Saúde mental e direitos humanos: situação portuguesa no contexto internacional

JM Caldas de Almeida

Lisboa, 16 de Dezembro de 2016

Mudança de paradigma

• Modelo biomédico estrito

• Cuidados episódicos e reativos

• Foco na doença

• Modelo baseado no hospital

• Cuidados prestados a doentes passivos

• Lógica asilar e de exclusão

• Abordagem holística

• Cuidados continuados e assertivos

• Foco na qualidade de vida do paciente e no bem estar

• Modelo baseado na comunidade

• Cuidados em colaboração com doentes participativos

• Lógica de inclusão e de recovery

United Nations Human Rights System

• Universal Declaration of Human Rights (UDHR)

• International Covenant on Economic Social and Cultural Rights (ICESCR)

• International Covenant on Civil & Political Rights (ICCPR)

•Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment

• Convention on the Elimination of All Forms of Discrimination Against Women

• Convention on the Rights of the Child

•Convention on the Elimination of All Forms of Racial Discrimination

•Convention on the Rights of Persons with Disabilities

•Resolução “Mental Health and Human Rights” de iniciativa luso-brasileira adotada na 32a. Sessão do CDH, junho 2016.

Direito a cuidados de qualidade na comunidade

1. Acessa a serviços proficcionais adequados

• Disponibilidade

• Acessibilidae General Comment 14/ICESCR

• Aceitabilidade

• Qualidade

2. Direito a tratamento individualisado (MI Principles, CRPD)

3. Direito a reabilitação a a tratamento que estimula a autonomia (CRPD, ICESCR, MI Principles)

4. Direito a serviços na comunidade (Art 19 CRPD)

5. Direito aos tratamentos menos restritivos (MI Principles)

6. Proteção da dignidade humana (CRPD, ICESCR, MI Principles)

Carga das doenças neuropsiquiátricas (DALY´s and YLD) em2012

DALYs YLD

Mundo 10.4% 28.5%

Europa Ocidental 17.4% 29.1%

América Latina e Caraíbas 14.8% 36.6%

Prevalência de casos tratados de doenças físicas e mentais (Ormel et al, 2008)

Mental Health Services through

Primary Health Care

Self-care

Informal Community Care

Community Mental Health

Services

Long-stay Facilities

& Specialist Services

Psychiatric Services in General Hospitals

WHO Mental health pyramid of care

IHosp. Treat. Out-patient Long-term

Psychiatric Hospital

General Hospital

Primary Health Care

Residential facilities Community Mental Health Teams

Mental health included in the UN

Sustainable Development Goals

• For the first time, world leaders recognized the promotion of

mental health and well-being, and the prevention and treatment of substance abuse, as health priorities within the global development agenda.

• The inclusion of mental health in the Sustainable Development Agenda, adopted at the United Nations General Assembly in September 2015, is likely to have a positive impact on communities and countries where millions of people will receive much needed help.

A two-day series of events, co-hosted by the World Bank and the World Health Organization during the World Bank-

International Monetary Fund Spring Meetings, to emphasize the urgent investments needed in mental health services, and the

expected returns in terms of health, social and economic benefits.

• Conferências internacionais

• Documentos técnico-científicos em parceria com OMS

• Mind Rights Film Festival

• Programas de cooperação técnica com países

– Brasil

– Índia

– Geórgia

– Cabo Verde

• Formação de líderes de saúde mental

Countries with mental health policy (WHO Atlas 2014)

Countries with mental health policy/plan in 2014

Countries with policy updated since 2010

Americas 80% 43%

Europe 79% 56%

– Nova Lei de Saúde Mental (Lei 36/98)

– Política Nacional de Saúde Mental (D. Lei 36/99 e D. Lei

304/2009)

– Plano Nacional de Saúde Mental (2008)

– Bases dos Cuidados continuados de saúde mental (Despacho

Conjunto 407/98; DL nº 8/2010)

Novos serviços / estruturas de saúde mental em H. Gerais

(1995 - 2010)

Projectos de saúde mental comunitária financiados em

2009 (n=46)

Novos serviços / estruturas Infância-adolescência

(2008-2010)

Serviços de reabilitação psicossocial (1998 – 2010)

27

Situação atual

Global Mental Health Plan of Action 2013-2020

1. Strengthen effective leadership and governance for mental health – Develop, update, implement policies, plans and legislation in line with international

human rights instruments

– Resource planning in accordance with measured needs

– Engage stakeholder collaboration

– Empower people with mental disorders

2. Provide comprehensive, integrated mental health and social care services in community-based settings

– Service reorganization and expanded coverage

– Integrated and responsive care

– Mental health in humanitarian emergencies

– Human resources development

– Address disparities

Global Mental Health Plan of Action

• Implement strategies for mental health promotion and prevention across the life course, including programmes for children, mental health at the workplace, and suicide prevention

• Strengthen information systems, evidence and research for mental health

Progressos alcançados em Portugal e na Europa (% de “Progresso significativo”)

Insuficiências do tratmento da depressão (Under treatment of people with major depressive episode in 21 countries, Brit. J Psych,

2016)

12 month depression A

Perceived need for treatment B

Any 12 month Treatment C

Minimally adequate treatment of C

Minimally adequate treatment of A

Brazil 10.1 56.1 63.8 41.7 14.9

Mexico 3.7 58.3 43.4 25.4 6.4

Portugal 7.0 65.4 88.3 32.5 18.8

Spain 3.8 74.2 79.5 46.0 27.2