Pedro Gabriel Delgado, a psychiatrist, is changing the way mental patients are treated in Brazil.
A nova ideia
A longtime advocate of mental patients' human rights, Pedro has been the driving force behind a new law, expected to win approval this year, that will better regulate the country's mental health system to put a stop to current widespread abuses. A key provision of the law requires that a government public defender be notified within twenty-four hours of a person's involuntary commitment to a mental institution. The public defender must interview doctors, family members, and other people to determine whether the person's commitment is warranted. The law also prohibits the creation of additional mental hospitals in favor of creating a network of mental health care alternatives, including short-term hospital stays (seventy-two hours), daytime treatment, and supervised group living arrangements. "This law represents more than simple progress," says Pedro. "It means radical change for the better."Drawing upon this success, Pedro and other professionals have created a group called SOS-Human Rights for the Psychiatric Patient to provide twenty-four-hour-a-day protection for mental patients. A full-time secretary will receive complaints about medical negligence, physical and sexual abuse, and unwarranted incarceration of patients. The secretary will then contact an on-call SOS psychiatrist who will investigate the complaints and pressure authorities to intervene when necessary. The group will announce serious cases to the press. It will also carry out an information campaign, aimed at the general public and health care professionals, to eliminate stereotypes about mental patients and to publicize alternatives to traditional institutional care. SOS also plans to maintain close contact with politicians, lawyers, jurists, and human rights organizations to ensure rapid investigation of any suspected abuses.
As in many other countries, Brazil's mental hospitals have often served as the repository for many who, if offered alternative forms of treatment, could avoid long periods of hospitalization. As many as 110,000 people are interned in private and public clinics, and an additional 30,000 people receive treatment of one kind or another, or await available space in a hospital.During the 1960s, the military government then in power created incentives for the opening of privately run hospitals. They offered to compensate the hospitals on a per-patient basis for admitting people that otherwise would be treated in government hospitals, where beds were scarce. The system encouraged private hospitals not to efficiently treat and discharge mental patients who need only short-term care, but to keep them as long as possible. Today fully eighty percent of all mental patients in Brazil are treated in private institutions, which are reimbursed by the government. In numerous cases, patients spend fifteen to twenty years confined to a mental institution for no reason at all.
"The private clinics all try to keep their beds full at all times," Pedro says. "The emphasis is on keeping the patient there, and not on helping him to reintegrate into the world. This private clinic attitude has dominated official attitudes toward mental health care in Brazil for years."
Pedro is well aware that laws alone will not guarantee the improvement of mental health care. That is why Pedro believes it is so important to build the SOS-Human Rights for Psychiatric Patient program. SOS, which has been operating on a shoestring budget, plans to install a small office that will relay emergency calls to four doctors carrying message beepers on their belts at all times. They will form the core of the twenty-four-hour-a-day hotline.In addition, a network of mental health activists will report abuses to the press, send letters of protest to public officials defending individual cases or pressuring for policy changes, and publish a regular newsletter with information on advances in mental health treatment. The group will also serve as a watchdog to make sure that new legal provisions are implemented, like the one requiring a public defender to approve involuntary institutionalization.
Pedro also hopes to strengthen the Franco Basaglia Institute, of which he is a founder and president, which organizes debates and discussions concerning mental health issues. "There is a very important debate already under way on how mental health services must be changed," Pedro says. "The more we stimulate this debate, the faster change will come, and the more readily society will accept it."
Pedro has spent most of his professional life attempting to protect the rights of mental patients and to improve the quality of their treatment. In the mid-1970s, while in medical school, he worked as a volunteer in a psychiatric hospital. He saw firsthand the sad state of psychiatric care in Brazil and became convinced that confinement should be avoided whenever possible.During his residency in psychiatry, Pedro became active in defending patients' rights. He was laid off from a Rio de Janeiro psychiatric hospital when he and eight other doctors denounced the inadequate conditions there. Since then, he has worked in a number of private and public clinics, taught psychiatry at the university level, earned a master's degree, and is now completing a doctorate in preventive medicine.
Pedro not only has been the driving force behind the new Brazilian law regulating mental health services, but has also helped found several important groups seeking to carry out fundamental reforms in Brazil's mental health system: the National Movement of Mental Health Professionals, the Mental Health Department of the Physician's Syndicate of Rio de Janeiro, and the International Network of Alternatives to Psychiatry. Over the past decade, these groups have attempted to stimulate a debate among patients and former patients, health workers, government officials, and relatives of mental patients to come up with a more humane and effective way of treating patients interned in private and public mental institutions.