Opinion – Saúde em Público: Without a commitment to Mental Health in the SUS, the country will continue to worsen post-pandemic indicators

Election 2022 is approaching. With this, candidates and candidates have the duty to present proposals to the challenges that our population lives daily, aggravated by a cruel pandemic and the mismanagement of social interventions and public policies in the last period, which revealed even more inequalities and aggravated the shocks to the mental health of Brazilians and Brazilians.

The pandemic has brought with it an increase in unemployment levels, a drop in income, mourning, an increase in poverty and hunger, among other risk factors for mental health. In the world, cases of anxiety and depression grew by more than 25% in the pandemic and in Brazil, between the pre-pandemic period and the 1st quarter of 2022, there was a 41% increase in the medical diagnosis of depression – surpassing diseases such as diabetes. These consequences can be worse for people who have weaknesses in socio-affective networks, job instability and financial difficulties, or even for those who do not have an adequate place to stay in social distance.

The third diagnosis of the Mais SUS Agenda, released today (09/09) and focused on mental health policies, points out the bottlenecks and ways to solve the sector’s current problems. Despite so many difficulties and the need to expand support in mental health, the document shows that there is a lack of attention towards especially vulnerable populations. With regard to the Consultório na Rua, for example, a policy aimed at the access of the homeless population to health services, the data that IEPS and Cactus obtained through the Access to Information Law (Law nº 12.527/2011), indicate that there was a drop in investment for this policy. In 2019, the investment was BRL 580,470.

Shortly after, in 2021, the Ministry of Health’s investment in the area dropped to R$ 490,436, even with the number of homeless people having grown at a worrying rate in Brazil: according to an estimate by the Institute of Applied Economic Research (IPEA), the homeless population more than doubled between 2017 and 2020, from 101 thousand to 222 thousand people, that is, it doubled.

In addition, today in the country we are experiencing a serious process of disfigurement and underfunding of central services of the National Mental Health Policy and the Psychosocial Care Network (RAPS), especially since 2017. Since then, a series of policies have been modified or revoked, without broad public debate and without the endorsement of social control in Health, which violates the SUS legislation. At the same time, many private institutions that act as psychiatric hospitals, and that prioritize the isolation of people, have been having more public investments, via public-private partnerships. In 2022, for example, the Ministry of Citizenship published Public Call Notice nº 03/2022, which finances with R$10 million Civil Society Organizations that act as psychiatric hospitals. In other words, it is taking away from equipment based on territorial and community care from the SUS to invest in “psychiatric NGOs” that do not even have an adequate model for implementing and/or monitoring their actions.

Widely and equally distributed in the territory, we need healthy and valued professionals, who are able to fully absorb the mental health demand and have a careful look at suffering, with emphasis on Primary Care professionals, who often exercise the gateway role for services. When we talk about mental health, it’s not just about training psychologists and psychiatrists, but all professionals who interact with people in distress or with mental disorders. In addition, valuing professionals and caring for their mental health is the first step to ensure that workers are welcoming and capable of dealing with the mental health of others.

To guide policy planning through robust evidence, improving decision-making and resource allocation in the area, we also need to ensure the existence of consistent, updated and publicized data on the subject. Through these, it is possible to have visibility of the impacts achieved, allowing to separate the actions that promote the reduction of the violation of human rights and greater quality in care and services, from those that negatively impact the mental health of Brazilians.

Transforming this scenario will only be possible with the reinforcement of RAPS, investment in services in the territory, debureaucratization to open equipment and strengthening points of care in the face of a growing demand for mental health in our times. Mental Health Policy cannot just be about putting out fires, there must be continuity to build a healthy and prosperous society, which also looks at disease prevention and health promotion. This is what the eligible should keep in mind for their government plans.

In view of this, IEPS, Umane and Cactus defend possible directions that can strengthen Brazilian public health: 1) Generate information and encourage the monitoring and inspection of public mental health policies; 2) Improve RAPS; 3) Promote policies for training and valuing mental health professionals; and 4) Resume and advance the Psychiatric Reform. These and other important information to reverse this scenario are available in the Diagnosis on Mental Health in Brazil, which is part of the More SUS Agenda: Paths and Evidences to Strengthen Public Health in Brazil.