An analysis of the federal funding for mental health care in Brazil

ABSTRACT

This article analyzes spending on mental health by the Brazilian Ministry of Health between 2001 and 2014. It is documental research of the Brazilian Ministry of Health’s databases. It analyzes the data using descriptive statistical analysis. Total spending on mental health for the period 2001 to 2014 shows a percentage increase in resources destined for outpatient care, but this increase is a reallocation from hospital services to community-based services and total resources for the mental health program remain at an average of 2.54% of the total health budget. Within outpatient expenditure, spending on medications remains high. Professionals committed to psychiatric reform fight to guarantee that a small fraction of the surplus appropriated by the state is directed towards social policies.

Keywords:

• Brazil
• mental health care funding
• psychiatric reform

Funding

The study proposal presented here is part of a research project approved by the National Council for Scientific and Technological Development--CNPq–(process number 485937/2012-3), titled “Gastos em Saúde Mental” (Spending on Mental Health), which aims to analyze mental health policy in Brazil. We also received financial support from Fapes (nº 445/2014).

Notes

^1. Throughout the 1990s and the first decade of the 21st century, until the approval of Law 141, 2012, the proponents of SUS fought for the approval of Constitutional Amendment 29 of 2000, which proposed a minimum participation by federal entities in health funding and, contrary to the proposal, mean the beginning of underfunding of health at the national level by imposing a greater share of funding on the states and municipalities, as we will show in this study (Carvalho, 2013; Marques & Mendes, 2010).

^2. I suggest deepening this discussion in Marques and Mendes (2010) and Carvalho (2013).

^3. The RTSs are a substitute mode of care for long-term psychiatric admissions. They provide a housing alternative for a large contingent of people that have spent years hospitalized because they could not rely on adequate community support (Brasil, Ministério da Saúde, Secretaria de Atenção à Saúde, 2004).

^4. Relocate the care of patients with mental disorders from psychiatric hospital to community-based outpatient services, in which the “crazy” are individuals with rights and not protected by any institution (Amarante, 2007).

^5. The spending on medications is intended for high-cost medications, designated as special medications until 2008. In 2009, Ordinance GM/MS No. 2.981 (Portaria n. 2.981, 2009) standardized them as medications with Specialized Components, currently regulated by Ordinance GM/MS No. 1.554 of 2013 (Portaria n. 1.554, 2013). The dispensing of these medications is made through outpatient care and processed by The Authority for High Complexity Outpatient Procedures (Autorização de Procedimentos Ambulatorial de Alta Complexidade [APAAC]). This process is open to the regional pharmaceutical bodies that direct the medications to the requesting units (basic municipal pharmacies) to be dispensed to the requesting service user.

Additional information

Funding

The study proposal presented here is part of a research project approved by the National Council for Scientific and Technological Development--CNPq–(process number 485937/2012-3), titled “Gastos em Saúde Mental” (Spending on Mental Health), which aims to analyze mental health policy in Brazil. We also received financial support from Fapes (nº 445/2014).