Opinion – Saúde em Público: People are meant to fly, not to die in the asylum

Today, May 18, the National Anti-Asylum Struggle Day is celebrated in Brazil. Its origin dates back to the Congress of Workers of Mental Health Services, held in 1987, in the city of Bauru, in the interior of São Paulo. Marked by the iconic “Letter from Bauru”, the meeting ended up founding the Brazilian anti-asylum movement, which would contribute to the process of redemocratization and the creation of the Unified Health System (SUS).

In the last 30 years, the national mental health policy has undergone transformations guided by the psychiatric reform that began with the mobilization of anti-asylum movements that increasingly began to integrate people with a long history of hospitalizations. They are the protagonists of this revolution, whose horizon is to remove Brazil from the barbarism perpetuated by the asylum institutions that maintained and maintain concentration camps for more than 200 years.

In these spaces a multitude of people survive, disappear and die deprived of what makes human beings part of humanity: freedom. As Chico Science sang: “They are demons who destroy the wild power of humanity”. Brazilian society urgently needs to face its demons. It’s no use repressing – the way we treat the so-called “crazy” comes to the fore and defines us as a society.

After more than three decades of the “Letter from Bauru”, the anti-asylum legacy is threatened. The pace of destruction has accelerated dramatically since 2019. In the first half of 2022, acts of the federal government dismantled, through an ordinance, virtually all legal provisions for the cost of deinstitutionalization programs, in addition to determining a new millionaire transfer to hospitals psychiatric.

Provided for by Law nº 10.216/01 – or “Psychiatric Reform Law” -, of 2001, deinstitutionalization consists of an obligation of the State, which, through existing equipment in the Unified Health System (SUS), must insert socially, in full, all people who were deprived of their liberty by internment in psychiatric hospitals and in judicial asylums.

The fact that recent governmental acts have been imposed by means of an ordinance without popular consultation or broad discussion with social control bodies demonstrates, once again, the total disconnection of the federal government in relation to the democratic principles of SUS and the national policy of mental health.

The duty of deinstitutionalization is supported not only by domestic legislation, but also by international law. Brazil was even convicted by the Inter-American Court of Human Rights (IACHR) in the “Case Ximenes Lopes X Brazil”, in 2006, this being the first Brazilian conviction in the IACHR and the first precedent in the Court regarding the violation of human rights in the field of mental health.

The judgment in the case recognized the practice of serious human rights violations in the case of torture and death of the young Damião Ximenes Lopes in 1999. As is notable, despite the postulated recommendations, which include the progressive replacement of asylums by deinstitutionalization programs, the State has shied away from fulfilling them.

The arbitrary character of the decisions converges with the corporate interests of hospital owners to the detriment of investment in SUS and RAPS, precisely at a time when the mental suffering of the population indicates that it has been strongly aggravated by the economic, social and pandemic crisis.

As if the dismantling and public support of obscure institutions were not enough, we are experiencing a blackout of data on public mental health policies in Brazil. Since 2015, the Ministry of Health has refused to continue the publication of Mental Health in Data, violating one of the basic principles of public administration, transparency.

Public health social problems have an intersectoral character. However, the Bolsonaro government has repeatedly transferred – especially with regard to the reception of people who make problematic use of alcohol and other drugs – to the moral-repressive field, including opening the way for public funding of groups of religious fundamentalists.

Historically, the so-called social organizations and therapeutic communities (TCs) have conflicts of interest with deinstitutionalization, as they benefit from the expansion of hospitalization vacancies. According to the Mental Health Panel: 20 years of Law 10.216/01, an unprecedented balance of the last 20 years, produced by the non-profit organization Desinstitute, in 2021, the Ministry of Health increased funding for hospitalizations in these institutions by 60% in 2017.

As has been presented by the press, the TCs are the target of denunciations of systematic practices of torture, ill-treatment, violations of religious freedom and work analogous to slavery in their facilities, kept outside social control. With an aggravation: some of these institutions shelter teenagers.

The bleak scenario isn’t just in the TCs. Data from the last national inspection of psychiatric hospitals, coordinated in 2018 by the National Mechanism for the Prevention and Combat of Torture (MNPCT) and other control bodies, show that more than half of these institutions did not have a health permit to operate and at least 42% offered food. inappropriate. In 77%, the unjustified and recurrent use of mechanical restraint was identified.

From my own experience, I can categorically state that asylums are not in the past. In 2011, in the middle of the 21st century, the Sorocaba Anti-Asylum Fight Forum (Flamas) denounced a real massacre continuously perpetrated by a private network of hospitals in the then largest asylum center in Latin America, in Sorocaba-SP, which recorded the frightening number of one death every three days.

In place of asylums, the political agents that give life to the principles of the Psychiatric Reform build an interdisciplinary network of services that offers care in freedom for people in psychological distress or with a history of problematic use of alcohol and other drugs. Among the consolidated public policies, the therapeutic residences are one of the most successful experiences and in line with the preservation of human dignity.

In this sense, Desinstitute launches, this May, a document on deinstitutionalization in Brazil. the publication DEINSTITUTIONALIZATION – From leaving the asylum to living in the city: management and care strategies focuses on municipal and state managers, in addition to the Justice System. The intention elaborated in the document is to present a series of deinstitutionalization experiences that can serve as inspiration for those who wish to put care in freedom into practice.

On this Anti-Asylum Struggle Day, once again, users of substitutive services absolutely refuse to return to asylums. Once freedom is established, it imposes its truth: the human being was born to fly and to desire. So the cages that take over bodies and colonize minds must be broken.

Given the facts and arguments, it is up to civil society organizations, anti-asylum movements and society as a whole to denounce and firmly face the setbacks imposed and prevent those that are still being engineered. Returning to the history of the last decades in Brazil, it seems evident that we live under categorical attacks on the principles and achievements that, more than fundamental, are decisive for the very existence of the Democratic State of Law.