Psychiatric care policies and deinstitutionalization in South America

Abstract

Introduction: The process of restructuring psychiatric care in South America began in the 80’s and increased in the 90’s. This process had its landmark in the Declaration of Caracas (1990), which reinforced the need for alternative services to the mental hospital.

Objectives: to analyse the current situation of the psychiatric care in South America, with special emphasis on Psychiatric Units in General Hospitals (PUGHs).

Methods: Two mail surveys were carried out. Questionnaires were sent to all Ministries of Health, Psychiatric Societies and key informants.

Results: All countries were represented in the returned questionnaires. In 7 countries there is a mental health plan. Material and human resources are inadequate in most countries. There has been a decrease in the total number of psychiatric beds over the last tem years. PUGHs were created in all the countries surveyed.

Conclusions: All South America countries have a mental health program. A higher percentage of the programs is devoid of an evaluation system and almost all the countries lack budget estimates for mental health care. It was observed that the total number of psychiatric beds has been decreasing in most countries, and that the PUGHs and other decentralized centers were adopted as an alternative to the mental hospital.