Brazil's Psychiatric Reform Challenged as SUS Debates Expanding Psychiatric Hospital Beds

Brazil's Unified Health System (SUS) announced in September it will debate expanding psychiatric hospital beds, a move seen as counter to the psychiatric reform in place for over 15 years. The proposal was supported by municipal and state health secretariats and suggested by the National Council of State Health Secretaries (Conass) in a meeting with the Ministry of Health and the National Council of Municipal Health Secretaries (Conasems). Since 1987, mental health sectors have fought to end asylums, citing atrocities like the Hospital Colônia in Barbacena, Minas Gerais, where over 60,000 people died. The 2001 Psychiatric Reform Law established hospitalization as a last resort, promoting community-based care through Psychosocial Care Centers (CAPS) and therapeutic residences. Despite this, 159 asylums remain in Brazil, though psychiatric bed availability in SUS has decreased by nearly 40% in the last 11 years. Psychologist Lumena Almeida, former national secretary of Health Care, criticizes the measure as a setback, arguing for strengthening the substitute care network instead of returning to institutionalization. She highlights that Brazil has closed 30,000 beds for long-term residents and built housing for freedom, viewing a return to psychiatric hospitals as reversing dignity restoration efforts.