Shortage and underutilization of psychiatric beds in southern Brazil: independent data of Brazilian mental health reform.

BACKGROUND: Mental health policies throughout the world are being subjected to several changes due to increased pressure from the public and from health administrators. Mental health policies in the developing world experienced changes following advice and consultation from the World Health Organization (WHO). This was the case with Brazil, which enacted several laws and policies affecting community care and the closure of beds in psychiatric hospitals (the deinstitutionalization movement). Rio Grande do Sul, the southeast state in Brazil, adopted this policy in 1992, but still suffers from a shortage of psychiatric beds in both general hospitals (GHs) and psychiatric hospitals (PHs), despite advances in the provision of community care. As a result, Rio Grande do Sul (RS) can be studied as an example of "what actually happens" in mental health care in the developing world. METHODS: The study analyzed online administrative data from 2000 to 2007 for three main parameters of mental health care (i.e. hospital use rate, length of stay, and hospital bed capacity). These were used to evaluate differences in psychiatric care among GHs and PHs. The number of existing and required psychiatric beds in RS was also calculated. RESULTS: GHs had very low hospital use rates, while PHs had a very high length of stay (200% higher than GH). The number of admissions to GHs grew by 170% over the 8 year period, and psychiatric bed availability was 1.5 per 10,000 inhabitants. CONCLUSIONS: The study provided evidence for the need of 30-50% more psychiatric beds in GHs. Also, additional staff training is needed to increase use rates in GHs and decrease the length of stay in PHs. Additional studies covering national data must be carried out to assess the extent of these problem in other Brazilian mental health care services.

A falácia da adequação da cobertura dos Centros de Atenção Psicossocial no estado do Rio Grande do Sul / The fallacy of adequate coverage offered by Psychosocial Care Centers in the state of Rio Grande do Sul

Introdução: A análise dos resultados da expansão da rede de atenção à saúde mental para a população brasileira tem utilizado como medida de desfecho o indicador de cobertura dos Centros de Atenção Psicossocial (CAPS), que considera adequada a existência de um CAPS para cada 100 mil habitantes. O Rio Grande do Sul encontra-se classificado em terceiro lugar no ranking nacional, com índice de 0,7 CAPS/100.000 habitantes. Este estudo objetivou testar a variabilidade de cobertura de cada região para verificar se esse índice global representava as realidades regionais. Método: Foram utilizados dados do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e dados populacionais do ano de 2009 disponibilizados pelo site do Departamento de Informática do Sistema Único de Saúde do Ministério da Saúde. Foram calculados os indicadores de cobertura para as 19 regionais de saúde, sendo gerado índice de cobertura resultante da razão entre o indicador observado e o esperado de acordo com a população de cada região geográfica analisada. Resultados: Analisada a variabilidade de cobertura de cada região, foi evidenciada a ocorrência de sete regiões com cobertura insuficiente, representando 49 por cento da população do estado com cobertura inadequada. Conclusão: O estudo demonstrou que o uso do índice global é falacioso, pois não representa as realidades regionais, sendo que cerca de metade das regiões com excesso de cobertura mascaram as regiões deficientes. Isso sugere que as análises de cobertura devem ser realizadas por áreas geográficas para identificar carências regionais e fornecer subsídios para a extensão da rede de forma igualitária para usuários de diferentes regiões do estado.

Introduction: Analysis of the results of the ongoing expansion of the Brazilian public mental health care network has used the indicator of coverage offered by Psychosocial Care Centers (Centros de Atenção Psicossocial, CAPS), which considers the rate of one CAPS per 100,000 inhabitants to be adequate, as its outcome measure. The state of Rio Grande do Sul ranks third in nationwide CAPS coverage standings, with 0.7 centers per 100,000 inhabitants. The present study sought to assess the variability of coverage in different regions in order to verify the representativeness of the overall coverage rate. Method: We used data collected from the National Database of Health Facilities (Cadastro Nacional de Estabelecimentos de Saúde, CNES) and 2009 population data made available at the website of the Ministry of Health Department of Information Technology. We calculated 19 coverage indicators, one for each health region, and computed a coverage rate based on the ratio between the actual indicator and the expected indicator according to the population of each region. Results: Analysis of the variability of coverage for each region showed that seven regions had inadequate coverage, with 49 percent of the state population receiving inadequate coverage. Conclusion: This study showed that the use of an overall rate for mental health care coverage can be considered a fallacy, as it fails to represent regional realities; roughly half of the regions with excessive coverage masked the regions with poor coverage. This finding suggests that analysis of care coverage must be broken down into geographic areas, in order to identify regional needs and provide support for equal expansion of the community mental health care network for users living in different geographic areas.