The Ministry of Health revoked, through Ordinance 596, of March 22, the Deinstitutionalization Program for the social reintegration of people with mental health problems resulting from the use of alcohol and other drugs who have been hospitalized in psychiatric hospitals for more than one year. year. The ordinance also revoked the program’s financing mechanism.
A week later, the Ministry of Citizenship launched a public notice (3/2022) for funding psychiatric hospital projects, those that the Deinstitutionalization Program intended to restrict to the minimum necessary. The incentives total R$ 10 million.
The sequence of measures provoked a strong reaction from civil society organizations linked to health policies and the anti-asylum struggle.
Responsible for the implementation of psychiatric reform in the country, Law 10,216, of 2001, reoriented the national mental health policy and reiterated both that people with psychiatric disorders have rights and that their social reintegration needs to take place in the territory, and not in isolation.
At the same time, psychiatrists sympathetic to the measures point out that the deinstitutionalization program was expensive and that its task was already being carried out by Caps (Psychosocial Care Centers) and by the psychiatric hospitals themselves. Some question the hiring of hospital services through social organizations and outside the Health portfolio.
The case ended up in the Senate Human Rights Commission, with a public hearing scheduled for this Monday (18). “The cut followed by resources for the structuring of the psychosocial care network and the change of line in the Ministry of Health are a way back to the past”, said the president of the commission, Senator Humberto Costa (PT-PE).
The Deinstitutionalization Program was created in 2017 as part of the Raps (Psychosocial Support Network), of the SUS (Unified Health System), to promote the autonomy and exercise of citizenship of people with mental disorders through their progressive social inclusion. .
The Ministry of Health says, by means of a note, that the program was extinguished due to “lack of adhesion” of the municipalities. To the report, the folder did not present, however, data on this justification.
Health claims to maintain “all efforts to expand access to mental health services in the SUS for patients leaving long-term psychiatric hospitalizations”, with emphasis on the Therapeutic Residential Service (SRT).
Data obtained by the Institute of Studies for Health Policies (Ieps) via the Access to Information Law indicate that today 6,000 people live in these therapeutic residences, to which those who left psychiatric hospitals through the extinct program are referred. The Ministry has not published data on mental health in the country since 2015.
The Ministry of Citizenship, also in a note, says that the public call aims to select “a civil society organization that provides care as a psychiatric hospital” and that “has as its object the execution of care, treatment and/or reintegration projects in a hospital environment”.
The note also argues that Citizenship has “competence for care actions for people with chemical dependence, including those who have comorbidities with mental disorders”, a competence that is questioned by organizations in the health field.
The text also states that the provision of treatment for those who “need care in a protected regime is a central theme of the National Policy on Drugs”. Entities in the field of drug policy have long denounced the federal government’s investment in therapeutic communities, religious entities that offer labor therapy and spirituality.
In a joint statement, the Brazilian Drug Policy Platform, the Brazilian Mental Health Association and the Black Initiative for a New Drug Policy pointed out that funding for health services outside the SUS “constitutes dangers for inspection, discussion and deliberation” which may jeopardize “human rights and the well-being of the people to be served”.
“In practice, to disinvest in the Deinstitutionalization Program and invest in psychiatric hospitals is to change treatment in freedom for treatment in confinement”, says Rebeca Freitas, Coordinator of advocacy and government relations at Ieps.
“We are putting the pieces together because the public notice [da Cidadania] aims to achieve social reintegration. But how can we talk about social reintegration if what is resumed is the logic of treatment in isolation?”, evaluates Dayana Rosa, public policy researcher at Ieps. “Confining makes social reintegration unfeasible.”
“It is a consensus in the scientific literature that community-based treatment is very effective and long-term hospitalizations not only have no positive effects but also violate human rights”, points out psychiatrist Nicola Worcman, director of scientific affairs at the NGO Desinstitute.
“The ordinance revokes a process supported by law 10,216, the WHO and international human rights law,” she argues. “They are passing the herd, as ex-minister Ricardo Salles would say, in the field of mental health.”
It is not the first time that the government of Jair Bolsonaro (PL) has taken measures against deinstitutionalization programs. The management also defends the therapeutic communities, for which the transfer of funds has doubled from 2019 to 2020,
In December 2020, the federal government tried to revoke several ordinances in the field of mental health to end the De Volta para Casa program, for the social reintegration of people with mental disorders, and reduce the attributions of Caps (Psychosocial Care Centers). These structures are the basis of Brazilian mental health policy.
The changes that the government of Jair Bolsonaro (PL) is now promoting, via public notice and ordinance, took place without public debate, not even with Conass (National Council of Health Secretaries).
Conass, through a note, stated that the Citizenship notice is “a mistake, as it disrespects Brazilian legislation when trying to create health services outside the Unified Health System (SUS) and represents a violation of the National Mental Health Policy” .
“Conass understands that the aforementioned public notice must be immediately canceled and that the discussion on mental health returns to the management bodies established in the SUS.”
“It’s the return of the madness industry,” says sociologist Paulo Delgado, author of the 2001 psychiatric reform law.
For him, although hospitalizations are necessary in some cases, the ordinance and the public notice attract “psychiatric entrepreneurs”. “By putting more resources into the closed system than into the open one, the government is offering a path to hospitalization in a country that has chosen the opposite path. It is a submission by the Ministry of Health to the drug industry and the madness industry.”
Psychiatrist Gilberto Alves, a professor at the Federal University of Maranhão (UFMA), believes that the current mental health policy model is “well organized and structured”, with residential care structures and street clinics, but “needs to be improved according to data epidemiological”. Furthermore, he points out, “the model doesn’t work in poorer states because it’s expensive and complex.”
Regarding the Citizenship notice, the specialist, who is the residency coordinator at the largest psychiatric hospital in the capital of Maranhão, assesses that care via social organization “is worrying because they are entities with a lot of political influence and where health professionals have very little autonomy”, in general because they work in an outsourced regime.
For Alves, the anti-asylum movement, by attacking medical and hospital mental health services as “stuck possibilities for modernization of care”.
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