Law, mental health care and the public health system: achievements and vulnerabilities of the Brazilian model
| Autor | Márcia Araújo Sabino de Freitas |
| Ocupação do Autor | Ph.D candidate and Master in Law at University of São Paulo, USP (Brazil) |
| Páginas | 1920-1941 |
1920 • XXVI World Congress of Philosophy of Law and Social Philosophy
1
Márcia Araújo Sabino de Freitas2
Abstract:While some developed countries of Europe and North America discuss
the creation of a public health system, Brazil handles its implemented integral
anduniversalUniedHealthSystemSistemaÚnicodeSaúdeSUSwhich
has constitutionally been provided since 1988. However, SUS is challenged to
achieve in practice its ambitious project to its full extent. Moreover, it keeps
struggling against distorted conceptual viewings of its actual scope. The role of
lawincarryingoutthisprojectandtheethicalobstaclesthatpervadeitseec-
tiveness are discussed in the present paper. Its methodological approach focuses
onthementalhealthcareandmorespecicallyinthelawnknown
as the Psychiatric Reform Law. Mental health care faces all the challenges tack-
led by SUS, and even more: it has been profoundly reorganized after the new
psychiatric paradigm. Research has been made in LILACS database, by collect-
ingreferencesthatcontrastlawnwiththepracticeofmentalhealth
care after its promulgation. The paper also brings an overview of SUS and the
mental health care in Brazil.
Keywords: Law; Mental Health Care; Public Health System; SUS; Brazil.
Introduction
At a time when some developed countries of Europe and North
America discuss the creation, or the reformulation, of public health sys-
1
is paper is an expanded version of the term paper written for the course “Law and
development in complex societies”, taught by Celso Campilongo and Jean-Paul Rocha in
the Master and Ph.D. courses of University of São Paulo Law School.
2
Ph.D candidate and Master in Law at University of São Paulo - USP (Brazil). Graduated
in Law at Federal University of Minas Gerais - UFMG (Brazil). Bioethics and Biolaw
Studies and Research Group Assistant C oordinator - University of São Paulo Law School
- FD/USP (Brazil). Professor of Bioethics at Health Sciences Faculty of Barretos - FA-
CISB (Brazil). Studied Bioethics at Georgetown University/Washington D.C. (USA).
Working Group: Bioethics and biopolitics • 1921
temsBrazilreasonsonitsUniedHealthSystemSistemaÚnicodeSaúde
– SUS) within a new context.
SUS is a public health system, with universal access and compre-
hensive care covering. Its creation was formalized by the 1988 Constitu-
tion, the 8th Brazilian Constitution. It represented the largest movement
of social inclusion ever seen in the history of the country (Brasil 2007a).
The enormous political and administrative architecture that supports it,
integrating with agility the three executive bodies – municipal, state and
federal – has no counterpart in the world, and not even in other sectors
of the Brazilian government (Brasil 2007b).
However, a system responsible for achieving the constitutional
wording that health is a State duty and a right for everyone, certainly
faces dicult challenges especially in an extremely unequal country
with complex political structure. Young, SUS is still under construction;
and, as a project in progress, it is also under healthy constant discussion.
Making the project real within the social reality is the great chal-
lenge of SUS.
In this context, the question to be made refers to the role of leg-
islationinturningeectiveitsown rights content In other words in
which extent law is able to contribute to social development.
The methodological approach will focus on the mental health
caremodel embraced by SUS Dealingwith this issue the aforemen-
tioned question seems even more delicate, for in addition to its inclusion
in SUS, the mental health care has been reformulated in several coun-
tries all over the world, including Brazil, after the psychiatric reform
movementsstartedinthesDesviatAmaranteDuetoits
peculiarities, the mental health care revealed itself as a good study niche
forthisparticularworkpurposeItsuersthesamedicultiesthataf-
fectSUSasawholeandexposesthelawtoamoresubtleeectiveness
testnamelyhowtointegratelegislationinthesocialseinginorderto
extract social gain, in this case, improvement of population health.
It is believed that the description of the Brazilian public health
system care and management model, as well as its limitations and the
roleoflawinrenderinghealtheectivemaybringfurtherdatatosup-
port the discussion that takes place in other countries regarding the
adoption or reformulation of their public health systems.
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