Opinion – Health in Public: The country’s mental health in the dark

Imagine cooking a dish for the first time, but not knowing what ingredients to use or how to make it. Can you imagine? With the exception of the naturally gifted, it would be hard to get good. This is how most public mental health policies have been conducted in Brazil: in the dark.

Since the last edition of “Mental Health in Data”, more than 7 years have passed since the official publication of transparent and qualified information on the Executive Branch’s mental health policies and programs.

Not only governments, but also managers and researchers are forced to resort to other forms of information in an attempt to implement evidence-based public policies. One of the consequences of this blackout is the disinvestment in the Mental Health Policy, as approved and implemented in the SUS Psychosocial Care Network (RAPS).

To cover part of this gap, the Institute of Studies for Health Policies (IEPS) and the Cactus Institute joined forces to gather relevant information and map what the Executive Power has to offer in the area of ​​Mental Health, at all levels of Attention and also in the strategies of social reintegration – one of the main objectives of the Psychiatric Reform.

Mental Health services could be closer to those in need

Primary Health Care (PHC) is the main gateway to the SUS, that is, where prevention has more space to take place. In it, there are the Family Health Support Centers (NASF) and the Street Clinics. The NASF, one of the most accessible types of services to people in their neighborhoods, have training teams from different areas of knowledge, ensuring a broader and, at the same time, resolute service.

However, in 2017, the revision of the National Primary Care Policy ended the federal funding of the NASF and, consequently, the same happened with the Street Clinics, responsible for expanding access and developing actions for the homeless population – notably a segment of the population that continues to grow.

Lack of information closes services and reduces access to health

In Strategic Psychosocial Care, that is, those services that manage demand and supply, we have as main equipment, Psychosocial Care Centers (CAPS) and Multiprofessional Specialized Care Teams. These are composed of psychiatrists, psychologists, social workers, occupational therapists, speech therapists, nurses and other professionals who work in the treatment of people with mental disorders in outpatient clinics.

On the other hand, CAPS, which can be aimed at children, adolescents, adults or users of alcohol and other drugs, propose to replace the model of hospitalization, that is, incorporating care in the community and encouraging integration with their families and society. . But in 2018, the Ministry of Health disabled 72 CAPS units, alleging the absence of records of procedures in the SUS information systems in these specific services.

Increase the chances of making wrong decisions

In Transitory Residential Care, we have Shelter Units (UA) and Therapeutic Communities (TC). The UAs, which have a CAPS of reference, can serve adults or children and adolescents, with the objective of offering voluntary reception and continuous care for people with needs arising from the use of alcohol and other drugs, in situations of social and family vulnerability. and that require therapeutic and protective follow-up.

The TCs, in turn, are civil society entities that are not necessarily registered as a health service, that do not always have voluntary hospitalizations, and that have already been the target of several complaints of human rights violations – as disclosed in the Report National Inspection in Therapeutic Communities. However, while the UAs received, in 2021, just over R$ 20 million in transfers from the Federal Government, the CTs received, as is known, six times that amount, and recently began to enjoy tax immunity from contributions to social security.

No evaluation, no improvement

Regarding Hospital Care, both Specialized General Hospital Wards, Specialized Psychiatric Hospitals and Day Hospitals have not received inspections from the Executive Branch for 8 years. The last National Program for the Evaluation of Hospital Services (PNASH)/Psychiatry was carried out in the 2012/2014 biennium.

The PNASH is a user satisfaction survey in the Emergency, Outpatient and Inpatient units, which involves, in addition to the application of a technical guide carried out by state and municipal managers in public and private hospitals linked to the SUS, the analysis of the existing structure and the priority processes.

The main goals are no longer a priority

Among the social reintegration strategies, which is one of the main objectives of the Psychiatric Reform, are the Therapeutic Residential Services (SRT), the Return Home Program and the Continued Provision Benefit (BPC). SRTs are housing alternatives for a large number of people who have been hospitalized for many years in psychiatric hospitals because they do not have adequate support in the community.

The Volta para Casa Program guarantees psychosocial rehabilitation assistance to accompany people in these conditions. And the BPC, in turn, is intended for people who have an income of less than a quarter of the minimum wage and are over 65 (or disabled at any age). As with the CAPS, in 2018, 194 SRTs were disabled, and the Federal Government has just revoked, in March 2022, the Monthly Cost Incentive for the RAPS Deinstitutionalization Program and transferred another expansion of investments to the Ministry of Citizenship. in psychiatric hospitals, through a public notice for Civil Society Organizations (CSOs) – including religious organizations.

The recent history of mental health policies in the Executive Branch is confused with a historical lack of information that, in turn, impacts all phases of public policies – from their formulation to evaluation and improvement.

Today, managers, researchers and civil society organizations do not have access to data such as the number of people who are hospitalized in Hospitals of Custody and Psychiatric Treatment, how many TCs receive public funding or how many people were treated at the RAPS and what the outcome was. of clinical cases.

Civil society organizations, with the support of Municipal Health Departments, mobilized to supply some of the missing data and advance this debate, but strategic prioritization is necessary in all spheres in the sense of measuring and evaluating the quality of services, so that we have continuous improvement in the provision of care and in the use of public resources.

The services offered by the SUS for people with mental disorders, when they receive investment to have the RAPS as a care guide and are committed to the protection of the rights of users and families, are a good start to make efficient public mental health policies.

However, when decision-making is not based on evidence, or evidence is rarely produced and disclosed with transparency, the mischaracterization of policies is inevitable and its consequences are real in the daily lives of those who suffer. Producing data and generating information is the beginning and end of this impasse: a basic assumption to guarantee care and a light at the end of the tunnel for mental health policies.

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