DENVER, Colorado — Brazil is one of the leading countries in prevalence rates of depressive and anxiety disorders, two common yet debilitating psychiatric illnesses. In 2016, depressive and anxiety disorders in Brazil were the fifth and sixth causes for years of life lost and years lived with disability. Two decades ago, Brazil began to address the prevalence of mental health disorders and the needs of the government to enact mental health reform in Brazil. The transformation of the mental healthcare system focused on promoting the protection, social inclusivity and civil rights for those affected by mental disorders in Brazil.
Studies have found that having a mental health disorder increases the chance of experiencing poverty. In 2019, Brazil was listed as one of the poorest countries in the world. In fact, nearly 20% of the population was living on less than $5.50 a day. The strong, cyclical relationship between poverty and mental illness negatively affects well-being, physical health, employment opportunities, access to quality healthcare and more.
Brief History of Mental Health Policies in Brazil
In the 1970s, Brazil began shifting from using Brazilian psychiatric hospitals to community-based, therapeutic services. In 1988, the Public Health System developed health policies that would guarantee free, universal healthcare access to all Brazilians. Between 1991 and 2001, deinstitutionalization procedures focused on the humanization of those with mental disorders. These procedures funded new services, managed hospitalizations and increased access to and expanded outpatient services. The movement and policies prompted an official mental health reform in Brazil, followed by the Mental Health Policy and adoption of Law 10.216. These legislations guaranteed:
- The protection and rights of those with mental disorders.
- The deviation of psychiatric hospitals as primary and exclusive modes for mental disorder treatment.
- The optimization of access, quality, and effectiveness of treatments.
The Current Mental Health Network
Mental health reform in Brazil changed from ostracizing institutions to social support programs that aim to provide independence and empowerment. Brazil’s aforementioned Mental Health policy is sustained through a plethora of services and facilities. Some of thes services include Psychosocial Community Centers (CAPS), the Return Home Program and the Family Health Strategy (FHS).
CAPS are teams that provide clinical and psychosocial treatment for those with acute or persevering mental disorders. Focusing on individualized strategies for strengthening a support network, the centers provide daily care, limited hospitalization and social rehabilitation. In 2012, there were a total of 1,742 available at Psychosocial Care Centers in Brazil.
Brazil enacted the Return Home Program in 2003 under the Luiz Inacio Lula Da Silva administration. It aims to liberate and “increase social inclusion” for those with mental disorders. It also promotes deinstitutionalization strategies and decreases psychiatric beds in Brazil. The program also uses a monthly rehabilitation benefit for those with a history of psychiatric hospitalization so patients can be financially independent post-treatment. The program has benefited at least 3,000 individuals as of 2016.
The Family Health Strategy (FHS) consists of trained medical teams that provide care to particular geographic regions. FHS aims to improve mental health, aid individuals with a history of mental illness and introduce coping skills to mitigate drug withdrawals.
Challenges of the Reform
Over the past decade, hundreds of new programs have strengthened mental health reform in Brazil. However, the prevailing stigma around mental health, disproportionate distribution of resources, a lack of expenditure on the health budget and infrequent training are still prevalent challenges. Discrimination and mystification still impact those suffering from mental disorders. They impede complete liberation from institutionalization ideologies. As mental health reform continues, a further deconstruction of historic notions around mental health will allow for the targeted inclusivity and respect and rights for all.
CAPS have become a fundamental service for mental health reform in Brazil, yet only 0.9 exist per 200,000 inhabitants. Furthermore, there is a lack of center availability in poorer areas. This inadequate and unequal distribution of centers can lead to disparity in access and accurate reporting of genuine benefits. In 2016, the Brazilian government spent roughly 2.4% of the total health budget on mental health. That’s nearly 50% less than the WHO suggests.
A cohesive training program for primary care teams to understand the elaborate nature of the human psyche would allow for continued separation from traditional psychiatric beliefs. Formalized training programs focusing on early detection and mental health screening would permit primary care staff to manage mild cases. This would improve the overall quality of care. This methodology is utilized in Chile and Panama. It has resulted in an increase in patients receiving mental health treatment and a decrease in psychiatric inpatient beds.
A Continued Effort
The radical new services, programs and interventions from mental health reform in Brazil increase access to care and promote human rights for people with mental disorders. Despite the challenges of deinstitutionalization and increasing community-based services, between 2002 and 2015 CAPS tripled its coverage. In addition, the use of psychiatric hospital beds decreased, and federal funding for community-based mental healthcare doubled.
The high prevalence of mental disorders in Brazil can have detrimental economic and social impacts: health impairments, violence, homelessness and poverty, unemployment and drug use. Therefore, leveraging the effects of mental health reform in Brazil is imperative for the well-being of individuals and society. Sufficiently funded models, adequately trained teams and continued expansion of community services that prioritize liberation, social inclusion and empowerment will fortify maximized outcomes for mental health in Brazil.
– Violet Chazkel