February 23, 2021

Humanised mental health care under threat in Brazil

topic:	Health and Sanitation
located:	Brazil
editor:	Ellen Nemitz

Mental health public policies - and the use of the polemic electroconvulsive therapy (ECT) - have been gaining prominence in Brazil recently. 

The first debate around the issue came up in 2019, when the country’s Public Health System, known by its Portuguese acronym SUS, was authorised to purchase ECT’s machines. The issue came back to the trending topics once again this February, after the nomination of the psychiatrist Rafael Bernardon Ribeiro (who is part of a clinic which largely defends the ECT) for the general coordination of the Mental Health, Alcohol and other Drugs department of the Ministry of Health.

ECT, a technique used since the 1930s, is the controlled application of electricity to patients suffering from some mental disorders, such as depression and schizophrenia. There is scientific evidence (though not a consensus) of the treatment’s effectiveness, despite possible side effects such as temporary memory loss and headaches - even following the requirement of anesthesia, professional supervision and the signing of a consent form. 

Nevertheless, patients may face the stigma derived from a long history of abuse, misapplications and torture, which caused harm and even death to an immeasurable amount of people in the past.

Despite the huge commotion that may be caused by the ECT’s idea, however, the debate on mental health policies must go beyond. The main issue to be worried about is the slow, but deep, dismantling of the Brazilian Psychiatrist Reform, which entailed a law that went into effect in April 2001 - the Psychosocial Care Network - and was formed by community-based facilities focused on the individual treatment plans which avoid patients' freedom deprivation (resulting from the prolonged activity of an anti-asylum movement that was first implemented in Italy and later crossed the ocean).

Over the last couple of years, an asylum lobby is successfully calling the governments to increase investments in psychiatrist hospitals and rule changes regarding how the health system takes care of people with mental disorders and problematic use of alcohol and other drugs, taking a turn back to the past. 

In December 2020, there were rumors that the government of Jair Bolsonaro could revoke nearly 100 mental health policies’ decrees, which would represent virtually the death of the Psychiatric Reform. There has been no massive revocation, but changes may still happen, even if step by step. The nomination of a doctor such as Ribeiro, a public supporter of Bolsonaro, is something to be aware of.

The Federal Psychology Council, a historic bastion of the anti-asylum fight, wrote a note under the slogan “Manicômios nunca mais” (Asylums never again, in free translation) that summarises the situation and the urgency for the society to keep surveillance: “The paradigm shift in mental health care has promoted, over the decades, a more humanised, complete, in freedom and with respect to users’ autonomy care, comprising the different and singular experiences of madness, psychic suffering and the consequences of problematic drug use. 

“However, recent attacks on policies in the area represent a setback and threaten inestimable achievements and the advances needed to guarantee freedom, dignity, citizenship and the lives of people with mental suffering.”

Image by drkirklands service. 

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