Opinion – Saúde em Público: Mental Health: SUS is the remedy to get Brazil out of depression

Have you ever thought if there was a place to serve, free of charge, people in suffering and with mental disorders? Because this already exists in the Unified Health System (SUS) and not just in one place, but in a set of services and attention points of the most varied intended for this purpose: the Psychosocial Care Network (RAPS).

RAPS, which was created in 2011 with the objective of expanding the population’s access to mental health treatments, including people with needs arising from the use of crack, alcohol and other drugs and their families, is this network of services already structured and capillarized approach for mental health care in Brazil. Therefore, if the next governments want to reduce the impacts of the Covid-19 pandemic on the mental health of the population, investing in RAPS is one of the shortest and most efficient paths.

RAPS offers different treatments, guaranteeing the articulation and integration of health services, qualifying care for those who need it most through welcoming, continuous monitoring and attention to emergencies. The Network is composed of several services and actions according to the table below:

Source: More SUS in Evidence – Mental Health

Despite all the existing potential, in recent years the Network has undergone structural changes without the support of a broad, participatory and evidence-based discussion, which generates asymmetries that harm the quality of the service and the focus on people who need this type of service. of attendance. Today it is possible to identify inequalities in access and investment between the services offered by RAPS An example is the increase, without technical foundations and debate, of funding in services that are difficult to monitor, such as Therapeutic Communities, and the encouragement of psychiatric hospitalizations, to the detriment of the investment in more humanized services and practices that make up the Network.

An important step to transform the Brazilian scenario, characterized by the increase in depression and suicide, is to achieve minimum coverage of Psychosocial Care Centers (CAPS). CAPS, in their different modalities, are substitutes for the asylum model, having as a premise the importance of family and community integration in therapeutic processes. They are fundamental to changing the logic that confinement is the best type of treatment and they do it in a decentralized way, located close to our homes and communities.

• Learn more about these and other proposals for Mental Health at More SUS schedule.

We know that mental health care does not only take place through the treatment of individual aspects, but also in the articulation to work on the different social and structural determinants of illness, which involves access to culture, housing and living spaces. Therefore, other services that deserve to be highlighted are the Living and Culture Centers and the Shelter Units. The Community Centers, through the construction of living spaces and support of differences in the community, facilitate the construction of social bonds and the inclusion of people with mental disorders. If government officials and managers want to combat stigma and prejudice and promote citizenship, it is important to prioritize this type of service, making it comparable to the other components of the RAPS – that is, the Executive Power must establish monthly funding and minimum and standardized funding. all over the country.

The same must be done with the Shelter Units, which, in turn, aim to offer voluntary shelter and continuous care for people in situations of social and family vulnerability and who require temporary housing. In a scenario of worsening socioeconomic indices, such as an increase in the homeless population, this type of service is essential to guarantee the minimum necessary for these people. This type of service can also be provided by other facilities, such as social hotels in the city of São Paulo.

States can also articulate to strengthen this network: the success story of state co-financing in Rio de Janeiro

Although the Federal Executive Branch is primarily responsible for investing in mental health, states can also contribute to improving the mental health of Brazilians. This is what the state of Rio de Janeiro has done and the initiative has proved to be a powerful alternative for expanding investments through state co-financing of the RAPS (Cofi-RAPS), a possible result from the approval of a law in 2018. get off the ground, it was determined that the State employ 0.25% of the State Fund to Combat Poverty and Social Inequalities in the area.

In the second year of Cofi-RAPS, the amount transferred was 13 times greater than what was allocated before the Program. In 2021 alone, resources were allocated to 169 Therapeutic Residential Services (SRT), 53 general hospitals with 226 mental health beds and 136 CAPS. In a pandemic context, the transfer to the municipalities was vital to expand and qualify the RAPS in the territories. This is the case of CAPS III Casa Azul, in Mesquita, which now has 24-hour service. The unit, which previously had 14 employees, now has 57 health professionals to serve the population of the municipality in their demands related to mental health.

This is just one example of how it is possible to reverse the illness scenario of Brazilians. The SUS Mental Health Network is there to welcome those who need it most and to act in the prevention of new cases. Without the strengthening of an articulated and capillarized network, such as the RAPS, there is no medicine that cures the suffering and disorders to which we are all exposed.

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