Where does the Mental Health budget go? – 12/21/2023 – Health in Public

The 5th edition of the National Mental Health Conference has just come to an end, resuming the discussion of a central theme for Brazilian society: social participation in the construction of the National Mental Health Policy. Different debates on this topic took place at the event, whose main objective was the construction of public Mental Health policies that are more aligned with the needs of the population.

For the proposals to advance and materialize effectively, we need to talk about an aspect intrinsic to each of them: budgetary resources. There is a consensus among researchers and experts in the field that there is historical underfunding of mental health policies. Data from the Pan American Health Organization (PAHO) indicate that, in the Latin American and Caribbean region, resources allocated to mental health represent, on average, just 2% of the total health budget. In Brazil, it is no different. In addition to the low volume of resources capable of monitoring allocated to the area, there is a second problem in its budgetary composition: the lack of visibility.

According to Bulletin no. 7 of Health Budget Monitoring, prepared by the Institute of Health Policy Studies (IEPS), in partnership with the Cactus Institute and Umane, until 2017, it was possible to identify the main actions in which the mental health budget was being allocated . In short, the Psychosocial Care Network (RAPS) and the Crack is Possible to Win Program constituted the main actions, from the point of view of volume of resources, allocated to the area’s budget. Together, their average allocation corresponded to R$2.2 billion. As of 2018, however, the level of transparency of this budget composition has changed significantly.

This change occurred, especially, due to Ordinance GM/MS No. 3588. Published in December 2017 by the Ministry of Health, the ordinance in question began to concentrate the majority of mental health resources in a single action, but whose composition also includes resources from other initiatives within the department. In other words, today we do not know how much Brazil effectively allocates resources to mental health, nor to which initiatives these volumes of resources are being allocated.

One of the practical examples of this lack of visibility refers to the resources allocated to investments in mental health – in theory, these resources are used to build new Psychosocial Care Centers (CAPS). From 2017 to 2021, the number of CAPS grew by 10%, going from 2,912 devices spread across the country to 3,208. However, it is not possible to identify the budget line responsible for this expansion, making it impossible for society to monitor these resources.

This lack of visibility of budget data also makes it difficult to analyze the prioritization of the topic in the political field. According to available data, there is a low share of discretionary expenses for mental health, that is, expenses that the Ministry of Health has the autonomy to allocate according to strategic guidelines. In the Legislative Branch, information about the budget points to the absence of parliamentary amendments in the area of ​​mental health. Would it be possible to say, therefore, that there was a deprioritization of the topic between 2015 and 2022? Based on the data available, we could confirm that yes, however, with the visibility difficulties imposed on the analysis, it is difficult to make this statement.

In this sense, it is more than essential to resume actions that allow greater visibility and monitoring of resources for the area. This is because without transparency, there is no supervision, and without supervision, there is no social control. Ultimately, what ends up most harmed is Brazilian democracy and the population’s mental health care. This scenario becomes even more worrying, especially in a post-pandemic context, where we are still experiencing an incipient recovery in the country’s mental health indicators.

Despite the numerous challenges, it is also important to highlight its positive aspects, especially in the new federal management. With the resumption of the National Conference, the creation of a department focused on mental health within the Ministry of Health, the publication of ordinances that signal the expansion of resources for RAPS and its inclusion in the New Growth Acceleration Program (PAC), these appear to be promising paths in inducing improvements in the country’s mental health indicators. In short, by focusing on fundamental guidelines for SM, such as those already mentioned, and creating actions focused on providing greater transparency to the area’s budget, we will be able, in the coming years, to possibly envisage a more positive scenario in mental health policies, and, consequently, , in the health conditions of Brazilian men and women

Discover the Health Budget Monitoring project, an IEPS initiative in partnership with Umane

Follow the initiatives of the Institute of Health Policy Studies also on Instagram at @iepsoficial

Bruno Ziller has a master’s degree in public policy from the Hertie School (Germany) and project coordinator at the Cactus Institute; and Victor Nobre is an Institutional Relations Assistant at the Institute of Health Policy Studies (IEPS)

LINK PRESENT: Did you like this text? Subscribers can access five free accesses from any link per day. Just click the blue F below.