The challenges of deinstitutionalization in mental health in the context of brazilian public policies

An integrative review

Abstract

The aim of this study was to analyze the challenges of deinstitutionalization in mental health within the context of brazilian public policies through an integrative review of the literature from 2018 to 2022 using databases such as SciELO, BIREME, EBSCO, and MEDLINE with the following keywords: public policies, mental health, deinstitutionalization, CAPS, and RAPS. The inclusion criteria encompassed articles addressing deinstitutionalization mechanisms proposed in brazilian public policy, while excluding review studies, theses, and editorials. Out of 69 materials found, 14 were included after applying inclusion and exclusion criteria. From the analysis of these materials, three thematic categories emerged: user perceptions, professional practices, and public policies. In user perceptions, the studies revealed progress in terms of personalizing the patient's environment, meeting their need for belonging. In professional practices, the importance of interdisciplinary work and behaviors that either promote patient autonomy, contributing to effective social reintegration, or focus on professional convenience rather than the psychosocial development of patients was highlighted. Lastly, in public policies, mechanisms of deinstitutionalization such as the "return home program," therapeutic residency services, and the psychosocial care center stood out. In conclusion, the challenge of deinstitutionalization is related to the fragmentation between theoretical frameworks and professional practices. While public policies provide theoretical foundations, their operationalization lacks the effective implementation of substitute hospital services and equipment. Furthermore, professional training necessitates reflection on the know-how in mental health to ensure that practices are committed to social reintegration, user empowerment, and emancipation.