Wetzel C; Puntel de Almeida MC. A construção da diferencia na assistência de São Lourenço do Sul - RS. [The making of the difference in care provided in São Lourenço do Sul - RS.] Saúde em Debate (Health in Debate) 2001 May-August; 25(58):77-87.

Objectives: To analyze the construction of a Community Mental Health Center in a Brazilian municipality, undertaken within the framework of the Brazilian Psychiatric Reform.

Methodology: Qualitative. In-depth interviews with political decision makers, service providers, and users.

Results: The development of a mental health care center in the municipality of São Lourenço resulted from diverse processes. These processes included: the need to move patients in crisis to other cities due to lack of institutions in the municipality that could care for them; the dehumanized treatment that patients received in traditional psychiatric centers; the steep financial cost of moving patients to other cities; conflicts between the community and the “crazies wandering the streets”; the community’s demand for a solution to the problem from local authorities; and, the municipalization of health, namely the transfer of responsibility for health care from the federal and state governments to the municipalities. Local government played a leading role in reforming the healthcare system, in general, and the mental healthcare system, in particular.

The reform process was highly participative. Because São Lourenço is a heavily rural municipality, the Rural Community Assemblies were used to discuss and spread word about the reform process. With the participation of the community, These references analyzed the mental health situation. The project implied a paradigmatic change, by which the focal point became not mental illness itself, but the person experiencing mental disturbance and that person’s relationship with society. Participation by the family was a notable part of the program. The program also emphasized solidarity, the responsibility of the mentally ill and their families, andacolhimento (i.e., full acceptance within the healthcare system of the person needing mental health care).

Conclusions: The experience demonstrates the benefits of a participative social process in response to those suffering mental disturbances.

Copyright 2007 University of New Mexico