INTRODUCTION

Brazil is a Federative Republic comprised of 26 states, a Federal District, and more than five thousand municipalities. The public health sector, called the Unified Public Health System [Sistema Único de Saúde, or SUS] is universal, and operates in conjunction with private systems, consisting of health care and health insurance companies. More than 40% of the Brazilian population are treated exclusively by the public system.

The Unified Public Health System was instituted by the Federal Constitution of 1988, which marked the end of the country's last period of dictatorship. The system is regulated by Laws 8.080 and 8.142, of December, 1990, which determine:

• The universal right to health and health care in a just and integral manner;
• Unified organisation, under the responsibility of the three levels of government - federal, state and municipal;
• Social control, exercised by various actors, such as associations of health professionals, families and users, as well as other representative segments of Brazilian society.

The social participation in formulating and following up on health policies is regulated by the aforementioned Law 8.142, which provides that such participation should take the form of representation in collective organs, specifically, Health Boards and Health Conferences. The latter are held in municipal, state and national stages.

From the legal standpoint, the system is broad and democratic. It therefore represents an enormous step forward in the establishment of social rights, in comparison with the previous system, that served only the beneficiaries of governmental social security institutes.

The major historical events on the road to reforming psychiatric treatment and mental health policies over the last fifteen years can be summarised chronologically as follows:

• First National Mental Health Conference - 1987;
• National Congress of the Mental Health Workers' Movement, Bauru - 1987;
• Intervention in the Anchieta Hospital, Santos - 1989;
• Presentation in the Federal Chamber of Deputies of a bill presented by Deputy Paulo Delgado, in 1989;
• Declaration of Caracas, 1990;
• Publication of the first rulings by the Health Ministry, in 1991, to financially support the change in the model of treatment; the most recent law dealing with this question is No. 10.216, of 6 April, 2001.

Basically this latter law defines the progressive substitution of the hospital model with the open community services model. It also allows a legally instituted authority to question involuntary admission to a mental hospital and lists a number of rights of persons with mental disorders when submitted to any treatment. In addition, the excessive length of time required for this law to be passed led state and municipal legislators to approve other laws on their respective levels, also based on the original bill of 1989.

HISTORICAL BACKGROUND

As is true in almost all Western countries, the history of psychiatry in Brazil begins with the opening of its first psychiatric hospital. The Pedro II Asylum, named after the then Emperor of Brazil, was opened in 1852, in Rio de Janeiro, capital of the Empire. This asylum was subordinated to the Santa Casa general hospital, directed by a Roman Catholic institution. Treatment was typical of the times, consisting of moral postures and strict discipline. (Costa, J.F. 1981)

Pedro II Asylum entered a period of crisis even before the fall of the empire, in 1889, as the number of patients exceeded the institution's capacity. The attending physicians took over direction its management and, before the end of the 19th century, began setting up "Colonies of Alienated Persons," which were large hospitals located on the outskirts of important cities. The first of such institutions in Latin America were the São Bento and the Conde de Mesquita asylums, on Ilha do Governador, near Rio de Janeiro. (Amarante, P. 1995)

Many other such institutions were established in other states around the country shortly after the Proclamation of the Republic, in 1889, and this style of treatment dominated psychiatric treatment during the entire first half of the 20th century. Unfortunately, almost all became infamous, such as that at Juqueri, near São Paulo, and at Juliano Moreira, in Rio de Janeiro.

Psychiatry was legitimated at the beginning of the republic with the promulgation of a specific law that organised assistance to the "alienated." The Brazilian Mental Hygiene League was created in 1923, whose charter of principles sets down "a program of intervention in social space, with markedly eugenistic, xenophobic, anti-liberal and racist characteristics." (Amarante, P. 1995).