Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil.
OBJECTIVE
To investigate trends in the provision of mental health services and financing in Brazil.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Andreoli
Sérgio Baxter
SB
Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Almeida-Filho
Naomar
N
Martin
Denise
D
Mateus
Mário Dinis M L
MD
Mari
Jair de Jesus
Jde J
D001509:Bed Occupancy; D001938:Brazil; D002017:Budgets; D003156:Community Mental Health Services / Q000191:economics* / Q000600:supply & distribution; D003688:Deinstitutionalization; D018166:Health Care Reform; D006778:Hospitals, Psychiatric / Q000458:organization & administration* / Q000600:supply & distribution; D006801:Humans; D001523:Mental Disorders / Q000191:economics; D008603:Mental Health; D009313:National Health Programs; D000078329:Workforce