Paths and detours in the trajectory of the Brazilian psychiatric reform

This article looks at the principles and guidelines of the Unified Health System as well as the current situation and the limitations and possibilities of Brazilian mental health policy. Based on a review of national and international government documents and the scientific literature from 2015-2020, the study observed positive advances in mental health. However, the psychiatric reform has experienced setbacks, and the balance of mental health care has swung towards hospital-centered treatment. These changes have impeded the implementation of the Psychosocial Care Network, as well as the development of therapeutic practices and strategies focused on the person’s experience, their daily life and their relations with the health promotion network. By questioning the supremacy of medical-psychiatric knowledge in the treatment of “mental illness” in the public health care system, the psychiatric reform cleared a path for the construction of new ways of addressing psychological suffering. These gains are currently at risk, making a wider debate on the current trends in mental health care in Brazil essential.

A EVOLUÇÃO DA SAÚDE MENTAL NO BRASIL: REINSERÇÃO SOCIAL

In the nineteenth century, began the transformation of Mental Health of Brazil, where discussions on mental disorders gained strength. At that time the mentally ill was considered a danger to society, so he was excluded from society. With the Psychiatric Reform, this concept was changed, and new models of psychiatric care emerged. The objective of the present study was to discuss the evolution of Mental Health. For this, a bibliographic review was carried out in the literature with a temporal cut of the last 10 years with the following descriptors: mental health, mental health services, Psychiatric Reform in Brazil. Thus, it was possible to address the main points of Mental Health in Brazil.

Critical review: From neglect to a new look: the construction of the National Policy of Integral Attention to Users of Alcohol and Other Drugs as a conquest of the Brazilian Psychiatric Reform. The case of Recife (PE)

This work is based on secondary sources such as the conquest of the Brazilian Psychiatric Reform. It is an exploratory study, with the objective of briefly examining the structuring and transformations of mental health policies in Brazil. On the other hand, it seeks to highlight fragments in the enunciation mechanisms that strengthen services aimed at caring for people in psychic suffering. In conclusion, the analysis shows that, in some people, society shows different behavior patterns and norms, and they react differently to the problem in question. And that mental illness is now considered a social degeneration. And in this sense, we emphasize the necessary care to the carriers of this disease, as well as the importance of a quality nursing care. And this aspect, is emphasized in some congresses and seminars held for a social education, mainly in the aspect of education and awareness of drug use. And reinforced the construction of the National Policy of Integral Attention to Users of Alcohol and Other Drugs as a conquest of the Brazilian Psychiatric Reform. The case of Recife (PE).

Brazilian psychiatric reform: advances and constraints

This article discusses, temporally, the Brazilian psychiatric reform since its initial formulation to the present time – that is, from the organization of the anti-asylum struggle movement, even under the military dictatorship, until now – a time of neoliberalism marked by an offensive conservatism. It argues about the need to fight conservatism and neoliberalism, as both walk in the opposite direction to the principles of the Unified Health System and psychiatric reform (such as universality, integrality, equity, care in freedom, the non-commodification of madness and the end of asylums). It demonstrates the importance of territorially based services, the work of social workers and multidisciplinary teams in the field of mental health, as opposed to biomedical-psychiatric and hospital-centred. It discusses, therefore, the relationship between mental health and social issue. In addition, this article presents the contributions of Brazilian psychiatric reform, considering the socio-historic context to identify the main advances, challenges and limitations, and to contribute to the consolidation of the reform principles.

For a policy of conviviality: institutional movements in the Brazilian Psychiatric Reform

RESUMO O propósito do artigo foi visibilizar o processo de constituição e implantação do Fórum Permanente de Centros de Convivência e Cultura (Ceco) no estado do Rio de Janeiro. Descreveram-se as etapas de sua gênese, os pressupostos teóricos de sua formulação e os desdobramentos legais, éticos e políticos dos dispositivos de convivência no âmbito da Reforma Psiquiátrica Brasileira. A experiência do Fórum forneceu três pistas metodológicas que podem ser úteis para a construção de políticas: 1) abertura, estar aberto à participação de todos, não restringir; 2) itinerância, movimentar-se sem se fixar em um mesmo lugar; 3) multiplicidade, desejar as diferenças e não obstruir o trânsito entre elas. Como produto desse movimento instituinte, foi gerado coletivamente o Projeto de Lei nº 4.563/2018, que cria a Política Estadual dos Centros de Convivência da Rede de Atenção Psicossocial no estado do Rio de Janeiro, apresentado pela frente parlamentar em defesa da saúde mental e luta antimanicomial na Assembleia Legislativa do Estado do Rio de Janeiro. O movimento em torno dos Ceco, dispositivos de promoção de encontros na cidade, sustenta-se a partir da produção do comum e busca dar sustentabilidade à política da convivência que resiste às tentativas de desmonte do SUS e ao neoliberalismo.

Suicídio, direito à saúde mental e políticas públicas: realidade e perspectivas futuras

A reforma psiquiátrica brasileira, através da anuência do nosso país na Declaração de Caracas de 1990, culminou com o advento da Lei N.º 10.216 de abril de 2001, mais conhecida por Lei Antimanicomial e, posteriormente, com a Resolução n.º 3.088 de 23 de dezembro de 2011, com a instituição da Rede de Atenção Psicossocial – RAPS. Nesta perspectiva da saúde mental, apesar de todos os fatores que circundam a contemporaneidade, apresenta um limite – seja pela morte, seja pelo suicídio. O presente artigo tem por objetivo fomentar a reflexão acerca do fenômeno do suicídio, estabelecendo uma interlocução com o adoecimento da humanidade. Através de um estudo bibliográfico, tendo como método de abordagem o hipotético dedutivo, verificou-se que as políticas públicas de prevenção a este fenômeno devem ser propostas sob o olhar multifatorial e multicausal, alicerçadas em acepções da saúde mental. The Brazilian psychiatric reform, through the consent of our country in the Caracas Declaration of 1990, has culminated with the advent of the Law No. 10,216 of April 2001, better known as Antimanicomial Law and, later, with the Resolution No. 3,088 of December 23, 2011, with the institution of the Psychosocial Care Network - RAPS. In this perspective of mental health, despite all the factors that surround contemporaneity, it presents a limit - either by death, or by suicide. This article aims to foster the reflection on the phenomenon of suicide, establishing a dialogue with the sickening of humanity. Through a bibliographic study, using the deductive hypothetical approach method, it’s been demonstrated that public policies for the prevention of this phenomenon should be proposed under the multifactorial and multicausal view, based on mental health meanings.

‘Visions of another world’

This chapter explores Franco Basaglia’s relation with German psychiatry, from his early infatuation with the anthropo-phenomenological tradition to the disputes with the social psychiatric movement during the 1960s and 1970s. After an overview of Basaglia’s criticism of German psychiatric schools and institutions, the chapter focuses on his personal links, most notably with progressive psychiatrists and with the anti-psychiatric movement SPK (Sozialistisches Patientenkollektiv). Finally, it analyses Basaglia’s reception, by both the medical establishment and the actors of psychiatric reform. Contrary to the current narrative of a mutual influence, the chapter argues that Basaglia can hardly be regarded as a genuine inspiration for German psychiatric reform, and was retrospectively refashioned as such.

Spain

This chapter analyses the influence of Franco Basaglia and the organization ‘Psichiatria Democrática’ on the Spanish critical movements. These movements appeared in 1971 and were organized through a clandestine group known as the ‘Psychiatric Coordinator’. This organization linked professionals (mainly young psychiatrists) who had initiated innovative experiences in various psychiatric hospitals. These developments generated conflict when opposing the norms of the dictatorship. From 1975, and especially after the approval of the 1978 Constitution, the critical movement was a force for change in mental health structures in Spain, through the established organization, the Spanish Association of Neuropsychiatry. This effort made it possible to generate the psychiatric reform in 1985 that advocated community mental health and deinstitutionalization policies. Franco Basaglia began his contacts with the Spanish critical professionals in 1970, and the relationship was maintained periodically until 1980, the year of his death.