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more humanized. The Municipality of Sobral is considered a successful example in
this field, not only from the local point of view, but also from the national and
international perspective. The Municipality has been awarded several prizes; among
them, the award of sanitation specialist David Capistrano and other social inclusion
recognition awards. The State has constituted a benchmark in the reduction of
hospitalizations and represents the progress against Latin American asylums.
The creation of the CAPS was the starting point for the establishment of a structure
based on the interdisciplinary teamwork of doctors, social workers, psychologists,
pharmacists, therapists. The work with patients is now aimed at their economic
reintegration into society, while in the past they were doomed to live in asylums.
b)
Pedro Gabriel Godinho-Delgado, National Coordinator of the
Mental Health Program of the Ministry of Health
Since the death of Damião Ximenes-Lopes, 19,000 psychiatric hospital beds have
been closed in institutions similar to Casa de Reposo Guararapes within the State.
Furthermore, between 1999 and 2005, 500-600 outpatient services were created,
with the capacity of coping with serious mental health situations without
hospitalization being necessary. Other types of services were also created, such as
therapeutic residences qualified to treat less serious cases. This was a period in
which Brazil faced an important controversy on the life conditions of psychiatric
system patients.
In 2001, Law No. 10,216 was passed. Its main purpose is to defend mental patients’
rights based on the conversion of the health care model of institutions like Casa de
Reposo Guararapes into an open health care network focused on the community, the
external control of involuntary psychiatric admissions, and the United Nations
Principles for the Protection of Persons with Mental Illness of 1991.
In 1999, approximately 90% of the financial resources that the public health system
devoted to the psychiatric care and mental health field were used for the Central
Hospital Model, and the external network received only 10% of the resources. Today,
the resources devoted to mental health in the State have globally increased: 63% is
still devoted to hospitals with expensive equipment, while 37% to 40% is already
being devoted to outpatient services. Today, the State is experiencing a transition
process towards a psychiatric care model based on the patients’ rights, integral care,
respect for their individual rights, and participation of the patients’ next of kin in
their treatment.
Hospitals are assessed through an Annual Assessment Program to which all of them
are subject. Associations of health municipal councils, state councils, next of kin and
users also participate on behalf of the society. The policy change process consists in
reducing large hospitals to obtain smaller hospitals, which tend to preserve and
respect patients’ rights to a greater extent.
The document designated “Principles of Brasilia”, which contains the evaluation of
the Caracas Declaration, confirms that there was progress in several countries and
mentions Brazil as an example of a country with relevant experience in the matter.
In 1999, the mental health care modernization process was underway. Monitoring of
the Single Health System is not based on complaints, but on the regular supervision