Marco Aurelio Soares Jorge

A number of social factors -such as the shared historical and cultural origin that the countries of the Iberia peninsula uphold, which are characterised by both their ethnic diversity and their economic and political insertion into the edge of capitalism- have given to Latin American countries a chronic underdevelopment.

These conditions might let us think that our health systems share the same organisational structure. However, each Latin American country adopted distinct social policies, despite of the fact that these policies might be based on similar principles.

The development of the health sector in Brazil, due to its extensive territory and its diverse political and social history, became a highly complex issue, which until now has not reached a unified consensus.

Since 1982, Brazil has had a gradual transition to democracy, when the first local governors were elected. This democratic transition was reflected in the health sector as a form of struggle for reaching a basic universal right to health. Right that should be guarantied by the State and implemented equally throughout the nation by the National Health System (SUS).

This was the main aim of the sanitary movement, which managed that the National Congress could include in the 1988s Constitution the fundamental principles of the SUS. Despite of all these efforts, the impact of such policies on people’s health is still very incipient. The absence of a national political and social consensus concerning the preliminary proposals of the movement has lead to a wide spread resistance, which still remains in some spheres in the society.

The orthodox neo-liberal ideas, which dominate the world’s political arena, have denied the Brazilian health reforms. Those reforms also found obstacles within some segments of the government, mainly in the economic domain, as their engagement was directed towards the reduction of the administrative expenditure and the privatisation of public institutions.

The economic interests of private medical corporations have also built up barriers that hinder the implementation of SUS principles. Besides, the pharmaceutical industry -mainly foreigner- has also imposed rules, products and prices to both the government and to the people. In this way, access to health services, improvement of their quality, and the acquisition of medicaments is still incipient.

The deep economic and social disparities among Brazilians create serious obstacles for building up an egalitarian health agenda. For example, in 1993, 40% of the poorest families obtained 12,6 % of the national rent, while a 40% of the richest families obtained a 42,2%. (Chatar, 1988, apud Labra, 2002). The former scenario facilitates the reappearance of many infections diseases that were considered to be eradicated, such as dengue and tuberculosis.

Within the mental health field, the Brazilian hegemonic policies have been characterized by an easy hospitalisation to psychiatric centres. The political repression, the social violence and the imposition of silence were common practices directed towards civilians. Numerous individuals were confined in psychiatric sanatoriums, some of them for lifetime.

The first hospice was funded in 1852, which at the same time, created the practice of an anarchic psychiatric hospitalisation that exercised diverse atrocities. This model had its apogee in the 70s, during the military regime, where several public health services were privatised and used for that purpose.

In the 80s, several civil movements that aimed at the democratisation of the public services and the participation of the civil society, organised themselves to fight against the former psychiatric model. The aim of this movement was to build a fairer mental health policy based on equanimity and community participation. Besides, it also looked for the implementation of internal changes in public hospitals by introducing a process of democratisation in the relationships between technicians and patients, seeking, at the same time, the reduction of beds in the psychiatric hospitals.

After a decade of discussions, on the 6th of April 2001, the National Congress approved the law 10.216/01, which protects the rights of people with psychiatric illness by defining a reorientation of the mental health model.

Currently, there are a number of governmental health advocates who seek for the creation of the political and technical conditions, which can ensure the organisation of an integral mental health network at a local level. This can be done through the integration of important socio-cultural and sanitarian dimensions to the daily life of individuals. The main aim of this model is to re-orientate the former psychiatric model from a hospitalisation-centred dimension to a more holistic one, which can integrate small and medium scale sanitary and psychosocial services to each municipality.

In this way, efforts are centred to implement, at municipal level, centres for psychosocial services (CAPS). These centres act as strategic core for the articulation of different health networks, such as the program for family health, ambulatory attention, hospitalisation and several communal activities such as nursing homes, protected jobs, training and legal advice on social welfare.

The first CAPS were built in historically isolated places, which lacked sanitation and social services. At the moment, several therapeutic offices are already functioning, mainly in the southeast and southern part of the country.

We are working in the implementation of a mental health policy based on community participation and the use of local resources, seeking to promote, at the same time, local responsibility and care among participants. Despite of all our efforts the health scenario in Brazil is nevertheless distressing. The psychiatric hospitalisations, which still are a hegemonic practice, and the medical-centred health model are both consequences of health practices oriented to dismiss people’s well being.