Mental Health Policy In Brazil Research Articles

The historical fight for the right to care: A critique of the Mental Health Policy in Brazil

This article critiques the Mental Health Policy in Brazil with emphasis on the history of struggle for the right of people who have mental disorders and against violence in psychiatric institutions. The article is divided twofold; firstly, addressing exclusion, violence and exercise of citizenship, highlighting the Psychiatric Reform Movement in Brazil from 1970; secondly, contextualising the Ximenes Case with the hospital-centred model in Brazil, bringing information about the National Inspection Report in Psychiatric Hospitals. The legal framework against torture about the deprivation of liberty of people considered ‘mentally ill’ and the social division between desirable and undesirable as a characteristic of this reality. It contextualises the Mental Health Policy and the ongoing counter-reform in the Brazilian Scenario by presenting an item about the Bolsonaro Government and the attacks on Brazilian Mental Health Policy. It is pointed out in the final considerations that torture materialises in the counter-reform underway through the ‘New Mental Health Policy of Brazil’, which masks a new form of torture and suffering exposed by the structuring inequalities of capitalist society. As for the processes of resistance, the fundamental defense of community and participatory policies is pointed out in the face of challenges and complaints against human rights in institutions and logic in the Brazilian government.

Reflexões baseadas no Tidal Model sobre no conceito de psicose

To reflect on the concept of psychosis using the Tidal Model framework. Reflective study developed from the bookEl modelo Tidal: salud mental, reivindicación y recuperación by Phil Barker and Poppy Buchanan-Barker and other texts. The reflection was organized into three axes of discussion: "The Tidal Model", "The metaphor, psychosis and the domain of the self" and "The Tidal Model, nonlinearity and psychosis: synergisms with the Brazilian mental health policy". The Tidal Model encompasses the concept of psychosis, in addition to being synergistic with aspects of psychiatric reform and mental health policies in Brazil. The limitations of the study are the fact that it only presents initial and general approximations about the relationship between the concept of psychosis and the Tidal Model, and it is necessary to deepen this knowledge in the specific context of care practice.

“Pay attention when turning a corner”: an overview of mental health policies in Brazil

Introduction: Brazilian’s history of psychiatric care is complex and has some dark periods, but the country managed to get international recognition for its mental health policies in the last years. Those have been currently suffering setbacks.
 Purpose: Review the historical context of mental health in Brazil, assessing the changes made after 2016, and carry out a critical analysis of the current inclination.
 Methodology: literature and narrative review using official governmental documents.
 Results and Discussion: Through its history, Brazil’s had ups and downs in the care of mental health patients. After almost 30 years of policies that are centered around the individual, and not only the individual’s disease, the hospitalocentric model of care has been subtly making its comeback, together with normatives that revogue rights before acquired and corroborates with segregation of the mentally ill.
 Conclusions: The current changes in the Mental Health politics are not walking alongside the line with movements responsible for the implementation of a biopsychosocial care. It provokes and invites us to continue fighting for fair health programs and for the continuation of the Universal Health System

Organization of mental health services to face COVID-19 in Brazil

Abstract Issue/problem Covid-19 pandemic requires rapid responses. The reconfiguration of the psychosocial care network was needed to ensure access to all patients during this period. Description of the problem Psychosocial Care Centers (PCC) are strategic equipment for strengthening the mental health policy in Brazil. These services work with a multi and interdisciplinary team, aiming to assist crisis and rehabilitation processes of people with severe and persistent mental disorders or those with impairments due to the use of psychoactive substances. This work shares the experience of two PCC over the COVID-19 pandemic in São Paulo, Brazil. In April 2020, in front of the increasing Covid-19 cases and hospitalization, lack of hospital beds for mental health care, suspension of PCC group activities, and restriction of face-to-face assistance, it was necessary to adjust the PCC work process and physical structure. Results Telemedicine was implemented to assure assistance and monitoring. An internal flow was implemented to identify and assess patients seeking the service with respiratory symptoms and proceed with case notification if confirmed. A station for respiratory symptoms screening was settled outside the PCC, an isolation room to symptomatic respiratory patients was defined to medical assessment, and referral criteria to the emergency care established. To reinforce beds for hospitals in the region, inpatient beds were created in the PCC to attend hospitalization of acute crisis cases. Further, professionals from Primary Health Care were relocated and trained to support PCC assistance. Lessons This experience reaffirms the role of PCC as an articulator of the psychosocial network. Reorganization of PCC work process enabled the continuity of mental health outpatient care as well as rearguard from inpatient beds. Key messages The COVID-19 pandemic reinforce the necessity of integrated healthcare networks to provide care access and continuity of care. This experience reaffirms the role of PCC as an articulator of the psychosocial network.

Critical review: From neglect to a new look: the construction of the National Policy of Integral Attention to Users of Alcohol and Other Drugs as a conquest of the Brazilian Psychiatric Reform. The case of Recife (PE)

This work is based on secondary sources such as the conquest of the Brazilian Psychiatric Reform. It is an exploratory study, with the objective of briefly examining the structuring and transformations of mental health policies in Brazil. On the other hand, it seeks to highlight fragments in the enunciation mechanisms that strengthen services aimed at caring for people in psychic suffering. In conclusion, the analysis shows that, in some people, society shows different behavior patterns and norms, and they react differently to the problem in question. And that mental illness is now considered a social degeneration. And in this sense, we emphasize the necessary care to the carriers of this disease, as well as the importance of a quality nursing care. And this aspect, is emphasized in some congresses and seminars held for a social education, mainly in the aspect of education and awareness of drug use. And reinforced the construction of the National Policy of Integral Attention to Users of Alcohol and Other Drugs as a conquest of the Brazilian Psychiatric Reform. The case of Recife (PE).

From "mentally ill" to "citizens": historical analysis of the construction of political categories in mental health in Brazil.

Public policies are based on categories that have a double effect: build eligibility for rights and generate symbolic effects, reproducing or fighting social stigmas. This article aims to analyze the historical setup of categories targeted in mental health policies in Brazil. Based in a study of the legislation from 1841 to 2017, we observed how was the processes of constructing the political categories of mental health - passing from users to citizens or mentally ill. The processes of control of public policies were selected for the respect of users of mental health policy, the social framework of data and the criteria for access to policies and the construction of social stigmas. The analysis shows important changes in these categories over time that tried to remove stigmas based on new conceptions proposed by social movements of mental health, international policies and social changes, such as Brazilian re-democratization. However, we also highlight the difficulty of effectively coping with stigmas due to the lack of consensus in the field itself, resistance to changes in social categories, family members and health professionals.

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

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.

Política psiquiátrica e agência religiosa: notas sobre caixas-pretas, o lúdico e a noção de in(ter)venção em saúde mental

Este artigo reflete sobre complexidades e caixas-pretas como Bruno Latour elaborou, aqui para as políticas de saúde mental no Brasil. Caixas-pretas são ‘máquinas’ que não se consegue destrinchar, panaceia de complexidades. O que abordo é uma caixa-preta dos estudos, e como decorrência, da intervenção, em saúde mental. Discuto a (des)articulação deletéria entre atitude e conduta a partir de um olhar semantizado pelas noções de práxis psiquiátrica, práxis terapêutica e agência religiosa. O ponto de partida digamos explorativo da reflexão é considerar que há nesta (des)articulação um regime estabelecido por inconsistências empíricas e epistemológicas, condicionado pelo jogo que chamei in(ter)venção, partindo da contribuição de Roy Wagner, e para considerar que intervenção e invenção são dispositivos articulados e inseparáveis.

Mental health policy in Brazil: what's at stake in the changes currently under way.

Mental health policy in Brazil: what's at stake in the changes currently under way.

Biolegitimacy, rights and social policies: New biopolitical regimes in mental healthcare in Brazil

This paper discuss biolegitimacy as an instrument and device for the production of rights, recognition and access to services and care from the state, as a means to demand and conquer rights and as an expression of a new biopolitical regime. Biolegitimacy is articulated with a broader context of political shift, with an emphasis on the processes of pathologization, medicalization or biologization of social experiences, particularly concerning the production of public policies and actions of the state in the field of rights and citizenship. Despite the breadth of the issues that can be addressed through this concept in its formulation by Didier Fassin, the focus of this article is mental health policies in Brazil in the context of Brazil's Psychiatric Reform program, particularly those policies aimed at women. If on one hand the Psychiatric Reform is based on the principles of the human rights of the ill and of psychiatric patients, and on the democratization and universalization of access to healthcare, on the other hand, in various aspects these same policies reproduce the device of biolegitimacy. The focus is the notion of the "life-cycle" of women, a principle widely used in the documents and guidelines mainly in those specifically aimed at women's health.

Política Social, Estado e Sociedade: Reflexões sobre a Política de Saúde Mental

This article intends to develop a historical, theoretical and critical debate about mental health, as a social policy, resulting from the dialectical relationship between state and civil society. The adopted methodology is qualitative, consisting on a bibliographical and reflexive review, through which it aims to evaluate positions of various authors on the subject. A discussion of the historical development of the Mental Health policy in Brazil was made, emphasizing the presence of various social movements, such as the Workers in Mental Health Movement, the Sanitary Reform Movement, the Psychiatric Reform Movement and the Anti-Asylum Movement. Therefore, it is verified that society has great ability to fight for effective social policies, in order to mitigate the destructive effects of capitalism. It is concluded that, although social policy is incapable of overcoming the social order, it includes significant changes to the recognition and assurance of rights to the people deprived of wealth and power in society.

The prevalence of medical/clinical technology over psychosocial care actions in outpatient mental health services

The scope of this study was to evaluate how aspects of mental health policy in Brazil have been conceived and implemented in outpatient services, such as the Regional Outpatient Mental Health Clinic and the Psychosocial Care Center II, both in Ribeirão Preto, São Paulo. Semi-direct interviews and focus groups were conducted with 22 health professionals. The theoretical method and data analysis were supported by the dialectical hermeneutic framework of Jürgen Habermas. The following aspects were detected: considerable technological advancement in health actions and centrality of clinical-medical technology in relation to other nonmedical therapeutic actions; the prioritization of treatment options emphasizing pathology and drug therapy, and a process of mounting precariousness in labor relations. With respect to psychosocial rehabilitation, analysis revealed that instrumental and technically-oriented treatment is imposed upon the practical and dialogical rationale proposed by Brazilian Psychiatric Reform. As an alternative, participatory evaluative research is required in order to unify clinical and psychosocial rehabilitation actions in therapeutic projects, while establishing mechanisms to promote the improvement of care based on the psychosocial care model.

The social adjustment of people with severe mental illness in São Paulo, Brazil

To investigate the social adjustment of individuals with severe mental illness living in the community in a large urban center of a developing country, and the characteristics associated with poor social functioning. A cross-sectional study was performed in the city of Sao Paulo. Eligible subjects were residents of a defined geographic area, aged between 18 and 65, with a diagnosis of functional psychosis who had had contact with any public psychiatric service during a defined period. Structured assessments were used to obtain information on social-demographic characteristics, diagnosis (ICD-10), psychiatric symptoms (PANSS), and social adjustment (DAS). One hundred and eighty-eight subjects were included, of whom, 120 (63.8%) had some degree of impairment in social functioning. The most frequently affected areas of social functioning were work performance and sexual role. Twenty-four patients (12.8%) showed poor or very poor social adjustment in the month prior to the interview. Negative symptoms, number of previous admissions and general symptoms showed statistically significant associations with global social adjustment scores. The proportion of patients showing any degree of impairment in social adjustment was as high as in more developed societies. In order to successfully implement the new mental health policy in Brazil, better provision of community-based mental health services for those with severe mental illnesses is needed.

The social adjustment of patients with schizophrenia: implications to the mental health policy in Brazil.

A sample (n = 124) of schizophrenic patients from a defined catchment area of the city os S. Paulo, Brazil, who had been consecutively admitted to hospital, was assessed for psychopathological status and social adjustment levels. Sociodemographic, socio-economic and occupational characteristics were recorded: almost 30% of the subjects had no occupation and received no social benefit, more than two-thirds had a monthly per capita income of US$ 100.00 or less. Sixty-five percent presented with Schneiderian first rank symptoms. Nearly half the sample showed poor or very poor social adjustment in the month prior to admission. The most affected areas of social functioning were participation in the household activities, work and social withdrawal. The current mental health policy of promoting extra-mural care as an alternative to the previous hospital-based model will then mean the investment in a network of new community-based services, that give effective treatment and support to patients and their families. The need of further research into the current picture of mental disorders in the country is stressed.