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vol.16 issue12International overview of psychiatric reformAdaptation of Critical Time Intervention for use in Brazil and its implementation among users of psychosocial service centers (CAPS) in the municipality of Rio de Janeiro author indexsubject indexarticles search
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Ciência & Saúde Coletiva

On-line version ISSN 1678-4561Print version ISSN 1413-8123


RIBEIRO, José Mendes  and  INGLEZ-DIAS, Aline. Policies and innovation in mental healthcare: limits to decoupling from the performance of the SUS. Ciênc. saúde coletiva [online]. 2011, vol.16, n.12, pp.4623-4634. ISSN 1678-4561.

We studied Brazilian policies on mental health with respect to normative, supply and demand and financing aspects. We concluded that the sustainability of innovations in psychiatric reform depends on enhanced financing and integration with primary care community services, on the overall performance of SUS and the reduction of autonomous and exclusive services in primary care. There is high and rising pressure in demand for services measured in DALY and the incidence of disease. The reduction observed in psychiatric beds was accompanied by the systemic reduction, though with selective reduction for psychiatric hospitalizations. CAPS services have institutional limits due to the model adopted of direct public administration and local government capacity. Secondary data available show that: (i) SUS has a virtual monopoly on general outpatient and hospital services; (ii) mental health specialists belong mostly to SUS; (iii) most mental health services are outpatient services; (iv) few CAPS have day-bed services available; and (v) there is reduced federal financing for these innovations.

Keywords : Psychiatric reform; Mental health; Primary care.

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