Psychiatric reform and counter-reform: an analysis of a socio-political and sanitary crisis at national and regional level.

Clarice Moreira Portugal,Mônica de Oliveira Nunes,João Mendes de Lima Júnior,Maurice de Torrenté

doi:10.1590/1413-812320182412.25252019

Abstract

This article addresses recent political, legal and welfare changes to mental health policies in Brazil, demonstrating their effects of Psychiatric Counter-Reform. Based on documentary analysis, we explain the tensions generated by this process, with its repercussions for the complex process of Brazilian Psychiatric Reform, particularly for the Psychosocial Healthcare Network. We discuss the paradoxical case of Counter-Counter-Reform, using the state of Bahia as an example because of its recent proposal to close psychiatric hospitals with the announced aim of deinstitutionalizing people who have been hospitalized, which does not coincide with this moment of change in Brazilian mental health policy. We conclude that the risk of the worsening of the sanitary, social and economic crisis in the country requires increased advocacy and mobilization measures, in order to prevent the loss of social protection mechanisms, which also include mental health. This crisis simultaneously poses a threat to human rights and to the inclusion of people in psychological distress, at the same time as it presents an opportunity to reinvigorate a reform that was at the peak of activity.

Highlights

A little-explored fact from the history of mental health was recently analysed by Desviat[1]: in current times, points of paradigmatic inflection addressing madness – usually known as “Psychiatric Reform” (PR) – are intimately connected to eras of crisis on the wider historical and social scene
We will briefly discuss Bahia as a paradoxical case of “Counter-Counter-Reform”, because of a recent proposal from state health managers to close all psychiatric hospitals as part of their stated intention of the deinstitutionalization of hospitalized individuals, which does not coincide with the current political moment in Brazilian mental health
We examined the following official documents, which redefine the Psychosocial Healthcare Network from 2017 onwards, marking a break from Brazilian Psychiatric Reform (BPR)’s purposes: Decree GM/MS 3.5888, Technical Note 11/20199 and Federal Law 13.840/201910

Summary

Introduction

A little-explored fact from the history of mental health was recently analysed by Desviat[1]: in current times, points of paradigmatic inflection addressing madness – usually known as “Psychiatric Reform” (PR) – are intimately connected to eras of crisis on the wider historical and social scene. From an economic perspective, such movements may confront market and private interests linked to the madness industry, which profit from the confinement of individuals, but are connected to the pharmaceutical industry, which in turn profits from the excessive pathologization and medicalization of mental distress Since they have generated a whole gamut of tensions, no PR movement has been seen as a definitive historical victory. We will briefly discuss Bahia as a paradoxical case of “Counter-Counter-Reform”, because of a recent proposal from state health managers to close all psychiatric hospitals as part of their stated intention of the deinstitutionalization of hospitalized individuals, which does not coincide with the current political moment in Brazilian mental health

Methodological considerations

Type of Expenditure

Findings

Final considerations