Voltando para casa

When We Go Back Home

When a patient goes back home, he must feel welcome and protected. The image of care must be similar to the photos taken for the Going Back Home Program, which, since July 2003, when the law was enforced, strengthened the Brazilian psychiatric reform. The mental health question, helped by the image of care and affection and the work done after the law was published, has became compatible with the medical practice, politics and aesthetics.

The mental health question in Brazil is nowadays a matter of psychosocial nature. This expression is actually consensual among us challenging the contemporary clinical experience. By clinical experience we mean the border line between the individual and the community. As this line is not easily defined, the psychiatric reform work tries its best, replacing the asylums with the daily care services and management.

When the individual and the community fields differ, but are not totally distinctive, this happens because there is another tying relation: the medical practice and politics.

When making reforms, the medical practice cannot be defined as a private domain where our intimate secrets and personal inner experiences can be differentiated and set apart from politics. Public (polis) domain is understood as the power exercised between the several political forces.

When surpassing the old oppositions between the medical practice and politics, the individual and its world, we define subjectivity not as a nature, but as an essence and a given reality. We do not mean by that something identical to itself as an identity: the lunatic, the mental health patient whose illness seems to threaten his citizenship. We do not define subjectivity as a state of things or structure, but a creative process of the individual and the world. This process occurs with many elements involved: the family environment and its relations (father/mother, mother/son, father/son, etc.) the media, the present violence in urban areas, the social work participation, the public health policies, arts and other similar topics.

The psychiatric reform of the medical practice is a transversal experience, that is, we have to think about it on a level where medical practice, politics and also arts meet. Why stressing the interface between politics and arts ? Because in the daily practice of management and psychosocial care, we, not only encourage the production of consuming items and the workshops that generate incomes, but also and especially the means for collective production experiences (by meetings, associations and therapeutic groups). We also encourage other production forms expressing the relationship of the city madness (the therapy helper - AT, residential devices, the struggle to obtain the free ride ticket and going back home), production systems to express different types of madness (expressive workshops, radios and community TVs) and resuming: creative ways of oneself and the world. When mentioning the close relationship between the medical practice and politics we must also mention the interface of the medical practice with aesthetics, since we are dealing with creative procedures.

The mental health work of professionals is to take care of these creative procedures: to establish and make the respective follow-ups. This type of care cannot be confused with social assistance, which is the work of a professional defined as "a good man". As a matter of fact, care practices and psychosocial management are considered, in the public policies field for health, as an effective example of SUS, which faces serious problems of attendance, problems of care quality and equity offers of health. The human task of SUS is to replace the asylums, refuse attendance based on practices disrespecting patients’ rights, stimulate leaderships, autonomy and equal responsibilities on the part of managers, workers, users and the social net. A more human SUS is one that can recognize a citizen with full legitimate rights and value the different people engaged in the health production process. We back the renewal of the SUS care and management models. The psychiatric reform is presently a Governmental policy which, jointly with the HumanizaSUS, they strengthen the management and care practices, making us understand that health is a public political, aesthetic and medical practice that must constantly be developed and recreated.

Eduardo Passos
HumanizaSUS Health Care Secretary
Ministry of Health