Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil

Abstract

OBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41% (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5% of the budget in 1995 and 49% in 2005, and the expenses with community services and medication have increased 15% each. As a whole, the expenses in mental health decreased by 26.7% (2.66 to 1.95 US$ per capita). CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged.

Assessment of Patient, Family and Staff Satisfaction in a Mental Health Service

“…Other Brazilian studies also found moderate or low levels of satisfaction among patients (Camilo et al, 2012;Heckert et al, 2006;Kantorski et al, 2009) and workers concerning this aspect (De Marco et al, 2008;Ishara et al, 2014;Rebouças et al, 2007). These findings may be explained by a lack of public investment in the proper maintenance of these services (Andreoli, Almeida-Filho, Martin, Mateus, & Mari, 2007).…”

Composição das equipes de centros de atenção psicossocial da região Sul do Brasil

“…17,21 Pode-se observar também a carência de profissionais de nível técnico e com qualificação nesta área de saúde mental. Essa realidade foi observada em outros estudos com trabalhadores de saúde [16][17][18]22 e é apontada na literatura nacional e internacional como uma das principais barreiras para a qualidade da atenção em saúde mental. 11,[18][19][20][21][22][23] Quanto à realização de pós-graduação em saúde mental há uma exigência de formação acadêmica específica dos trabalhadores, regulamentada pela Portaria nº 336/GM 2002, que determina a composição mínima das equipes de CAPS.…”

Serviços de emergência psiquiátrica e suas relações com a rede de saúde mental Brasileira

“…58 Among the alternative units proposed within the reform of the Brazilian mental health assistance, 59 a prominent role is occupied by the psychosocial attention centers (CAPS, in the Portuguese acronym). 60 There are few studies assessing the relationship of this service with the mental health network in general 61 and the impact of such centers on PESs is little understood. Notwithstanding, the CAPS III deserves special attention in the context of psychiatric emergency, performing the broader function of managing emergency situations 24 hours a day.…”