Prospects and Challenges of Mental Health Services in a Major City in Latin America: Rio de Janeiro

Abstract

The Organic Health Law, which established the Unified Health System (Sistema Único de Saúde - SUS) in 1990, declared the universality of health care, the equity of access, and the regionalization of service. However, even though SUS is a national universal public health program, in practice, Brazil has a dual system, which combines public health care with private health plans. The discussion about the need for mental health care reform in Brazil began in the late 1970s and was characterized by a range of complaints and critiques of the hospital-centered model, the privatization of health, and the deplorable treatment of hospitalized patients. The new mental health law in Brazil defined a drastic reduction in the number of beds in psychiatric hospitals and the installation of a community treatment network in 2001. The city of Rio de Janeiro, the capital of the state of Rio de Janeiro, is the country’s second largest city, with 6,476,631 inhabitants. Given the current financial crisis of Rio de Janeiro, and Brazil in general, decision criteria for health care are often based on the benefit-cost ratio. In the context of a health system with scarce funds, it is important to consider how the reforms under way will affect care of individuals with mental disorders, especially those living in deprived and violent areas like slums in Rio de Janeiro. The fragmentation of the mental health service network is seen as one of the main obstacles facing mental health care in Rio de Janeiro.