saúde mental e direitos humanos: situação portuguesa no ... · saúde mental e direitos humanos:...
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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%
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)
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
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