Brazil without judicial asylums

Since August, the process of deactivating psychiatric custody and treatment hospitals, also known as judicial asylums, began. Gradually, it should be closed in May, when none of these establishments should be in operation. Medical entities are against the decision (read more below), considering that the measure will bring risks to society, with social and public safety impacts.

According to the Prison System Commission, External Control of Police Activity and Public Security of the National Council of the Public Ministry (CNMP), in the third quarter of this year, there were 29 establishments in operation, 11 in the Southeast and 10 in the Northeast, with capacity for 3,149 people and occupancy of 2,332 inmates, or 74.06% of the total.

According to the National Secretariat for Penal Policies, of this total number of inmates, 1,869 were obeying security measures – that is, they committed crimes and, after undergoing psychiatric evaluation, were considered unaccountable, but incapable of living in society. These are people who have committed homicide, crimes against property or crimes of a sexual nature, including pedophilia.

Resolution 487 of 2023, which determines the closure of psychiatric custody and treatment hospitals, was issued by the National Council of Justice (CNJ) in February. It would be a way of enforcing the provisions of the Psychiatric Reform Law of 2001, establishing the Judiciary’s Anti-Asylum Policy. The decision is in line with the so-called anti-asylum movement and opens up the possibility for people with mental disorders who have committed crimes to have access to “psychosocial rehabilitation assisted in an open environment”.

Among the perpetrators of crimes that could be released with the measure include Marcelo Costa de Andrade, the Vampire of Niterói, and Francisco Costa Rocha, known as Chico Picadinho. A medical board is evaluating each case. The inmates can be released – the family can take them in or appeal to the Public Defender’s Office or the Public Prosecutor’s Office so that they can be collected again, now in psychiatric hospital beds, alongside those who have not committed any crime. The resolution determines that hospitalization must take place, in “absolutely exceptional circumstances”, in general hospitals or environments referenced by the Psychosocial Care Network (RAPS), including Psychosocial Care Centers (CAPS).

When contacted by the reporter to inform how many establishments have already been closed since August and how many people detained are free, the CNJ did not comment.

Doctors warn of the risks of the decision

Throughout the year, a series of entities in the medical field reacted to the resolution. In a note of repudiation, the Brazilian Psychiatric Association (ABP) declared: “The determination that care for people with mental disorders be provided in beds at a General Hospital or other health institution referenced by CAPS is not sufficient to provide adequate and accurate care for all patients/citizens in this situation of illness, which can cause great harm to public health, as well as risk to the patient, family and the population in general”.

In a joint note, dozens of other entities also took a stance against the measure. Among them, the Federal Council of Medicine, the National Federation of Doctors (Fenam) and the Brazilian Medical Federation (FMB).

The Regional Council of Medicine of the State of São Paulo (Cremesp), in turn, issued a note stating: “The resolution was issued without any participation or consultation with specialized medical entities, notably psychiatric associations and Medical Councils. . As only happens when public policies are conveyed without qualified discussions between the affected social segments, the hastily approved guidelines suffer from ethical, legal and technical defects”.

For Pablo Kurlander, psychologist and director of the Instituto Eureka Educando, the CNJ resolution puts on the agenda an issue that had been pending resolution since the 2001 law. “It was a way of raising awareness about an agenda that had been paralyzed, the issue of closing mental hospitals. But I don’t believe that the action will move forward and that the establishments will all be closed in May.” One of the difficulties in implementing the measure, he states, is the insufficient structure of RAPS. “It is a network that does not have enough culture or capillarity to provide services of this profile.”

Attempts to stop the measure

There are attempts to prevent the end of judicial asylums from taking effect. Public defenders from all states of the federation asked the Federal Supreme Court (STF) to join as amicus curiae (friend of the court) in a Direct Action of Unconstitutionality (ADI) that questions the CNJ’s resolution.

And, in the National Congress, different bills in progress resume the collection of people with psychiatric problems and who have committed crimes. In March, deputy Kim Kataguiri (União-SP) presented Legislative Decree Project (PDL) 81/23, which suspends the application of the CNJ resolution. The measure passed through the Constitution, Justice and Citizenship Commission (CCJC) and awaits a vote in a virtual plenary session.

In December, federal deputy Daniela Reinehr (PL-SC) presented PL 6027/2023, which amends the 2001 law. “The closure of hospitals represents a risk to public safety. These custodians are responsible for serious crimes, such as homicide, rape and robbery, of a violent nature with indication of hospitalization by a medical board due to their non-imputability due to psychiatric incapacity and need to be held in custody by the state” says Reinehr. “In other words, they do not have the capacity to provide for their mental, social, psychological, legal health or to ensure the physical and patrimonial inviolability of third parties.”