Removal of People with Mental Health Disorders
The largest public psychiatric hospitals or asylums are institutions created in the 19th century to treat people with behavior and mental disorders (initially, mental illness). At that moment, the concept of deprivation of liberty and life of patient’s treatment emerged as an idea consolidated at the beginning of the 20th century. In addition to the deprivation of freedom and energy and the consequent removal of people with mental health disorders from social life, an impoverished routine of activities and occupations became common within these institutions.
Physical and psychological violence has practically also become part of this routine, either by one patient against one another or by professionals against patients; it has always been most normalized and legalized in the nation. The use of punishment procedures in these spaces (confinement in solitary cells, excess medication, starvation, electric shocks, astrophysical violence, sexual abuses) and the lack of hygienic conditions, poor and insufficient food, and the lack of protection of the privacy of the interned subjects became part of institutional functioning.
In 1978, the Movement of Mental Health Workers appeared, denouncing the institutional violence that had already occurred for some time. With permanent activism since then, this Movement had the support of the Health Reform Movement in the fight for changes in the Legislation that would establish a new model of treatment in Mental Health. In 1989, Paulo Delgado’s bill was presented in the Chamber of Deputies and provided for the gradual extinction of asylums. This project gave rise to Law 10,216, which was approved in 2001 and became known as the Psychiatric Reform Law after many years of processing. The changes made to the initial Bill, Law 10,216, redirect the care model instituted rights.
According to the Law, the Brazilian mental health care model, guided by an institutional arrangement that is supposed to privilege the subjects’, avoids the deprivation of liberty as much as possible, to be carried out primarily in open institutions. This arrangement allows for the conciliation of treatment and the re-insertion of subjects into social life. Law 10,216 also instituted the progressive reduction of beds in psychiatric hospitals and the requirement that they should have a multidisciplinary team that promotes therapeutic and occupational activities in the institution’s routine.
The multi-professional team must have a sufficient number of professionals, facilities, and material resources for the number of hospitalized patients. It is essential to remember a historical relationship between the Anti-manicomial Fight and the re-democratization process in Brazil. The demands of the Anti-Asylum Struggle Movement for a legal apparatus that would recognize the rights of people with mental health disorders prevent arbitrariness in determining the deprivation of liberty and recognize the Human Rights of persons deprived of freedom coincided with the effort to conquer the Democratic State of Law in the country. The Federal Constitution of 1988 gave rise to the questioning of treatment in an asylum institution.
Psychiatric Reform Law
Laws 8,080/90 (Organic Health Law) and Law 8,142/90 (which deal with society’s participation and health financing) ensured the right to care in freedom for people in situations of vulnerability. The Psychiatric Reform Law is part of the efforts to humanize asylum institutions. The great convergence with international Legislation for the Defense of Human Rights, such as the International Convention on the Rights of Persons with Disabilities, emerged in 2006 and was ratified in Brazil in 2008. Persons with a history of behavior or mental health disorders include in the concept of persons with disabilities.
In 2013, the Law that established the National System for the Prevention and Combat of Torture defined that people hospitalized in psychiatric hospitals should consider persons deprived of their liberty. Cruel and degrading treatment in psychiatric hospitals can, from this Law, and equated with Torture. In this sense, psychiatric hospitals that impose degrading treatment on people can be framed not only in the crime of ill treatment but also in the crime of Torture.
In 2015, the Brazilian Law for the Inclusion of Persons with Disabilities approved the Statute of Persons with Disabilities, covering people with mental disorders, including people with conditions resulting from drug use. According to this Law, cases of suspected or confirmed violence against persons with disabilities must be compulsorily reported to the police authority, the Public Ministry, and the Councils for the Rights of Persons with Disabilities.
Before Law 10,216, the government instituted the evaluation and restructuring of psychiatric hospital care to redirect the mental health care model. The National Hospital Services Program (PNASH/Psychiatry) and the Annual Psychiatric Hospital Care Restructuring Program (PRH). The lawmakers had planned that the assessments would take place annually.
However, only four evaluations were carried out by the PNASH (years 2002, 2003-2004, 2007-2009, and 2012-2014). It is noteworthy that the Psychiatric Hospitals of Maranhão (Hospital Nina Rodrigues, Clinic LaRavardiere, and Clinic São Francisco) were nominated for disqualification from the SUS after the 2012-2014 assessments. Since 2014, without the PNASH assessment, the means to proceed with restructuring the care model with a view to the Humanization of Mental Health Care have decreased.
On the contrary, in 2017 and 2018, new administrations in the Federal Government implemented changes in the Legislation that allowed an increase in the number of beds in psychiatric hospitals and private entities. The objective to redirect the treatment model to the network of open services without continuity evaluation of these hospitals is what was not needed and the converse of work towards progress.
Humanization of Mental Health Care
In 2018, the Public Ministry of Labor (MPT) and the Federal Council of Psychology (CFP) carried out a National Inspection through an inter-institutional action organized by the National Mechanism for the Prevention and Combat of Torture (MNPCT), the National Council of the Public Ministry (CNMP), This inspection found irregularities and violations of patients’ rights in psychiatric hospitals, including hospitals accredited to the SUS in Maranhão (Hospital Nina Rodrigues, Clinic LaRavardiere, and Clinic São Francisco).
Severe violations of rights: Proof of these violations by inspections of supervisory bodies faces obstacles and limitations. Generally, those responsible for reviews cannot enter institutions outside of specific hours and cannot fully participate in the routine of an asylum institution. They are likely to observe fewer rights violations than what happens in these spaces.
Complaints by users. Users suffered violations of their rights. Several obstacles for users to reach the institutional channels of the Judiciary. In addition to access to legal institutions, people social socioeconomically disadvantage are often overloaded with the care of a person with a mental disorder, and their efforts are focused on seeking health care, and not on reporting a violation of rights. The violence suffered in institutions is attributed to “delusions,” “fanciful reports” of people with mental illnesses. These are not credible.
Reports from relatives showed strong evidence of having been victimized by institutional violence at Clinic São Francisco, a psychiatric institution accredited to the SUS and which receives patients from all over the State of Maranhão. Some of these people died under suspicious conditions during or shortly after treatment at the Clinic mentioned above. We hope that with this collective initiative, the Public Defender’s Office of Maranhão will be able to take steps to demand a rigorous investigation into what appears to be a case of repeated violations of the rights of the population of the State. In this same report, we would also denounce the State’s violence against people with mental health behavior who have been killed by state employees (law enforcement).
Francisco Osvaldo Dias de Sousa
The relatives of Mr. Francisco Osvaldo Dias de Sousa have already obtained legal assistance from the Public Defender’s Office of the State of Maranhão at the Regional Center of São José de Ribamar, with Defender Everton Rocha. The next of kin of the other three alleged victims at this moment request the assistance of the Public Defender’s Office of Maranhão in São Luís. 38 years old. Official diagnosis: bipolar disorder Treatment: he used a prescription drug (Olanzapine) for 13 years. Reason for hospitalization: due to the lack of medication provided by FEME-MA, Francisco Osvaldo started having psychosis and became aggressive. In one of the crisis s, the mental health system took the family on 11/24/2020 to Nina Rodrigues Hospital. He was referred to the São Francisco de São Luis Neuropsychiatry Clinic the following day. When he was hospitalized, his physical and mental health status was healthy, weighing 86 kilos, and he had some mood swings due to lack of medication. Period of hospitalization: from 11/25/2020 to 03/10/2021.
Family contact and visits were not allowed in the first weeks. After that period, the family managed to visit Francisco only twice, as soon after, the visits were suspended with the justification of the Covid-19 pandemic. Osvaldo’s physical and mental health status when he was released to his family: He was left at the door without medical discharge, in the company of the social worker Lindinees Vieira, forty kilos thinner, teeth damaged, dark skin (apparently burned), with confusion mental, with marks of aggression such as bites, scratches and evident signs of abuse and medical negligence. In addition, with the abdomen distended and unable to evacuate.
Osvaldo was taken to Nina Rodrigues. There, he was in mechanical restraint for more than 30 hours. At the family’s insistence, he was referred to the General Hospital for a CT scan, which evidenced clear signs of medical negligence. Francisco was transferred between these hospitals several times without getting medical help until he was taken to Hospital Socorrão 2, where he could not resist and died at the age of 38 on 03/13/2021.
The autopsy report: showed death from septic shock and pneumonia. The family filed a police report with the Civil Police Station of Operária city three times to file a police report (before and after Francisco’s death). The same was denied by the office in charge of the police station Edmar Gomes.
Complaints: the Observatório de Direitos Humanos and the Public Ministry were made before his death and as soon as he left the Clinic. The case has already been reported on national and international blogs and by the main TV networks (Globo, Record, SBT, and BAND).
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This is the Public Defender’s Office of Maranhão, Regional Center of São José of Ribamar.
Jorge Luis Oliveira Junior
Jorge was eighteen years old . He suffered from a diagnosis of chemical-dependency. His recommended treatment was a fifteen-day hospitalization at the Clinic for detoxification and psychiatric medication. Physically and mentally, his health status when hospitalized was lucid. He was physically healthy but with signs of psychomotor agitation.
During the hospitalization, there was no contact allowed with patients and Jorge’s family. Jorge’s mother believes that Jorge was discharged because of his fragile physical condition. Jorge was found on 01/31/214 roaming around disoriented at night nearby the clinic area by a family member. Jorge showed signs of beatings, vomiting blood, and burning his mouth, according to reports, from the use of acid.
Family members took Jorge to Hospital Socorrão 2 on 02/01/2014. He had part of his tongue extracted and went into a coma. Jorge died on 04/22/2014, aged 18, due to head trauma and tongue burns. The same was delivered to the family for burial without going through the IML for autopsy. Jorge’s mother tried to register a police report at the Civil Police Station of Cidade Operária. Still, she was referred to the Jardim Tropical Police Station (claiming that the Clinic belonged to the municipality of São José de Ribamar. Neither of the two police stations provided a report of the event. The family sought the Public Ministry, which also did not offer assistance. Jorge Luis left a daughter who was less than one year old and who was also an orphan. Jorge Luis’ mother went into depression after the happened and, to this day, awaits justice. There are no investigations into the case so far.
Vitor Vinicius Alves Salles
Vitor was 21 years old. His official diagnosis is chemical-dependency. He was hospitalized for detoxification and referred by the States Hospital Nina Rodrigues tô Clínica São Francisco for hospitalization and detoxification purposes. When he was hospitalized, Victor’s physical and mental health status did not have any physical health problems, entering the Clinic healthy.
Vitor stayed hospitalized from 11/23/2015 to 12/14/2015. His family strictly relied upon and prohibited any contact with the patient during his hospitalization. The family could not have contact with the patient throughout hospitalization. The patient’s physical and mental health status when leaving the Clinic, the family found Vitor in Socorrão 2 Hospital dead, with signs of Torture, malnourished, and one arm was broken. Hospital workers used inappropriate treatment leaving shock marks, genitals with shock marks, broken ribs, broken nose, loss of teeth, broken teeth, and cuts from ear to ear on the back of the head and his skull fracture, the body already showing signs of decomposition. The autopsy report stated the cause of his death from pneumonia.
The remedy, his family, filed a police report at the Civil Police Station of Cidade Operária and tried to file a lawsuit in court. Still, the lawyer abandoned it before the lawsuit was filed. There are currently complaints in the Federal Public Ministry in Maranhão, complaints in the Human Rights of Maranhão, and monitoring by the Observatory of Human Rights. The family seeks a public defender to assist with the case. The case was reported by TV Mirante (Rede Globo) shortly after Victor’s death, and to this day, it has repercussions on social networks and digital media. The family reports that in between, his mortal remains have gone missing from the place where he was placed to rest. There has been no trial so far.
Jose Vandeilson Silvina de Sousa
Jose was forced disappeared on November 9-2020, by the Agents of the Child Protective Services. (Conselho Tutelar do Alto Alegre do Maranhão.) Jose Vandeilson Silvina de Souza (Vava) 17 years old black teenager who had Schizophrenia and Intellectual developmental delay. During the Covid-19 pandemic, he was having a crisis of anxiety. Medical care assistance was denied to him, and after three visits to the Child Protective Services on the third visit, the agents from Child Protective Services disappeared. The minor lives no trace to this day, where they have him locked up. The coverup and injustice did all without any knowledge of the family to this day. We do not know where he is locked up; there are suspicions that he was severely tortured inside his own home before the State took him away. Remedies the justice has not punished the perpetrators of this crime, and no one has been held accountable for the violations.
Jenivaldo de Jesus
Jenivaldo was a thirty eight year old black man killed by federal law enforcement on May 25-2022. He had a history of behavior mental health disorder schizophrenia, was executed by Torture inside a police car, transformed into a gas chamber, and died by suffocation.
Alino Fernandes Campos from Ariri-MA
Alino suffered from chronic depression and is suspicious he uses illegal substances. The police killed him in the State of Maranhao during a mental health crisis; the law enforcement did not know how to help him. The solution was to execute him on the spot.
Marcelo was twenty five years old man who had Schizophrenia. The last time he was seen alive getting in a police car in the State of Maranhao 30 days later. His body was found with bullet holes in 2021, about nine months ago
Hamilton Cesar Lima Bandeira
Hamilton was twenty three years old. He suffered from Developmental Intellectual Delay during mental health crisis was executed inside his home in cold blood with three shoots in his chest on June 18, 2021
This work was done with many hands on working together with:
Editor Max Guttman, Licensed Clinical Social Worker
Translation and adaptation Ana Medeiros
Psychologist Jose Algusto