Psychiatric care in Brazil and the need for a balanced model
DOI:
https://doi.org/10.25118/2763-9037.2025.v15.1442Keywords:
mental disorders, deinstitutionalization, psychosocial care centers, public health policy, psychiatric hospital care, mental health services, PCCAbstract
The Mental Health in Data report, 13th Edition, published by the Ministry of Health in February 2025, reaffirms the continuation of Brazil's anti-asylum policy, prioritizing deinstitutionalization and community-based care. The expansion of CAPS and the RAPS is highlighted as progress, but the report ignores scientific evidence demonstrating that this model is insufficient for treating patients with severe and persistent mental disorders. The drastic reduction in psychiatric beds and the increase in mortality among these patients highlight the ineffectiveness of a policy driven more by ideology than by robust medical evidence. Additionally, the closure of psychiatric hospitals without adequate alternatives leads to the phenomenon of transinstitutionalization or invisiblereinstitutionalization, where patients are transferred to prisons, streets, and overcrowded emergency rooms. Studies show that the lack of adequate psychiatric care is linked to increased suicide rates and untreated chronic diseases, especially among individuals with schizophrenia and bipolar disorder. The report emphasizes the ongoing education of mental health professionals but provides no updated data on the density of psychiatrists in Brazil. The financing for mental health remains insufficient, with allocations representing a tiny fraction of what is necessary. The diminishing role of psychiatry within mental health policy and the lack of proper medical support negatively impact the quality of care. A revision of the current model is urgently needed, focusing on an integrated approach that balances community-based and hospital care, based on scientific evidence.
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1. Brasil, Ministério da Saúde, Secretaria de Atenção Especializada em Saúde, Departamento de Saúde Mental, Álcool e Outras Drogas. Saúde Mental em Dados. 13. ed. Brasília: Ministério da Saúde; 2024. https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/s/saude-mental/saude-mental-em-dados/saude-mental-em-dados-edicao-no-13-fevereiro-de-2025/view
2. World Health Organization. Mental health Atlas 2020. Geneva: World Health Organization; 2021. https://www.who.int/publications/i/item/9789240036703
3. Thornicroft G, Tansella M. Components of a modern mental health service: a pragmatic balance of community and hospital care: overview of systematic evidence. Br J Psychiatry. 2004;185:283-90. https://doi.org/10.1192/bjp.185.4.283 PMID:15458987
4. Nordentoft M, Wahlbeck K, Hällgren J, Westman J, Osby U, Alinaghizadeh H, Gissler M, Laursen TM. Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden. PLoS One. 2013;8(1):e55176. https://doi.org/10.1371/journal.pone.0055176 PMID:23372832 - PMCID:PMC3555866
5. Insel TR. Rethinking schizophrenia. Nature. 2010;468(7321):187-93. https://doi.org/10.1038/nature09552 PMID:21068826
6. World Health Organization. Health for all: transforming economies to deliver what matters - final report. Geneva: World Health Organization; 2023. https://cdn.who.int/media/docs/default-source/council-on-the-economics-of-health-for-all/council-eh4a_finalreport_web.pdf?sfvrsn=a6505c22_5&download=true
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Copyright (c) 2025 César Augusto Trinta Weber, Antônio Geraldo da Silva
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