According to the publication, about 100 ordinances, created between 1991 and 2014, are in danger of being revoked amid a historic crisis in Brazilian health, driven by the pandemic of the covid-19
In the midst of the Brazilian health crisis, caused by the covid-19 pandemic, the Ministry of Health would be preparing the revocation of around 100 mental health ordinances. This week, the portfolio presented to the National Council of Health Secretaries (Conass) and Municipal Health Secretariats (Conasems), a “repeal” of ordinances dealing with mental health in the Unified Health System (SUS), created between 1991 and 2014 The information was released by Época magazine, last Sunday (6/12).
If the ordinances are, in fact, repealed, programs such as the annual restructuring of psychiatric hospital care in SUS are at risk; the Street Consultancy teams, which seek to increase the access of the homeless population to public health services; the Psychosocial Care Network, for people with suffering or mental disorder and with needs resulting the use of crack, alcohol and other drugs; and the Monitoring Committee for the Back to Home Program and the Residential Therapeutic Service, which aim to psychosocially rehabilitate patients undergoing long psychiatric hospitalizations.
If the revocations are executed in the coming weeks, there will be difficulties with eventual reactions and questions, since the Supreme Federal Court (STF) and the National Congress will be in recess.
In a note, the Brazilian Association of Psychiatry (ABP) informed that there will be no "extinction" of all ordinances related to mental health, closing of Psychosocial Care Centers (CAPS) and Therapeutic Residences.
“The ABP defends the ninth National Mental Health Policy, voted in the Tripartite Inter-Management Commission (CIT) of SUS, with representation state and municipal governments, published in December 2017. It is worth mentioning that such changes, which are now three years old, need be widely implemented so that the lack of assistance to patients with mental disorders is ended ”. BPA representatives signed the note.
The president of the Brazilian Psychiatric Association and the Latin American Psychiatric Association (APAL), Antônio Geraldo, informed that the ordinances are all being revised in order to generate an improvement in the care of the public mental health system. According to Antônio, ABP, Conass and Conasems will work together with the Ministry of Health to analyze the ordinances to recognize which are “obsolete”.
“All ordinances are under evaluation to decide what can be done to improve (the public health system). What is best for you to deploy? Having two or three ordinances with everything written in 100 ordinances and being able to throw away what has already fallen into disuse or simply keep 100 ordinances without you knowing which way to go? ”Asked Antônio.
The psychiatrist, associate professor at the Federal University of São Paulo (Unifesp / Baixada Santista) and former coordinator of the General Coordination of Mental Health, Alcohol and other Drugs at the Ministry of Health, Roberto Tykanori Kinoshita, says that he saw the presentation made by the Ministry of Health with the National Council of Health Secretaries that indicated the closure of the Residential Therapeutic Service and programs such as the Back to Home.
"These two aspects alone already involve a very big problem in relation to thousands of people who are living in residential services today, people who are receiving resources that are a product of the last 20 years of reforms."
He recalls that the Executive has prerogatives to make changes to the ordinances, however, points out that in the process of building the SUS, which is 30 years old, these ordinances go through a negotiation called the Tripartite Commission. “What is the central issue? You do not eliminate 30 years of ordinances accumulated in one stroke. These ordinances are being debated, constituted, reformed. So, they are being accumulated over the years. They are not temporary solutions, they reflect the stability of thousands of patients ”.
Tykanori also stresses that the revocation of the ordinances has an immediate effect of suspension of payment to the municipalities and states of the existing services. “There are big financial stocks when you start to remodel the system in one go. This is a problematic issue, because you suspend the financing of a lot of things at a certain time. How is this situation for municipalities? The ministry is left without the means to pay for the services ”.
For the specialist, the change will end up resulting in less care and, above all, less resources for mental health. In addition, he points out that increased stress, depression and chemical consumption can be of the pandemic. "Everyone has been feeling this need to have a place of support."
The Ministry of Health has been contacted, but has yet to respond.