agents. Obviously, Genivaldo could have been approached differently and his death avoided. But how to promote public policies that are capable of humanizing relationships and, ultimately, expanding the protection of life and dignified care?

According to the Action Plan for Mental Health adopted by PAHO, the lack of training of professionals is one of the main challenges to be faced in the area. However, when we talk about mental health, it is not just about training psychologists and psychiatrists, but about all professionals who interact with people in suffering or with mental disorders. At the age of 37, Mário Travassos died in less than 24 hours after being admitted to a private psychiatric clinic in Rio de Janeiro, in 2017. A nurse and a nursing technician were held responsible for the death, which resulted from undue physical restraint.

The lack of access to mental health care is also accentuated by the lack of trained health professionals. There is a relevant gap in mental health specialists, such as psychologists and psychiatrists, and a very uneven distribution in the territory. In Brazil, the Southeast region has 5x more psychiatrists per 100,000/inhabitant than the North region.

Source: CNES/TABNET, June 2021.

The first step to expand access to care through public mental health policies is to value workers in the area, as emphasized in the Mais SUS Agenda. Within the scope of the Unified Health System, the preparation of teams that provide care to people with mental disorders is directly related to the existing work situation: the vast majority of professionals in the area have precarious work relationships, salary delays and lack of infrastructure to exercise. your activities. The establishment of safer bonds promotes a healthier work environment and, consequently, a better reception of mental health, following the maxim of caring for those who care. This can be promoted by implementing a Plan of Positions, Careers and Salaries for professionals in the Psychosocial Care Network (RAPS), including regulation of caregivers and harm reducers. Without this appreciation, professionals, often subjected to multiple employment relationships, also get sick and are unable to care for other people. The Fiocruz survey entitled “Invisible Workers” showed how health professionals were left with their own mental health vulnerable during the pandemic: 65% of workers interviewed had symptoms of stress disorder, 61.6% of anxiety and 61.5% of depression.

• Learn more about these and other proposals for Mental Health on the Mais SUS Agenda.

The second step is professional qualification. Once the workers are valued and motivated, then yes, qualification actions can be more efficient. For this step, we propose four strategic approaches:

1. Expand care also for non-specialists and also qualify professionals and other workers in Primary Care health units, with the objective of identifying and welcoming suffering in the daily lives of SUS users;
2. To mental health professionals, with the Psychiatric Reform as the main guideline;
3. To police officers, firefighters and other emergency service workers, such as SAMU and emergency hospitals, advising on an unarmed approach and avoiding unnecessary physical restraint;
4. To public managers, advancing in the understanding of the need to prioritize policies for mental health. The focus of such training should involve an integral, multidisciplinary and intersectoral health perspective, including training advocating the fight against stigma, prejudice, racism and LGBTphobia. For managers, they must additionally include modules on resource allocation, transparency, evaluation and monitoring of public mental health policies.

To promote policies that humanize relationships, it is also necessary to humanize the relationship between public policy and people, valuing their work, recognizing the difference they make in society and the importance they have in the lives of family and friends of people who are suffering or have mental disorder, and also of those who need new social bonds – as is the case of people who have left long psychiatric hospitalizations. When public policies also take care of those who care and guide the expansion of life, Brazilians living longer and better is an inevitable result.

>> For agenda suggestions, partnerships and comments, please contact us at [email protected] and [email protected]. Until the next Mental Health on the Agenda!