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More than 120 organizations from different sectors have sued the Federal Public Ministry against the ‘revocation’ planned by the government of Jair Bolsonaro in ordinances that structure mental health policy in the country. The entities ask that the Prosecutor’s Office open a civil investigation to investigate what, in the opinion of the group, could cause a setback and the dismantling of the area.
The discussions of the Ministry of Health have already caused a rift among psychiatrists. On Thursday 10, more professionals joined to face the Brazilian Association of Psychiatry (ABP), representative entity of the category that defended the “revocation” under discussion in the government. For psychiatrists, the favorable manifestation of ABP comes from “corporate and marketing interests.”
One of the planned changes is to withdraw psychiatric care for drug users from the Psychosocial Care Centers (Caps). The measure had already been the government’s objective before: in July, Bolsonaro regulated the so-called ‘therapeutic communities’, entities that make the same treatment, but are linked to churches and advocates of abstinence, while the Caps act with the perspective of reduction Of Damage. and they are part of the Unified Health System (SUS).
Another proposal aims to loosen control over involuntary hospitalizations of drug-dependent patients, eliminating the need for communication with the Public Ministry, as is done today.
In a letter sent to the Public Ministry, 128 entities affirm that the measures, if implemented, would represent a dismantling of public policies in the area of mental health and would open a gap due to the lack of government control over patient monitoring.
“The removal of the SUS from the management of ‘reception units’, relegating them exclusively to the Ministry of Citizenship, would open a space for the proliferation of therapeutic communities and private units, financed with public resources, but not subject to control by the area of health regarding the therapeutic plan, presence of a mental health team and internal care procedures ”, they point out.
The Ministry of Health reported that the ordinances that structure the mental health policy are under scrutiny by an integrated working group, in addition to the APB, by representatives of the Ministry of Citizenship, the Federal Council of Medicine (CFM), the National Council of Secretaries. (Conass) and the National Council of Municipal Health Secretaries (Conasems). The folder states that the rules are “obsolete”.
Professionals heard by Status They also fear that the ongoing discussions in the Ministry of Health will lead to measures to weaken the Psychosocial Care Network (RAP) of the Unified Health System (SUS), which follows an integrated, territorialized and flexible model from primary care.
With the word, the Ministry of Health
The Ministry of Health clarifies that, at present, there are more than 100 ordinances related to mental health that establish guidelines for the treatment and care of patients -and their families- with needs related to mental disorders and with pictures of harmful use and psychoactive substance dependence. After a careful analysis by technicians and specialists in the area, it was observed that many of these ordinances are obsolete, which confuses managers and makes it difficult to effectively monitor and consolidate mental health policies.
To make mental health care more accessible and effective, the analysis of negative indicators in this area should be considered, such as the increase in suicide rates in the last 15 years in Brazil, with worsening of self-harm; the increase in homeless people with serious mental disorders; the social isolation of patients with severe mental disorders; the increased mortality of these patients; overcrowding in emergency services; the increase in drug use and chemical dependency in the country; the growth and expansion of cracolândias in the majority of Brazilian cities; and the increase in workers on leave, through Social Security, mainly due to depression and chemical dependency.
In this context, the Ministry of Health established a working group with representatives of the Ministry of Citizenship, the Federal Council of Medicine (CFM), the Brazilian Association of Psychiatry (ABP), the National Council of Secretaries of Health (Conass) and the Advice. National Department of Municipal Health Secretariats (Conasems), in charge of analyzing, discussing, improving, revoking and creating new instruments to guarantee compliance with the new National Mental Health Policy, approved by the Tripartite Interagency Commission (CIT) in December 2017 , by means of CIT Resolution No. 32/201 and MS Ordinance No. 3,588 / 2017.
It is also worth noting that, in the new proposed update, the closure of Psychosocial Care Centers (Caps) and Street Offices is not suggested. As for the Therapeutic Residences, as they are not medical equipment and are intended exclusively for reception and social rehabilitation, their transfer to the Ministry of Citizenship is discussed.
It should also be noted that the Ministry of Health, through tripartite management, promoted a series of actions in the field of mental health during the Covid-19 pandemic, such as: video lessons for health professionals and society, with content provided in the link: https: //coronavirus.saude.gov.br/capacitacao; actions of health education in defense of life, with promotion of suicide prevention and self-mutilation courses in the form of distance education, available on the prevencaoevida.com.br platform; institution of the Steering Committee of the National Policy for the Prevention of Self-mutilation and Suicide; expansion of mental health services in the SUS (Ordinances 2,451 and 2,452, of September 16, 2020); transfer of R $ 650 million to municipalities for the acquisition of essential drugs (Ordinance 2,516, of September 21, 2020); among other.
The following actions are also in preparation: creation of a mental health support telephone service – line 196; development of a training program for service professionals 196; development of a training program for Primary Health Care professionals in psychiatric consultation; and training of medical professionals and nurses from the Mobile Emergency Care Service (Samu) in emergency care for psychiatric patients.
Finally, the Ministry of Health understands that the construction of an essentially safe, effective, comprehensive, humanized mental health care network, with approaches and behaviors based on scientific evidence, and guided by specialists in the health area is a continuous organizational process, which requires constant monitoring and care of public investment.
