Para onde foi o dinheiro da saúde mental? análise dos gastos da secretaria de saúde do estado espírito santo com ações e serviços em saúde mental

Abstract

This dissertation sets out to identify the trend in the state of Espírito Santo's funding of mental health actions and services, considering how this funding does or does not implement the guidelines established within the management instruments, guaranteeing (or not) out-ofhospital and community-based services and actions, as defined in this policy. We carried out documentary research in a mixed approach, using the Concomitant Triangulation Strategy. The time frame was 2009-2021 and the locus of the research involved the Espírito Santo State Health Department, through nine (09) sectors - Complementary Network Contractualization Management; Special Health Services Programming Nucleus; Mental Health Technical Area; Pharmaceutical Assistance Management; Bipartite Interagency Commission of the SUS/ES; State Planning and Institutional Development Management; State Health Fund; Contractualization Management of the Own Network and the Special Inpatient Regulation Center -, where we consulted restricted access documents on spending on the state's actions and services with the Psychosocial Care Network. We also used public documents from three (03) websites - the Espírito Santo State Department of Health, where we accessed the state health plans and health budget documents; the Espírito Santo Transparency Portal, where we accessed data on spending on health policy funding at state level; and the Department of Information Technology of the Unified Health System, where we identified data on federal transfers to Espírito Santo. The data showed fragmentation between planning and execution in the financing of Psychosocial Care Network actions and services in the state subnational entity, resulting in a lack of information on the competencies attributed to or assumed by this entity in it.With regard to the targets that the state set itself for expanding the network's services, none of them were met to the extent established. As for funding, among the resources that can be identified, we found a trend towards funding for hospital institutions, with 57.50% of all the resources used from 2009-2021, mainly for beds in psychiatric hospitals (48.01%). In the caseof out-ofhospital services, Residential terapheutic service funding accounted for 23.70%. For medicines, the allocation was 18.80%. In this scenario, we highlight the participation of Civil Society Organizations in the management of mental health services in Espírito Santo, which have changed the way equipment is managed, installing goal-based management. Thus, the results point to an increasein the trend of state resources for mental health after the state joined the RAPS, however, the trend of allocating resources remains centered on the asylum logic. What this scenario reveals isthe failure to guarantee out-of-hospital and community-based actions and services, as definedin the Mental Health Policy, with the continuation of disputes between the Psychiatric Reformmodel of care versus the Manicomial model.