Academic journal article International Public Health Journal

Federal Financing for the Brazilian Mental Health Policy

Academic journal article International Public Health Journal

Federal Financing for the Brazilian Mental Health Policy

Article excerpt


"Financing is a critical factor in the realization of a viable mental health system. It is the mechanism by which plans and policies are translated into action through the allocation of resources. Without adequate financing, plans remain in the realm of rhetoric and good intentions. With financing, a resource base is created for operations and the delivery of services, for the development and deployment of a trained workforce, and for the required infrastructure and technology" (1).

World Health Organization (1) indicated that "... among the broad challenges faced by the financing of mental health care systems are: the diversity of resources among countries; the lack of financial data; the varying control and influence of mental health policy-makers and planners over mental health care financing; the varying levels of development of mental health systems between countries." Specifically, these concepts should be applied to understand the mental health system in Brazil. The Ministry of Health currently identifies that 3% of the population suffer from severe or persistent mental disorder where about 12% of the population needs some kind of mental health care, whether continuous or eventual (2), demonstrating an unmet need. As far as alcohol and psychoactive substances are concerned, more than 6% of the population has serious psychiatric disorders. In 2011, however, the Brazilian Ministry of Health spent 2.51% of its annual health budget on mental health (2). To fully understand the trend, this article analyzes reviewed a ten year pattern of federal funding for mental health services.

The primary profession serving mental health is social work making this debate fundamental understanding workforce issues as they relate to social work service provision. Data from Brazilian Institute of Geography and Statistics (3) shows that the number of social workers in health services in 2009 was 19.000 compared to the 2012 estimate by the Brazilian Federal Board of Social Work (4) of 120.000 registered social workers who were associated with health care, a significant increase in a three year period. This increase supports the perspective of a Psychiatric Reform (RP) within Brazil. Social workers contribute to the well-being and quality of the services provided within the mental health field and supports an individual's search for autonomy and social integration. Since there are a number of patients deprived from effective services then policy change is important in order to improve quality of life, not only for persons needing mental health care but in other areas as well.

This analysis encompasses pessimism of intellect and optimism of the will (as suggested by Gramsci). On the one hand, there is a struggle for advances in the field of mental health that contribute to psychiatric reform. On the other hand, there are the strains from multiple and contradictory interests that exist in an emerging country. This analysis required an objective assessment of the dynamics of Brazilian society within the context of an emerging world market. Our research made Bibliographical review and documental research on annual reports by the Brazilian Health Ministry's Mental Health Coordination (2001 to 2012).

Brazilian mental health policy

After the creation of Brazilian Unified Health System (SUS) in the 1988 Federal Constitution, the implementation necessitated that the Brazilian Ministry of Health would be responsible for formulating and implementing mental health policies through National Mental Health Coordination, which happened in 1991 (5). This led to a new stage in public mental health policy construction. A ".theoretical-ideological uproar around the direction the Brazilian psychiatric reform was taking place and, as far as the healthcare system was concerned, the moment the laws regulating SUS were passed and implemented" (5, pp. 458), the Brazilian National Mental Health Coordination of the Health Ministry promoted changes contributing to psychiatric reform even before any Law of Psychiatric Reform was ever passed. …

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