Levantamento das políticas e recursos em saúde mental no Brasil

• Ano de defesa: 2009
• Autor(a) principal: Mateus, Mário Dinis [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Reforma da assistencia psiquiátrica; Health care reform; Health policy; Mental health; Evaluation; Brazil; Saúde mental; Avaliação das políticas de saúde; Brasil; Avaliação
• Link de acesso: http://repositorio.unifesp.br/handle/11600/9783

Introduction: A health policy is not an independent technical process, but a compromised negotiation with the choice between conflicting positions that steam from historical, social and economical factors that need to be taken into account in an evaluation process. Objectives: The aim of this paper is to evaluate the mental health policy in use nowadays in Brazil, calling attention to its advantages and disadvantages and how efficient it is in relation to its aims. Methods: We have used the WHO-AIMS, an instrument developed by WHO to systematize the description of resources and processes involved in the health care system. The data sources were extracted from the following sources: governmental data sets, (DATASUS and CNES); interviews with the Mental Health Coordination, the Health Ministry; a questionnaire to qualified informants; in addition to a legislation review, governmental documentation and studies linked to the Brazilian mental health system and the reform of psychiatric attention that took place in the last decades. Results: The Brazilian mental health policy was successful in obtaining social and governmental support to make a reform in mental health care. The advent of the SUS (Unified Health System), which happened at the same time, was fundamental to generate principles and investments to the mental health policy. The system is based in the principle of community care, with action centralized in the Psychosocial Community Centers (CAPS). There was a significant reduction of psychiatric hospital beds, and many long-stay patients have had access to a therapeutic residence program as well as a monthly rehabilitation benefit. Both the integration in the basic attention actions and in the general hospital is too far from what is needed. There is a small number of professionals well trained for the new model and the ideal of multi-professional team that, even though it is less dependent on the psychiatrist figure (a long and expensive formation, almost inexistent away from the great urban centers), it also brings the risk of actions lacking specialized knowledge and low quality care. The information system, essential to guide action planning in mental health, still needs to be improved, for its lack of data in many areas that are strategic to the mental health policy. Conclusion: The data shows that the mental health system reform presented, in the last two decades, intense chances in the psychiatric care model, in financial resources destination, and in the legislative framework. The mental health system in Brazil is based on a hybrid policy that moves in constant tension between different conceptions of psychiatric care reform: the traditional communitarian psychiatry and the one strongly influenced by the Italian psychiatric reform, sometimes generating contradictions and lack of clarity in the mental health policy planning.