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PSYCHIATRIC DEINSTITUTIONALIZATION IN BRAZIL: THE ROLE OF

THERAPEUTIC RESIDENCES AND THE IMPORTANCE OF THE FAMILY

HEALTH STRATEGY

Lays Costa Silva1

Abstract: The Brazilian Psychiatric Reform is a movement that seeks to transform the mental

health care model, promoting the deinstitutionalization and social inclusion of people with

mental disorders. In this context, Therapeutic Residences represent an alternative to psychiatric

institutionalization, oering residential support for individuals who face these disorders and

need family or community support, aiming for their social reintegration. This experience

report seeks, therefore, to share the experience of a team from the Family Health Strategy in

the city of Rio de Janeiro-RJ after one year of monitoring residents of a Therapeutic Residence.

Keywords: “Therapeutic Residential Service in Mental Health”, “Health Services Reform”,

“Deinstitutionalization”, “Psychiatric Rehabilitation” and “Primary Health Care”.

C ontextualization

Deinstitutionalization actions in Brazil needed to articulate a proposal for people with mental

disorders who were ineligible for psychiatric hospitalization, but without family support or any other

support that could guarantee the social insertion of these individuals. To this end, based on the dialo-

gues of the II National Conference on Mental Health (in 1992) and, after some successful experiences

1 Family and community doctor, master’s degree in family health and doctoral candidate in

public health at the State University of Rio de Janeiro (UERJ).

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in the 90s, subsidies were generated for the elaboration of Ordinance No. 106/2000, of the Ministry of

Health (MS ), which introduces the Therapeutic Residential Service (SRT) (or Therapeutic Residen-

ce - RT) within the scope of the Unied Health System (SUS) with the aim of ensuring assistance to

those people, who were previously institutionalized in psychiatric units, in their process (sometimes

complex) of reintegration into society (Brazil, 2000).

RTs are, therefore, an alternative to institutionalization and are a tool for people who do not

have adequate support in the community to guarantee adequate living space, such as family and

friends, which often occurs after years of hospitalization . in psychiatric hospitals (Brazil, 2003; Cas-

tro et al , 2021). Among the states that have RT, the state of Rio de Janeiro has the largest number,

being the capital with a total of 100 units maintained by the city hall, which house around almost 600

people in the year 2024 (Rio de Janeiro City Hall January, 2024).

Goal

Share the experience of a team from the Family Health Strategy in the city of Rio de Janei-

ro-RJ after one year of monitoring residents of a Therapeutic Residence: Challenges and Learning.

Experience report

The RTs These are houses located in the urban space, with no physical link to hospital units,

planned to respond to the housing needs of their inhabitants and constitute the beginning of the psy-

chosocial rehabilitation process of their users (Brasil, 2004). RTs must be monitored by the Psycho-

social Care Center (CAPS) or outpatient clinics specialized in mental health and also, if possible, by

the family health team ( eSF ) responsible for the territory of the residence. It is important to establish

a collaborative relationship with CAPS and eSF and dene roles and responsibilities for each team.

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Amid the challenge and complexity of mental disorders, a team from the Family Health Strate-

gy (ESF) in the city of Rio de Janeiro-RJ has been monitoring the residents of a therapeutic residence

for a year. The home has six residents who face dierent mental health disorders, such as schizophre-

nia and mental retardation. During this period, home visits and consultations were carried out at the

health unit itself. In addition to mental health issues, clinical issues were addressed, such as the ma-

nagement of diabetes and the active search for women to undergo preventive examinations. During

this period, eorts have been made to promote integrated care with various challenges and invaluable

learning experiences for the ESF team.

The routine of regular home visits allows the team to understand the environment and needs

of each resident and establishes a signicant bond, necessary for the longitudinal segment. Care at

the health unit, in turn, is used as a tool to contribute to the socialization of residents so that they can

express themselves in the community and seek health support like other FHS users. The role of PHC

encompasses disease prevention and we highlight the participation of RT women in the Pink October

campaign, where they underwent the oncotic Pap smear test (preventive) for the rst time and this

process revealed a signicant clinical nding and enabled the necessary follow-up to the health of one

of these women.

On the other hand, there are challenges to be highlighted, such as: the initial failure of com-

munication between the eSF and the CAPS responsible about their roles; the inexperience of the eSF

with this care proposal; and the turnover of RT technical professionals. Continuous eorts from all

professionals are essential for the consolidation of RT.

Learnings and Critical Analysis

Housing is a constitutional right for every Brazilian citizen and it would be no dierent for

those with mental disorders (Brazil, 1988). In this sense, RTs are not precisely or only health services,

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but spaces for living, linked to the psychosocial care network of each municipality.

It is, therefore, up to PHC, especially the eSF , to understand its role in the scope of mental

health care for RT residents. With integrality and longitudinality as essential attributes, PHC is res-

ponsible for providing comprehensive and continuous monitoring, promoting the physical and emo-

tional well-being of individuals, as well as health promotion and disease prevention.

The team’s inexperience and the challenges faced in this rst year of contact were the neces-

sary encouragement to review their role and formulate more assertive strategies. By establishing solid

bonds over time, the team can better understand individual needs and oer personalized support,

aiming for residents’ recovery and autonomy.

Final considerations

In recent years, the Municipal Secretariat of Rio de Janeiro has made signicant progress in

the process of deinstitutionalization of psychiatric patients, introducing the CAPS and SRT care ne-

twork as a new model of care, and culminating in the closure of the city’s last two large psychiatric

hospitals. , in accordance with the principles of the Brazilian Psychiatric Reform (Rio de Janeiro City

Hall, 2023).

It is important to highlight that despite progress in the deinstitutionalization of psychiatric pa-

tients in Brazil, there is still a signicant historical delay that needs to be overcome, given that, while

in the USA and European countries this movement began in the 1950s through reforms psychiatric

disorders ( Soares and Silva, 2019), national implementation became a formal reality of the SUS only

in the 2000s, which reects the need for discussion and relevance of the topic.

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