Fernandes Cristofthe Jonath, Lima Aluísio Ferreira de, Oliveira Pedro Renan Santos de, Santos Walberto Silva Dos
Universidade Federal do Ceará, Fortaleza, Brasil.
Faculdade de Psicologia e Ciências da Educação, Universidade do Porto, Porto, Portugal.
Cad Saude Publica. 2020 Apr 22;36(4):e00049519. doi: 10.1590/0102-311X00049519. eCollection 2020.
Nearly 20 years after the implementation of Brazil's psychiatric reform, the country has a hybrid model of mental health care, in which asylum services are part of the network that should replace them. This study aimed to critically analyze the supply of mental health services in Brazil in order to verify whether there is actually a replacement of asylum-based services by community-based services. A retrospective longitudinal study was performed on the supply of mental health services in Brazil from 2008 to 2017, building a single database on 5,570 municipalities (counties). As an ancillary tool for critical analysis of the psychiatric reform, we developed the Health Coverage Index for the Psychosocial Care Network (iRAPS, in Portuguese), considering the services legal parametrization. The results showed an increase in the supply of community-based services and a reduction in asylum services. However, the iRAPS tool found that 77% of the Brazilian population lives in areas with low or nonexistent coverage of community services. Small towns, with 16% of the Brazilian population, were those with the greatest increase in iRAPS. Only 439 cities, 7.9% of the total, showed total coverage by the Psychosocial Care Network (RAPS, in Portuguese), expressing only 6.69% of the national population. The metropolises, with 46% of the Brazilian population, did not show an increase in community services. The analysis of the supply of mental health services based on the iRAPS tool showed that the increase in community services did not occur homogeneously across the country.
在巴西实施精神卫生改革近20年后，该国形成了一种混合式精神卫生保健模式，其中庇护服务是本应取代它们的服务网络的一部分。本研究旨在批判性地分析巴西精神卫生服务的供应情况，以核实基于社区的服务是否真的取代了基于庇护的服务。对巴西2008年至2017年精神卫生服务的供应情况进行了一项回顾性纵向研究，在5570个市（县）建立了一个单一数据库。作为对精神卫生改革进行批判性分析的辅助工具，我们根据服务的法定参数制定了社会心理护理网络健康覆盖指数（葡萄牙语为iRAPS）。结果显示，基于社区的服务供应有所增加，庇护服务有所减少。然而，iRAPS工具发现，77%的巴西人口生活在社区服务覆盖率低或不存在的地区。占巴西人口16%的小城镇是iRAPS增长最大的地区。只有439个城市（占总数的7.9%）实现了社会心理护理网络（葡萄牙语为RAPS）的全面覆盖，仅占全国人口的6.69%。占巴西人口46%的大都市，社区服务并未增加。基于iRAPS工具对精神卫生服务供应情况的分析表明，社区服务的增加在全国范围内并非均匀发生。
