The Brazilian Psychiatric Reform and the Mental Health Policy

Humankind has coexisted with mental illness for decades, and before it became a mainly medical issue, the insane occupied popular belief in many different ways. From victims of mockery and ridicule to being said to be possessed by demons, even being marginalized for not fitting into the then current moral norms; mental illnesses are an enigma that threatens all knowledge comprised by man.

In the Renaissance, the insane were banned from the walls of the European cities and their unjust detention was to either be condemned to walk from city to city or being put onto ships that, due to the unpredictable nature of the seas, wandered without end, arriving, occasionally, at some port.

In the middle ages, however, the inane were confined in huge retreats and hospitals destined for all kinds of undesirable - nullified, bearers of venereal diseases, beggars and the wanton. In these institutions, the most violent ones were shackled; some were allowed to beg.

During the 18th century, Phillippe Pinel, regarded as the father of psychiatry, proposes a new treatment for the insane, freeing them from the shackles and transferring them to psychiatric hospitals, meant only for the mentally ill. Many experiments and treatments were developed and spread throughout Europe.

The treatment at mental hospitals, indorsed by Pinel, is based mainly in the re-education of the estranged, discouraging inconvenient behavior in respect to the norms. For Pinel, the disciplinary function of both the doctor and the mental hospital need to be carried out firmly, although with gentleness. This shows the basically moral character with which madness was then handled.

As time went on, Pinel’s moral treatment kept being modified and his original methods were no longer used. The idea of correcting behavior and habits remained, but it was used as a means of inflicting order and institutional discipline. In the 19th century, the treatment of the mentally ill included cold showers, whippings, rotary machines and bloodletting.

Slowly, with the progression of the organicist theory, what was regarded as a moral illness before was then considered to be an organic illness. However, the treatment techniques used by the organicists were the same as the ones used by the supporters of the moral treatment, which meant that, even with this new approach to madness that resulted from the discoveries of the neurophysiology and Neuroanatomy experiments, the submission of the insane continued well into the 20th century.

As of the second half of the 20th century, radical criticism and transformation of knowledge on treatment in psychiatric institutions began. It was propelled by Franco Basaglia, an Italian psychiatrist. This movement began in Italy, but had repercussions in the whole world, especially in Brazil.

This is how the anti-asylum movement was born deeply set apart by the belief in human and citizens’ rights of those who had mental disturbances.

Allied to this fight, the Psychiatric reform movement is born. It proposes the production of a web of services and strategies within the territory and the community. It went beyond just notifying authorities about psychiatric hospitals that were violence institutions.

In Brazil, this movement started at the beginning of the 70s with the faction of the mental health professionals, and relatives of patients with mental illnesses. This movement falls into the context of the country’s re-democratization and the social political mobilization of that time.

The Brazilin psychiatric reform was fueled by important events such as the arbitration and the closing down of the Anchieta Clinic, in São Paulo/SP, and the ammendment of the proposal of the then representative Paulo Delgado, by means of Bill 3.657, both of which occurred in 1989.

In 1990, Brazil becomes a signatary of the Declaration of Caracas, which proposes the reform of psychiatric aid, and, in 2001, Federal Law 10.216 is approved, which guards the protection and the rights of those who have mental disorders, and redirect the aid model in mental health.

The Mental Health Policy originates from this law. Basically, it secures care of the patients with mental disturbances in replacement services in psychiatric hospitals, overcoming the former practice of long stays and treatment of patients which secluded them from their family or from society as a whole.

The Mental health policy in Brazil encourages the programmed reduction of psychiatric wards for long periods of time, promoting the idea that psychiatric admission, when necessary, should take place in the surroundings of a general hospital and that should last for only a short period of time. Apart from that, this policy seeks to attain a mesh of distinguished dispositions that endeavor to achieve the deinstitutionalization of patients that have been admitted for long periods of time in psychiatric wards, and still, actions that allow the psychosocial insertion through work, culture and leisure.

The photograph shown here proves, beyond words, the change in the attention paid to people who suffer from psychiatric disorders. It’s not only possible, but also real, and it in fact happens.

Together, the national coordination of mental health, and the Humanization program at SUS, both from the ministry of Health, have examined the everyday habits of 24 homes located in Barbacena/MG, in which people who were admitted for long periods of time in psychiatric wards - and whose stories of abandonment of mental care facilities – seem to be more like unreal characters.

Before anything, they were deprived from their own identities, deprived from their most basic right to freedom, without the chance of having any personal object (the few that they owned had to be carried on themselves).

These survivors now live. They are characters of a city: passer-bys of the urban scenarios, neighbors, workers, and also tourists, students and artists. They have written and still write new stories in the world.This photograph shows the recipients of the Going Back Home Program, residents of the Therapeutic residency services, and above all, is a tribute to those who have crossed both the hospital and society’s barrier, as well as their own.