THIS SPECIAL ISSUE OF THE JOURNAL ‘SAÚDE EM DEBATE’, entitled Portraits of the Brazilian Psychiatric Reform, is a democratic commitment, historical tribute and sharing of knowledge. In each text, we have a portrait of our time. A clipping of the daily health services and forms of care that reveal a time that demanded social changes. Each composition is a kind of snapshot cut from the flow of productive time of the new paradigms of deinstitutionalization. Portraits that present themselves as parts of the wheel of knowledge and practices in the field of contemporary mental health and psychosocial care. They are snapshots of the boldness in which the acceptance of diversity and the maturation of the construction of democracy abolished what was imprisoned, to consummate freedom. They are portraits of inclusion and social justice that bring mental health closer to collective health.
In the factual scenario, the 1988 Constitution presents itself as the beacon of those transformations in Brazilian Public Health, the moment of the construction of the Unified Health System and the opening of horizons of mental health care with the Brazilian Psychiatric Reform in the context of the country’s democratization. These new models of care led to the construction of a Care Network aimed at replacing the logic of hospitalization, until then the main means of treatment for those who had psychological distress. It was this implementation and political support, for over 30 years, that gave Brazil a prominent place and international recognition in the field of mental health11 Caldas ALJM. Política de saúde mental no Brasil: o que está em jogo nas mudanças em curso. Cad. Saúde Pública [internet]. 2019 [acesso 2020 out 1]; 35(11):e00129519. Disponível em: https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102- -311X2019001300502.
Science, activism, artistic and cultural sensitivity, and reports of experiences of the services have consolidated narratives with different nuances about care in freedom, showing how the expressiveness of these constructions with strong symbolic and material content demarcate the territories of local practices. However, as of 2016, changes in government guidelines regarding mental health policies and normative publications threaten the achievements of the Brazilian Psychiatric Reform process.
Personalized care and psychosocial care strategies have been leaving the front line giving way to the resumption of a model that privileges beds in Psychiatric Hospitals, centered on practices that disregard the needs and desires of people with mental distress or disorder and those with needs related to the use of psychoactive substances.
In this sense, the know-hows representative of the advances in Brazilian mental health, in contrast to the setbacks and disputes, need to be analyzed and debated in perspective. Measuring advances and difficulties, sharing knowledge and strategies, in order to stimulate the development of public health policies without major losses for guaranteeing rights, have mobilized this commission, resulting in the present editorial proposal.
It should be noted that the call for submission of papers for this thematic issue, the result of a partnership between the Brazilian Center for Health Studies (Cebes) and the Oswaldo Cruz Foundation (Fiocruz), preceded the Covid-19 pandemic and, therefore, does not include the theme. On the other hand, they are snapshots of an immediately previous world, already marked by uncertainty and social isolation/exclusion, now aggravated by the pandemic. The texts offer us an accumulation of learning about mental health care and remind us of the importance of bonds, of sensitive listening, of promotion of autonomy and citizenship.
This is the second time that the journal ‘Saúde em Debate’ has published a special issue on Psychiatric Reform. For the ‘Portraits of the Brazilian Psychiatric Reform’, more than 180 manuscripts were submitted, an absolute record for the Cebes and the journal ‘Saúde em Debate’ – and a challenge for the editorial team –, which welcomed the proposal, conceived in an adverse moment for the Brazilian policy on mental health, alcohol and other drugs, resulting from setback movements against reformists.
The result is a diversified panorama of production of knowledge by authors from different states and institutions in the country, which has sought to understand the scope and challenges of mental health policies and practices. The manuscripts published here highlight the advances, report implicated and dense experiences, but do not shy away from critical reflections; and, in addition to the achievements and possibilities, they contextualize contradictions, limits and impasses in the field.
The selected texts emphasize the bonds built in the life experienced in the territories of freedom, in the knowledge and practices present in the Psychosocial Care Networks and address the themes of deinstitutionalization, child and adolescent mental health, attention to the needs arising from the abuse of alcohol and other drugs, singular therapeutic project, crisis, autonomy in the role of culture and art technologies for the enhancement of life.
At the same time, topics in the historical process and the development of legal bases highlight the confrontation with the asylum model and the implementation of the community and territorial based assistance network. Among the guests for the edition, Benedetto Sarraceno looks into the future of psychiatry and mental health, Edmar Oliveira and Ana Szapiro talk to the density of the time lived and the horizon of possibilities for the Brazilian Psychiatric Reform at the present time. In the same tune, Ordinance No. 10,216 which, in 2019, completed 21 years, was revisited by Paulo Delgado, in an unprecedented cut of the text of an interview granted to the Center for Mental Health, Alcohol and other Drugs from Fiocruz Brasília.
Portraits of the Psychiatric Reform, like other portraits, cuts out, documents, describes, idealizes, knows and makes known, freezes a piece of the paths to be gazed – editions of time and space sustained on the status of verisimilitude and representations of the present . We live in arduous times that need reminders of what we are capable of accomplishing, of how much all our achievements required the expansion of the frontiers of knowledge, humanity, persistence, critical sense and a willingness to adjust. We hope that the reading of the works gathered here will inspire new questions for research and construction of strategic proposals, reaffirming the path of respect for diversity, of education for freedom22 Basaglia F, Ongaro FB, Casagrande D, et al. Considerações sobre uma experiência comunitária. In: Amarante P, organizador. Psiquiatria social e reforma psiquiátrica. Rio de Janeiro: Fiocruz; 1994. p. 11-40. and of guaranteeing full citizenship rights to all people.
We invite everyone to approach this collection of text-portraits as part of an effort to resist the consolidation of a memory that provokes reflections on what we have already accomplished in the Brazilian Psychiatric Reform, as a propulsion and power to face the renewed challenges.
- *Orcid (Open Researcher and Contributor ID).
- 1Caldas ALJM. Política de saúde mental no Brasil: o que está em jogo nas mudanças em curso. Cad. Saúde Pública [internet]. 2019 [acesso 2020 out 1]; 35(11):e00129519. Disponível em: https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102- -311X2019001300502
» https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102- -311X2019001300502
- 2Basaglia F, Ongaro FB, Casagrande D, et al. Considerações sobre uma experiência comunitária. In: Amarante P, organizador. Psiquiatria social e reforma psiquiátrica. Rio de Janeiro: Fiocruz; 1994. p. 11-40.
- Publication in this collection
13 Aug 2021
- Date of issue