Current state of the Mental Health Policy in Brazil

Prof Pedro Gabriel Delgado
Publication date: 
31 January 2018

In the last 30 years, Brazil has developed a State Policy for people with mental disabilities that has gained recognition from the World Health Organization.

This Policy was responsible for the creation of nearly 3,000 community mental health services, redirecting financial resources previously used in asylums. Many of those asylums, in fact, violated human rights, as reported by the press and the State Prosecutors Office.

The Federal budget, which used to subvert the logic by prioritizing hospitalizations, now allocates 75 percent of its resources to outpatient services, that help men and women find mental health and happiness wherever it may be in the daily life in community.

Such services help avoid hospitalizations and replace psychiatric hospitals, with advantage, when they are needed. In the more structured Psychosocial Care Centers (CAPS), that can have up to ten beds, people are cared for when on crises and out of it by the same team, in the same place, without fragmentation of care or loss of their identity.

Therapeutic residences offer housing alternative, supported by and inserted in the community to those with less autonomy.

This policy, which combines mental health and human rights with efficiency in public management, was born from the process of redemocratization of the country.

Its guidelines were agreed by users, family members and mental health service professionals at four major national conferences. It has gone through all the different managements in the Ministry of Health since 1990 and was registered under the Federal Law 10.216 / 2001 after 11 years of debate in the Congress.

The current Minister of Health, however, has made changes in the Brazilian mental health policy, despite contrary recommendations from the National Human Rights Council and the National Health Council.

The Minister proposes to extinguish legal mechanisms that allow transferring resources from asylums to new community services. And more: in a budget cut scenario, he wants to adjust funding to asylums, with an estimated impact of R$ 140 million, without adjusting the funding to any community service.

Worse, the Ministry proposes to allocate R$ 120 million for hospitalizations in therapeutic communities for substance users. These establishments, which deviate from the Brazilian Public Health System regulations, are a heterogeneous, deregulated universe, against whom complaints of human rights violations are pending.

Finally, the proposal brings back the financing of mental health clinics, which overlaps existing community services. The set of proposals favors hospitalization and duplicates services. As resources are scarce and decreasing, the result will be the scrapping of the community mental health network.

In the year 2017, the current government reduced the implementation of new Community Mental Health Centers to a minimum, paralyzing, in practice, the process of creating new community mental health services.

The Federal Public Prosecutor's Office questioned the legality of the proposals as they contradict the prioritization of community services, set in Law 10.216. The National Human Rights Council warned that the change threatens the fundamental rights of people with mental disabilities.

These changes cause serious damage to a State Policy supported by federal legislation, by the social control and globally recognized by its results. There is a long way to improve mental health care in Brazil, still, but the measures proposed by the current Minister takes us back to the past and away from an improvement course.



Domingos Sávio Nascimento Alves, neurologist, Mental Health coordinator in the Ministry of Health in 1991-1992 and 1995-1996;

Pedro Gabriel Delgado, psychiatrist, professor at the Federal University of Rio de Janeiro,   Mental Health Coordinator between 2000 and 2010;

Roberto Tyaknori Kinoshita, psychiatrist, professor at the Federal University of São Paulo,   Mental Health Coordinator between 2011 and 2015;

Eliane Maria Fleury Seidl, psychologist, professor at the University of Brasília; Mental Health Coordinator in 1993-1994;

Alfredo Schechtman, physician, Mental Health Coordinator in 1997-1998;

Ana Maria Fernandes Pitta, psychiatrist, retired professor at the University of São Paulo, Mental Health Coordinator between 1998 and 2000;

Leon Garcia, psychiatrist, Mental Health associate-coordinator between 2011 and 2013;

And mental health workers from Brazil.