Andreoli Sérgio Baxter, Almeida-Filho Naomar, Martin Denise, Mateus Mário Dinis M L, Mari Jair de Jesus
Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Braz J Psychiatry. 2007 Mar;29(1):43-6.
To investigate trends in the provision of mental health services and financing in Brazil.
Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005.
In ten years, the number of psychiatric beds decreased 41% (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5% of the budget in 1995 and 49% in 2005, and the expenses with community services and medication have increased 15% each. As a whole, the expenses in mental health decreased by 26.7% (2.66 to 1.95 US$ per capita).
There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged.
调查巴西心理健康服务的提供情况及资金筹措趋势。
收集了来自巴西统一卫生计算机系统（DATASUS）且可免费在网上获取的数据，内容涉及1995年至2005年期间的床位数量、新社区中心的发展情况、心理健康专业人员数量以及相关成本。
十年间，精神病床位数量减少了41%（从每万名居民5.4张降至3.2张），而社区服务增加了九倍（从每万名居民0.004个增至0.037个）。心理学家和社会工作者的招聘人数分别是精神科医生的三倍和两倍。1995年精神科住院费用占预算的95.5%，2005年占49%，社区服务和药物治疗费用各增加了15%。总体而言，心理健康方面的支出下降了26.7%（从人均2.66美元降至1.95美元）。
巴西已明显从医院精神病护理转向社区精神病护理，目前该系统能够提供多种治疗方式且可免费获取精神药物。然而社区服务的覆盖范围不稳定，改革并未伴随公共心理健康投资的增加。精神病改革并非降低成本的策略；如果各国决定更好地照顾弱势群体，必然意味着要增加投资。
