42 years ago, when health workers and family members founded the Mental Health Workers Movement (MTSM), one of the greatest health achievements in Brazil began: the anti-asylum struggle that gave rise to the Psychiatric Reform. the creation of the movement 'For a society without asylums', it became clear that the model implemented until then was not the most appropriate. After many denunciations of the violence practiced in asylums, the issue of the commodification of madness, with an extensive private network in assistance and the unpreparedness of professionals, this model began to decline. Almost a decade later, the first Psychosocial Care Center appeared in the country (Caps), in the city of São Paulo. According to the Ministry of Health document 'Psychiatric Reform and Mental Health Policy in Brazil', the intervention process of Hospital Anchieta, in 1989, and the creation of the first Caps were two milestones that 'Psychiatric Reform, not being just rhetoric, it was possible and feasible '.
May 18 appears in this context to make it registered in the calendar that this fight should not be forgotten. The National President of the Brazilian Health Association and one of the founders of the Psychiatric Reform, Paulo Amarante, says that the date appeared in 1987 during the 1st National Meeting of Mental Health Workers, in the city of Bauru, in São Paulo. "The movement started with mental health workers, but then we saw that it was very important to involve society, to take our struggle to other actors, including patients themselves, family members and other actors in social movements, such as of human rights and diversity, which is why it is important to set a special date for this fight. The idea of the asylum started to be reconfigured, not only as a hospice establishment, but also as a set of knowledge and practices that talk about madness, illness , knowledge that is stigmatizing, segregating, etc. ", he recalls.
Advances and setbacks
According to the professor, this struggle is experiencing a new chapter now. Among the setbacks are the privatization of health, including in the area of mental health, with the growing incentive to therapeutic communities, and compulsory hospitalization. On the other hand, researchers and workers in the area recognize that there have also been many advances: over these nearly three decades, investments by the Ministry of Health have changed medicalization to treatment, an example of which is the creation of Psychosocial Care Centers (Caps) , in addition to the change in thinking of the population that currently believes in alternative ways of caring for mentally ill patients.
Professor-researcher at the Polytechnic School of Health Joaquim Venâncio (EPSJV / Fiocruz) Nina Soalheiro also indicates the closure of psychiatric hospital beds as a great achievement. "Brazil had an asylum park stimulated during the period of dictatorship and financed by the State, the so-called stimulus to the madness industry. After many debates and with the approval of the law in 2001 - Law 10.216 / 2001 (Law on Psychiatric Reform) - the substitution of this hospitalocentric model and exclusion by a network of services that is being configured throughout the country is beginning to emerge more strongly ", he explains.
Paulo Amarante also points out how the great mobilization around this theme has been achieved. He recalls that authors like Boaventura de Sousa Santos come to recognize the anti-asylum struggle as one of the largest social movements in Brazil and Latin America. "The most interesting thing of all is that the struggle is a movement, it is not an association or entity. But it has legitimacy and representation in the National Health Council and several state and municipalities. This has created a very large dimension of participation throughout the country. Now, the 18th of May has become small, we have already talked about the week of the anti-asylum fight and we have even called the month of May the month of the anti-asylum fight ", he reflects.
The importance of Caps
With the publication of Ordinance GM No. 3088, of December 23, 2011, the Psychosocial Care Network (RAPS) was created for people suffering mental disorders, crack, alcohol and other drugs under the Unified Health System. health (SUS). The network includes the Psychosocial Care Center, Residential Therapeutic Services (SRT), Community and Culture Centers, Reception Units, comprehensive care beds, in addition to other initiatives, such as the Back to Home program, which offers grants to patients discharged long hospital stays in psychiatric hospitals.
Among these, Caps is considered the main alternative to the model of asylums. They are divided into Caps of types I, II and III, Capsi (for children and adolescents) and Caps ad (alcohol and other drugs), according to the type of care and complexity of the case. Currently, according to data the Ministry of Health, there are 1,981 Caps worldwide national report.
Amarante recognizes that the number of Caps has increased, but considers it still insufficient due to the demand. The Ministry of Health itself shows that 3% of the general population suffers severe and persistent mental disorders, that is, 5.7 million people. Another 12 million have severe psychiatric disorders resulting the use of alcohol and other drugs; and 12% of the population, or about 23 million people, need some mental health care, whether continuous or occasional. "There was a certain disinvestment the State. But it is not private to Mental Health, it is to SUS as a whole. Paradoxically, we are facing a popular government that is taking on more private interests, such as stimulating health plans, philanthropic companies" .
In 2011, the Federal Council of Psychology presented the ‘Report of the 4th National Inspection of Human Rights: places of detention for drug users' in which it shows violations of the most different forms in 68 therapeutic communities in 25 different states. 'There are clear signs of human rights violations in all reports. In a sharp or subtle way, this social practice is based on the trivialization of the rights of interns. Exemplifying the affirmative, we register: interception and violation of correspondence, physical violence, punishment, torture, exposure to situations of humiliation, imposition of creed, demand for clinical tests, such as anti-HIV - a requirement that is unconstitutional -, intimidation, disrespect to guidance sexual, vexing search of family members, violation of privacy, among others, are occurrences registered every ', says the report.
Paulo Amarante recalls that there is a departure the original project of the therapeutic communities. "The term therapeutic community refers to a very important project that emerged in England in the post-war to democratize psychiatric institutions. The military, even, in that vision of reconstructing democracy, wanted, through therapeutic communities, to develop a project to involve those abandoned chronic patients, with no prospect of treatment in daily activities, such as helping to make food, discussing what is bad and what is good, in treatment in general. And this had wonderful therapeutic effects ", he recalls and adds:" At first , the therapeutic community cannot be a closed place, there is violence, it has no rights, that is, everything contrary to what these communities are presenting, and they are related to a health service and are not. often of a religious nature and aimed at profit. Now the news is that everyone has figured out how to get money SUS and this is a new source ", I analyzed am.
Congressman Adriano Diogo (PT / SP), who is president of the Parliamentary Front for Anti-Asylum, defends that therapeutic communities are insane asylums. "Now the government gives this pompous name, but they are nothing more than asylum centers. They continue to use the lock, isolation, and incommunication system. Most are people who use this as a business, to earn money with few and honorable exceptions. . It is a deposit of people ", he says.
The president of the Regional Council of Psychology of Rio de Janeiro, Vivian Fraga, denounces that the State should invest more money in SUS instead of financing this type of treatment. "Religious organizations should not receive subsidies the State. Unfortunately, this practice is not isolated in São Paulo or Rio de Janeiro. We are talking about a directive the Ministry of Health itself and financed, in some states, by the social assistance policy", points.
EPSJV professor Nina Soalheiro recalls that during the military dictatorship there was a resounding growth of private beds and that this phenomenon has now been repeated. "It is evident that Mental Health opted strategically to accredit institutions under pressure the evangelical sectors of Congress and now begins to regulate them. Regarding the incentive to this model, we see this clearly as the recent program instituted by the state São Paulo, which delivers a value to the family and already destines its use. It is a grant that guarantees these clinics a captive clientele. The State then exempts itself responsibility, financing a private sector, which in addition has many problems " , informs, citing the 'Cartão Recomeço' program, which allocates a grant of R $ 1,350 per month to cover the treatment of crack users, but this benefit can only be spent in therapeutic communities associated with the program.