Análise da implementação da Política Nacional de Saúde Mental no período 2001-2008: fatos, debates e controvérsias.

Abstract

The present work aims to analyze the implementation of the National Mental Health Policy (PNSM), at the national level, from 2001 to 2018. It is a single case study, of an exploratory and analytical nature, which took as its object the process implementati on of the PNSM, in the FHC (2001 2002), Lula (2003 2010), Dilma (2011 2016) and Temer (2016 2018) governments, emphasizing the analysis of the actions carried out by the National Coordination of Mental Health of the Ministry of Health. Health and the actions and positioning of the different entities that make up the Social Movement organized around the Brazilian Psychiatric Reform, represented in the Intersectoral Commission on Mental Health of the National Health Council. The theoretical framework articula tes concepts extracted from Neo institutionalism, especially the Coalition Model of Defense and concepts derived from Strategic Thinking in Health. The empirical research used primary and secondary data, obtained through document analysis laws, norms, portarias, resolutions, management reports, reports of the National Mental Health Conferences and minutes of meetings, recommendations, motions of the National Health Council related to the PNSM and interviews with key informants, linked to the main national movements linked, both to the perspective of reform psychiatric and the perspective of the psychiatric counter reform, in addition to a representative of the National Coordination of Mental Health, from one of the study periods. The results are present ed according to the following dimensions: Fundamentals, objectives and strategies of the PNSM; Constitution and dynamics of the MS Coordination; SM Policy implementation process 2001 2018; Participation of the National Health Council in the PNSM implementa tion process (2001 2018); Debates and controversies around the PNSM implementation process. The analysis of the results shows that the implementation of the PNSM suffered inflections during the different governments in the analyzed period, which gave speci fic contours and rhythms to the actions of management, financing, social protagonism, implementation and expansion of services through normative acts adopted in in line with the macroeconomic situation, but mainly with the ethical political ideological pos ition on the phenomenon of madness and mental health prevalent in the management of the Policy. Even so, the PNSM, as it was implemented, represented, for most of the analyzed period, an important advance in the conception of madness historically construct ed in the country, as well as in the forms of care and attention to the population with mental disorders, psychological suffering and use, abuse of alcohol and other drugs. Considering that the constitutive actors of the different coalitions acted as guar dians ” of the structuring principles and projects of each of them, it is concluded that the State and the public health system (SUS), in particular, has been configured as a space in permanent tension. by the coexistence of a mental health care reform proj ect based on the universality and integrality of care, through the RAPS and the privatist, medicalizing, hospital centric and excluding project, traditionally hegemonic and resistant to the Brazilian Psychiatric Reform process.