Healthcare Reform in Brazil

A review of healthcare reform in Brazil as it relates to mental health policy.

Panorama of Brazil

Fifteen years ago, large psychiatric hospitals predominated in Brazil, operating under poor conditions, with serious human rights violations. Today, more than 79% of federal funding for mental health is invested in community-based service networks used by over half of the population diagnosed with mental disorders (Lociks de Araújo 2016). The goal of today’s mental health care reform in Brazil is to have a society free from asylum.

The Mental Health System Reform in Brazil replaced psychiatric hospitals with community-based service networks which promote recovery, social inclusion and human rights. The vicious cycle between mental health and poverty in the region signifies the need for a program like this. In Brazil, Research shows that 13% of disability-adjusted life years (DALYs) are due to mental illness, wherein depression occupies the 4th position overall and 1st among women. (Lociks de Araújo 2016)

"The main goal of the Brazilian Reform is to implement a community-based mental health system that promotes social inclusion and human rights to people with mental disorders" (Lociks de Araújo 2016)

Mental disorders are among the 10 most frequent reasons for inability of people to undertake daily activities in Brazil. Although more than half of Brazilian people diagnosed with depression are public health system users, there is still an unequal distribution of specialized mental health services in Brazil, because the mental healthcare system focuses on the community rather than the individual. Some of the specific reforms being used to tackle these issues are:

• Implementation of therapeutic residences and rehabilitation allowance out of long-stay psychiatric

• Hospitalizations (Going Back Home Program)

•  Integration of primary care, general hospitals and emergency services in psychosocial care networks

• (RAPS) coordinated by psychosocial care centres (CAPS)

•  Technical and financial support for local initiatives aiming at social rehabilitation Job and income generation and social advocacy groups for users.

In the policy brief written by Cinthia Lociks de Araújo, three recommendations were offered to continue to reform mental health policy. The three recommendations were to "Adapt legislation to ensure the respect for rights of people with mental disorders and reorient the mental health system accordingly... Plan the gradual replacement of psychiatric beds for community-based and primary healthcare mental health services... Promote training, technical and financial support to change mental healthcare paradigm" (Lociks de Araújo 2016).

Stigma and discrimination against mental illness affects not only the quality of life of people suffering from these disorders, but also makes it difficult to change the mental health care model. The stigma is challenged throughout this model, by initiatives that raise awareness of the judiciary agents, health professionals and health managers, and promoting advocacy and social rehabilitation initiatives.

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Written by Manisha Satheesh

Citation of relevant articles:

Lociks de Araújo, Cinthia. “Mental Health System Reform in Brazil.” Ministry of Health Brazil, Mhinnovation, Apr. 2016, www.mhinnovation.net/sites/default/files/downloads/innovation/reports/Brazil_Policy%20Brief_Final.pdf.