Mental health in the cities in Alto Uruguai, RS, Brazil: a diagnosis of the psychiatric reform

This study investigated the characteristics of mental healthcare in the cities situated at the Alto Uruguai from the perspective of the guidelines of the Brazilian Health System (SUS), and of the Psychiatric Reform. Based on a structured tool, we interviewed 31 subjects working in the public care network. The results point to centralized actions and "medicalization" of symptoms in the clinical care model although all cities count on Family Health Programs; lack of integrated care in mental health; inexistence of a mental health service network in the cities except in the main city; transfer to psychiatric hospitals to solve acute and chronic cases; lack of follow-up after the patient is released from the psychiatric hospital characterizing the phenomenon of the revolving door; the inexistence of mental health programs in the Health Policies of the city; and the weak representation of these professionals in the Health Councils. We conclude that the transfer of the responsibility for mental healthcare to the local authorities in the northern region of Rio Grande do Sul is still incipient and that hospitalization in psychiatric hospitals continues the main intervention in the field of mental health.