Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil
Autor(a) principal: | |
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Data de Publicação: | 2007 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://dx.doi.org/10.1590/S1516-44462006005000032 http://repositorio.unifesp.br/handle/11600/3559 |
Resumo: | OBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41% (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5% of the budget in 1995 and 49% in 2005, and the expenses with community services and medication have increased 15% each. As a whole, the expenses in mental health decreased by 26.7% (2.66 to 1.95 US$ per capita). CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged. |
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Is psychiatric reform a strategy for reducing the mental health budget? The case of BrazilÉ a reforma psiquiátrica uma estratégia para reduzir o orçamento da saúde mental? O caso do BrasilMental healthHealth policyHealth care reformDeinstitutionalizationHealth care costsSaúde mentalPolítica de saúdeReforma dos serviços de saúdeDesinstitucionalizaçãoCustos de cuidados de saúdeOBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41% (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5% of the budget in 1995 and 49% in 2005, and the expenses with community services and medication have increased 15% each. As a whole, the expenses in mental health decreased by 26.7% (2.66 to 1.95 US$ per capita). CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged.OBJETIVO: Investigar o desenvolvimento da infra-estrutura de serviço de saúde mental e do seu financiamento no Brasil. MÉTODO: Os dados sobre número de leitos, centros comunitários de saúde mental, profissionais de saúde mental e custos, no período de 1995 a 2005, foram coletados no sítio de internet de livre acesso do DATASUS. RESULTADOS: Em 10 anos, houve uma redução de 41% no número de leitos psiquiátricos (5,4 a 3,2 por 10.000 habitantes), enquanto os serviços comunitários aumentaram nove vezes (0,004 to 0,037 por 10.000). Psicólogos e assistentes sociais foram contratados três e duas vezes mais do que psiquiatras, respectivamente. As internações psiquiátricas representavam 95,5% do total de gastos com saúde mental em 1995, passando para 49% em 2005. Por outro lado, as despesas com serviços comunitários e medicação aumentaram 15% cada. Em relação ao total de gastos, as despesas com saúde mental diminuíram 26,7% (2,66 a 1,95 US$ per capita). CONCLUSÃO: Existe um claro movimento de transformação do modelo dos cuidados psiquiátricos no Brasil, passando do hospital psiquiátrico para os serviços comunitários. O sistema tem disponibilizado um maior número de modalidades de tratamento, incluindo o acesso gratuito aos psicotrópicos. A cobertura dos serviços comunitários, entretanto, ainda é precária e a reforma da assistência psiquiátrica não foi acompanhada pelo aumento do investimento público em saúde mental. A reforma psiquiátrica não é uma estratégia de redução de custos; ela necessariamente implica no aumento de investimentos se os países decidirem melhorar os cuidados em saúde para aqueles em desvantagens.Universidade Católica de SantosUniversidade Federal de São Paulo (UNIFESP) Department of PsychiatryUniversidade Federal da Bahia Institute of Collective HealthUNIFESP, Department of PsychiatrySciELOFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Associação Brasileira de Psiquiatria - ABPUniversidade Católica de SantosUniversidade Federal de São Paulo (UNIFESP)Universidade Federal da Bahia Institute of Collective HealthAndreoli, Sergio Baxter [UNIFESP]Almeida-Filho, NaomarMartin, Denise [UNIFESP]Mateus, Mário Dinis [UNIFESP]Mari, Jair de Jesus [UNIFESP]2015-06-14T13:36:45Z2015-06-14T13:36:45Z2007-03-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion43-46application/pdfhttp://dx.doi.org/10.1590/S1516-44462006005000032Revista Brasileira de Psiquiatria. Associação Brasileira de Psiquiatria - ABP, v. 29, n. 1, p. 43-46, 2007.10.1590/S1516-44462006005000032S1516-44462007000100013.pdf1516-4446S1516-44462007000100013http://repositorio.unifesp.br/handle/11600/3559WOS:000245008200013engRevista Brasileira de Psiquiatriainfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-06T13:02:33Zoai:repositorio.unifesp.br/:11600/3559Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-08-06T13:02:33Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.none.fl_str_mv |
Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil É a reforma psiquiátrica uma estratégia para reduzir o orçamento da saúde mental? O caso do Brasil |
title |
Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil |
spellingShingle |
Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil Andreoli, Sergio Baxter [UNIFESP] Mental health Health policy Health care reform Deinstitutionalization Health care costs Saúde mental Política de saúde Reforma dos serviços de saúde Desinstitucionalização Custos de cuidados de saúde |
title_short |
Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil |
title_full |
Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil |
title_fullStr |
Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil |
title_full_unstemmed |
Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil |
title_sort |
Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil |
author |
Andreoli, Sergio Baxter [UNIFESP] |
author_facet |
Andreoli, Sergio Baxter [UNIFESP] Almeida-Filho, Naomar Martin, Denise [UNIFESP] Mateus, Mário Dinis [UNIFESP] Mari, Jair de Jesus [UNIFESP] |
author_role |
author |
author2 |
Almeida-Filho, Naomar Martin, Denise [UNIFESP] Mateus, Mário Dinis [UNIFESP] Mari, Jair de Jesus [UNIFESP] |
author2_role |
author author author author |
dc.contributor.none.fl_str_mv |
Universidade Católica de Santos Universidade Federal de São Paulo (UNIFESP) Universidade Federal da Bahia Institute of Collective Health |
dc.contributor.author.fl_str_mv |
Andreoli, Sergio Baxter [UNIFESP] Almeida-Filho, Naomar Martin, Denise [UNIFESP] Mateus, Mário Dinis [UNIFESP] Mari, Jair de Jesus [UNIFESP] |
dc.subject.por.fl_str_mv |
Mental health Health policy Health care reform Deinstitutionalization Health care costs Saúde mental Política de saúde Reforma dos serviços de saúde Desinstitucionalização Custos de cuidados de saúde |
topic |
Mental health Health policy Health care reform Deinstitutionalization Health care costs Saúde mental Política de saúde Reforma dos serviços de saúde Desinstitucionalização Custos de cuidados de saúde |
description |
OBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41% (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5% of the budget in 1995 and 49% in 2005, and the expenses with community services and medication have increased 15% each. As a whole, the expenses in mental health decreased by 26.7% (2.66 to 1.95 US$ per capita). CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged. |
publishDate |
2007 |
dc.date.none.fl_str_mv |
2007-03-01 2015-06-14T13:36:45Z 2015-06-14T13:36:45Z |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1590/S1516-44462006005000032 Revista Brasileira de Psiquiatria. Associação Brasileira de Psiquiatria - ABP, v. 29, n. 1, p. 43-46, 2007. 10.1590/S1516-44462006005000032 S1516-44462007000100013.pdf 1516-4446 S1516-44462007000100013 http://repositorio.unifesp.br/handle/11600/3559 WOS:000245008200013 |
url |
http://dx.doi.org/10.1590/S1516-44462006005000032 http://repositorio.unifesp.br/handle/11600/3559 |
identifier_str_mv |
Revista Brasileira de Psiquiatria. Associação Brasileira de Psiquiatria - ABP, v. 29, n. 1, p. 43-46, 2007. 10.1590/S1516-44462006005000032 S1516-44462007000100013.pdf 1516-4446 S1516-44462007000100013 WOS:000245008200013 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Revista Brasileira de Psiquiatria |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
43-46 application/pdf |
dc.publisher.none.fl_str_mv |
Associação Brasileira de Psiquiatria - ABP |
publisher.none.fl_str_mv |
Associação Brasileira de Psiquiatria - ABP |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
instacron_str |
UNIFESP |
institution |
UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
collection |
Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
biblioteca.csp@unifesp.br |
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1814268422540754944 |