CNJ decision on judicial asylums brings risks to society

The determination of the National Council of Justice (CNJ) to deactivate custody and psychiatric treatment hospitals for people with mental disorders and illnesses who have committed crimes, until May of next year, brings risks to the patients themselves and to society. According to experts, as there is no adequate structure to care for these mentally ill patients in the Psychosocial Care Network (RAPS), indicated by the CNJ to replace judicial asylums, the resolution will facilitate the release of these patients, many of them unable to be in social life.

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CNJ Resolution No. 487, signed by Minister Rosa Weber on February 15, 2023, follows the guidelines of the so-called anti-asylum movement and wants to give people with mental disorders who have committed crimes the possibility of “assisted psychosocial rehabilitation in an open environment”. Patients who were in forensic asylums (for having committed crimes, but being considered unaccountable), no matter how serious their behavior and actions are, will be monitored and assisted only by Raps.

According to the resolution, from now on, these people must serve their sentence under house arrest, electronic monitoring or other measures in an open environment. In “absolutely exceptional circumstances”, they can be hospitalized, no longer in forensic asylums, but in general hospitals or environments referenced by the Psychosocial Care Center (Caps). This means that patients with mental disorders and who have committed crimes will be hospitalized with those who do not have this profile.

The CNJ also established that “no person with a mental disorder is placed or kept in a prison unit, even if in a ward, or is subjected to hospitalization in institutions with asylum characteristics”.

The resolution triggered a series of criticisms from experts, who fear the lack of adequate care for these patients and risks to public safety. The Brazilian Association of Psychiatry (ABP) published a note of rejection stating that the CNJ guidelines do not represent the appropriate treatment for these patients and that they can bring “great harm to public health”. “Generating a great risk to society in general and, above all, danger to family members, health professionals and people who live with them”, highlights the ABP.

“There is nothing more unscientific than the anti-asylum fight”, says psychiatrist

Historically, care for people with mental disorders has been precarious in Brazil. In the past, the mentally ill were seen as a problem for which the only viable solution was to lock them up in asylums. There are reports and stories of people forcibly hospitalized in asylums, victims of violence, as reported by journalist Daniela Arbex in the book “Holocausto Brasileiro”.

Over the years, there was a reorganization in the system, with the closing of asylums, mainly after the psychiatric reform, instituted by Law n° 10,216, of 2001.

If the anti-asylum movement managed to reduce abuses in former hospitals, it had a dangerous and still unresolved negative effect: the lack of psychiatric beds for people with violent disorders who need hospitalization. Despite the law providing for the possibility of voluntary, involuntary and compulsory hospitalization as a form of treatment, between 2005 and 2016, Brazil lost almost 40% of psychiatric beds for patient care within the public network, according to information from the Federal Council of Medicine. (CFM).

“Today, Brazil is one of the countries with the lowest rates of psychiatric beds in the world. There are 10 times fewer psychiatric beds, proportionally to the population, compared to OECD countries”, says Quirino Cordeiro, psychiatrist and former Secretary of Care and Drug Prevention at the Ministry of Citizenship and former Coordinator of Mental Health at the Ministry of health.

According to him, the abuses and violence of former asylums actually have to continue to be fought. In general, hospitalizations are brief, so that the individual recovers and can leave soon. The problem is to take advantage of this scenario as a pretext to defend baseless theses, such as that there is no need for hospitalization in some cases, especially for those who can go overboard and commit acts of violence.

“Where do pedophiles go, sexual aggressors at high risk of committing the same crimes again, the serial killers who are in this service? It is an irresponsible attitude by the CNJ that has no scientific backing. It brings problems for patients and for society”, he highlights.

Cordeiro also states that the decrease in psychiatric beds can lead to an increase in the suicide rate of these patients, violence and incarceration.

“If they don’t have adequate treatment, these people have a chance of being agents of violence and victims of violence. This resolution will not take care of patients, it will throw these people in a serious situation into a situation of lack of assistance”, he says. “There is nothing more anti-scientific than the anti-asylum struggle, it is an ideological movement that does not take into account scientific data, facts and life as it is”, adds Cordeiro.

Inadequate and unstructured system

The resolution determines that these patients with disorders and problems in the law will be referred voluntarily to the Psychosocial Care Network (RAPS). However, experts point out that the Raps system is no longer able to meet current demand. “It’s very difficult to think that a decision won’t have an impact, the system can no longer handle what it has”, says Pablo Kurlander, psychologist and doctor in collective health.

The expert points out that the existing structure is insufficient in quantity and quality. Regarding the CNJ’s decision, Kurlander points out that in addition to being “utopian”, it deserves attention. “In practice, it is necessary to have a structure prepared to have a determination of this type, in our scenario, I do not see that it will have a positive impact”, he says.

Doctor Quirino Cordeiro says that custody hospitals have not been able to meet the demand for psychiatric beds, with many queues. For him, although it is undeniable that these institutions need to be improved, it is not the deactivation that will solve the problem.

“It is necessary to establish outpatient clinics specialized in the management of these patients. Always work to improve the quality of service. And this cannot be done by interrupting a system and adopting a ‘make-believe’ policy, as it has nothing to do with reality”, says the specialist.

Other side

The Department of Monitoring and Inspection of the Prison System and the System for Executing Socio-Educational Measures of the National Council of Justice (CNJ) told the report that the resolution was discussed for almost two years in a working group set up by the CNJ. The group included representatives from the Pan American Health Organization (PAHO) and the World Health Organization (WHO).

Regarding the structure of Raps, the CNJ said that there are insufficient vacancies in the prison system as well. “The idea is that with the closure of beds in hospitals for custody and psychiatric treatment, the competent public authorities can encourage investment of resources in health equipment”.

“The idea is that patients have adequate mental health treatment and not in asylums that should have been extinct at least 20 years ago, according to the bases of the Psychiatric Reform in Brazil”, pointed out the CNJ. The body showed that the mentally ill is considered unimputable and, therefore, should receive medical treatment like other patients. “They must receive adequate treatment for the case, with strict observation of the execution of the measure by the Judiciary, which must take all the necessary measures recommended by the health teams to guarantee the health and safety of all”.