The mental health system in Brazil: Policies and future challenges

详细信息    查看全文

• 作者：Mario D Mateus (1)
  Jair J Mari (1) (2)
  Pedro GG Delgado (3) (4)
  Naomar Almeida-Filho (5)
  Thomas Barrett (6)
  Jeronimo Gerolin (7)
  Samuel Goihman (8)
  Denise Razzouk (1)
  Jorge Rodriguez (9)
  Renata Weber (3)
  Sergio B Andreoli (1) (10)
  Shekhar Saxena (11)
  
• 刊名：International Journal of Mental Health Systems
• 出版年：2008
• 出版时间：December 2008
• 年：2008
• 卷：2
• 期：1
• 全文大小：202KB
• 参考文献：1. The World Bank 鈥?Data & Stattistics 鈥?Country Classification [http://web.worldbank.org/WBSITE/EXTERNAL/DATASTATISTICS/0,,contentMDK:20420458~menuPK:64133156~pagePK:64133150~piPK:64133175~theSitePK:239419,00.html]
  2. CIA 鈥?World Factbook [https://www.cia.gov/cia/publications/factbook/geos/br.html] 2006.
  3. Minist茅rio do Planejamento, Or莽amento e Gest茫o 鈥?Instituto Brasileiro de Geografia e Estat铆stica (IBGE) [http://www.ibge.gov.br/home/default.php]
  4. Lobato L, Burlandy L: The Context and Process of Health Care Reform In Brazil (chapter 4). In / Reshaping Health Care in Latin Am茅rica. A Comparative Analysis of Health Care Reform in Argentina, Brazil, and M茅xico. Edited by: Fleury S, Belmartino S, Baris E. IDRC Books; 2000.
  5. WHO 鈥?Declaration of Caracas [http://www.who.int/whr2001/2001/main/en/boxes/box3.3.htm]
  6. Ministry of Health: / Reforma psiqui谩trica e pol铆tica de sa煤de mental no Brasil. Confer锚ncia Regional de Reforma dos Servi莽os de Sa煤de Mental: 15 anos depois de Caracas. OPAS. Bras铆lia; 2005.
  7. Principles for the Protection of Persons With Mental Illness and the Improvement of Mental Health Care [http://www.unhchr.ch/html/menu3/b/68.htm]
  8. Ministry of Health: / Legisla莽茫o em Sa煤de Mental 鈥?1990 鈥?2004. 5a edi莽茫o ampliada. Bras铆lia. Editora do Minist茅rio da Sa煤de; 2004.
  9. Ministry of Health: / "De Volta para Casa" 鈥?Manual do Programa. Bras铆lia. Editora do Minist茅rio da Sa煤de; 2003.
  10. World Health Organization 鈥?General Information WHO-AIMS Instrument, Version 2.2 [http://www.who.int/mental_health/evidence/AIMS_WHO_2_2.pdf]
  11. Ministry of Health: / Manual do Sistema de Informa莽玫es Hospitalares do SUS (SIH/SUS). Bras铆lia. Editora do Minist茅rio da Sa煤de; 2005.
  12. Departamento de Inform谩tica do Sistema Unico de Sa煤de (DATASUS) [http://w3.datasus.gov.br/datasus/datasus.php]
  13. Cadastro Nacional de Estabelecimentos de Sa煤de (CNES) [http://cnes.datasus.gov.br]
  14. Kantorski LP: Mental health care in Brazil. / J Psychiatr Ment Health Nurs 2002,9(3):251鈥?. CrossRef
  15. Ministry of Health: / Sa煤de mental no SUS: Os Centros de Aten莽茫o Psicossocial. Bras铆lia. Editora do Minist茅rio da Sa煤de; 2004.
  16. Ministry of Health: / Sa煤de Mental no SUS: Acesso ao tratamento e mudan莽a no modelo de aten莽茫o. Relat贸tio de gest茫o 2003鈥?006. Bras铆lia. Editora do Minist茅rio da Sa煤de; 2007.
  17. Larrobla C, Botega NJ: Restructuring mental health: a South American survey. / Soc Psychiatry Psychiatr Epidemiol 2001,36(5):256鈥?. CrossRef
  18. Dalgalarrondo P, Banzato CE, Botega NJ: Psychiatric admissions in a Brazilian general hospital: a review of outcomes. / Gen Hosp Psychiatry 2003,25(2):139鈥?0. CrossRef
  19. Dalgalarrondo P, Gattaz WF: A psychiatric unit in a general hospital in Brazil: predictors of length of stay. / Soc Psychiatry Psychiatr Epidemiol 1992,27(3):147鈥?0.
  20. Leit茫o RJ, Ferraz MB, Chaves AC, Mari JJ: Cost of schizophrenia: direct costs and use of resources in the State of S茫o Paulo. / Rev Saude Publica 2006,40(2):304鈥?09. CrossRef
  21. Mercier C, Saxena S, Lecomte J, Cumbera MG, Harnois G: WHO Atlas on Global Resouces for persons with Intellectual Disabilities 2007: Key Findings Relevant for Low and Middle Income countries. / Journal of Policy and Practice in Intellectual Disabilities 2008,5(2):81鈥?8. CrossRef
  22. Menezes PR, Mann AH: Mortality among patients with non-affective functional psychoses in a metropolitan area of south-eastern Brazil. / Rev Saude Publica 1996,30(4):304鈥?. CrossRef
  23. Fleck MP, Wagner L, Wagner M, Dias M: Long-stay patients in a psychiatric hospital in Southern Brazil. / Rev Saude Publica 2007,41(1):124鈥?0. CrossRef
  24. Ministry of Health: / N煤cleo de aten莽茫o b谩sica a fam铆lia. Bras铆lia. Editora do Minist茅rio da Sa煤de; 2003.
  25. Knapp M: Hidden costs of mental illness. / Brit J Psychiatry 2003, 183:477鈥?. CrossRef
  26. Patel V, Araya R, Lima M, Ludermi A, Todd C: Women, poverty and common mental disorders in four restructuring societies. / Social Science Medicine 1999, 49:1461鈥?471. CrossRef
  27. Patel V, Araya R, Chatterjee S, Chisholm D, Cohen A, Silva M, Hossman C, McGuire H, Rojas G, Ommeren M: Treatment and prevention of mental disorders in low-and-middle income countries. / The Lancet 2007, 370:991鈥?005. CrossRef
  28. Knapp M, Funk M, Curran C, Prince M, Grigg M, McDaid D: Economic barriers to better mental health practice and policies. / Health Policy and Planning Advance 2006,21(3):157鈥?70. CrossRef
  29. World Health Report. Mental Health: new understanding, new hope [http://who.int/whr/2001]
  30. Horton R: Launching a new movement for mental health. / Lancet 2007,370(9590):806. CrossRef
  31. Lancet Global Mental Health Group, Chisholm D, Flisher AJ, Lund C, Patel V, Saxena S, Thornicroft G, Tomlinson M: Scale up services for mental disorders: a call for action. / Lancet 2007,370(9594):1241鈥?2. CrossRef
  32. Jacob K, Sharan P, Mirza I, Garrido-Cumbrera M, Seedat S, Mari JJ, Sreenivas V, Saxena S: Mental health systems in countries: where are we now? / Lancet 2007,370(9592):1061鈥?077. CrossRef
  33. Hyman S, Chisholm D, Kessler R, Patel V, Whiteford H: Mental Disorders. In / Disease Control Priorities in Developing Countries. Edited by: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P. The World Bank and The World Health Organization; 2006:605鈥?25.
  34. Kohn R, Saxena S, Levav I, Saraceno B: The treatment gap in mental health care. / Bull World Health Organ 2004,82(11):858鈥?6.
  35. Patel V, Sartorius N: From science to action: the Lancet Series on Global Mental Health. / Curr Opin Psychiatry 2008,21(2):109鈥?3. CrossRef
  36. Mari JJ, Saraceno B, Rodriguez J, Levav I: Mental health systems in Latin America and Caribbean countries: a change in the making. / Psychol Med 2007,37(10):1514鈥?. CrossRef
  
• 作者单位：Mario D Mateus (1)
  Jair J Mari (1) (2)
  Pedro GG Delgado (3) (4)
  Naomar Almeida-Filho (5)
  Thomas Barrett (6)
  Jeronimo Gerolin (7)
  Samuel Goihman (8)
  Denise Razzouk (1)
  Jorge Rodriguez (9)
  Renata Weber (3)
  Sergio B Andreoli (1) (10)
  Shekhar Saxena (11)
  
  1. Department of Psychiatry, Universidade Federal de S茫o Paulo, S茫o Paulo, Brazil
  2. Centre for Public Mental Health, Health Services and Population Research Department, Institute of Psychiatry, King's College, University of London, London, UK
  3. Division of Mental Health, The Ministry of Health, Brasilia, Brazil
  4. Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
  5. Instituto de Sa煤de Coletiva, Universidade Federal da Bahia, Salvador, Brazil
  6. Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
  7. Center of Evaluation and Data Integration, CAIDI, Universidade Federal de S茫o Paulo, S茫o Paulo, Brazil
  8. Department of Preventive Medicine, Universidade Federal de S茫o Paulo, S茫o Paulo, Brazil
  9. Division of Mental Health, Pan American Health Organization (PAHO), Washington, D.C, USA
  10. Public Health Program, Universidade Cat贸lica de Santos, Santos, Brazil
  11. Mental Health: Evidence and Research, Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
  

文摘

Background The aim of this paper is to assess the mental health system in Brazil in relation to the human resources and the services available to the population. Methods The World Health Organization Assessment Instrument for Mental Health Systems (WHO AIMS) was recently applied in Brazil. This paper will analyse data on the following sections of the WHO-AIMS: a) mental health services; and b) human resources. In addition, two more national datasets will be used to complete the information provided by the WHO questionnaire: a) the Executive Bureau of the Department of Health (Datasus); and b) the National Register of Health Institutions (CNS). Results There are 6003 psychiatrists, 18,763 psychologists, 1985 social workers, 3119 nurses and 3589 occupational therapists working for the Unified Health System (SUS). At primary care level, there are 104,789 doctors, 184, 437 nurses and nurse technicians and 210,887 health agents. The number of psychiatrists is roughly 5 per 100,000 inhabitants in the Southeast region, and the Northeast region has less than 1 psychiatrist per 100,000 inhabitants. The number of psychiatric nurses is insufficient in all geographical areas, and psychologists outnumber other mental health professionals in all regions of the country. The rate of beds in psychiatric hospitals in the country is 27.17 beds per 100,000 inhabitants. The rate of patients in psychiatric hospitals is 119 per 100,000 inhabitants. The average length of stay in mental hospitals is 65.29 days. In June 2006, there were 848 Community Psychosocial Centers (CAPS) registered in Brazil, a ratio of 0.9 CAPS per 200,000 inhabitants, unequally distributed in the different geographical areas: the Northeast and the North regions having lower figures than the South and Southeast regions. Conclusion The country has opted for innovative services and programs, such as the expansion of Psychosocial Community Centers and the Return Home program to deinstitutionalize long-stay patients. However, services are unequally distributed across the regions of the country, and the growth of the elderly population, combined with an existing treatment gap is increasing the burden on mental health care. This gap may get even wider if funding does not increase and mental health services are not expanded in the country. There is not yet a good degree of integration between primary care and the mental health teams working at CAPS level, and it is necessary to train professionals to act as mental health planners and as managers. Research on service organization, policy and mental health systems evaluation are strongly recommended in the country. There are no firm data to show the impact of such policies in terms of community service cost-effectiveness and no tangible indicators to assess the results of these policies.