Letter of protest
Letter to the The Minister of Health of Brazil, Dr Marcelo Castro
20 December 2015
Subject: Replacement of the mental health national coordinator with a former director of one of the dreaded psychiatric hospitals in Latin America
The undersigned, all mental health professionals from around the globe, among them many who have closely followed the admirable efforts that Brazil has made in mental health care over the years, have learned that those efforts are at risk of coming to an end.
Your Excellency, we are aware that it is the Government of Brazil that dictates the policies that guide the process of the Psychiatric Reform in the country, but our concern for the future of the Reform is born from our profound debt to your country for having taught us so much over recent years how to convert an archaic system of care to one that is observant of human rights, is inclusive of all relevant mental health parties, and is scientifically based.
Beginning with the pivotal role it played to achieve the Caracas Declaration (1990), which orients the restructuring of psychiatric care in all countries of the Region and beyond, continuing with the organization of the Region-wide meeting in 2005 that formulated the Principles of Brasilia, and culminating with the active involvment in the Directive Councils of the Pan American Health Organization to promote the Mental Health Reform in all countries of the Americas, has become a world leader in implementing it.
It is important to emphasize that the efforts Brazil has made in the last two decades to advance its mental health system are completely in line with WHO recommendations to shift from hospital to community-based care. In addition, the mental health system developed by Brazil is also in line with the UN Convention on the Rights of Persons with Disabilities, a Convention that your country is supporting with its signature and ratification.
We trust that our unanimous voice in expressing our deep concern for halting the Psychiatric Reform will be heard. We are persuaded that both the World Health Organization and the Regional Office of the Pan American Health Organization will be ready to collaborate with Brazilto maintain its excellent achievements in mental health care: the unobstructed continuation of the Psychiatric Reform will be for the benefit of Brazil and the countries in which we work.
Benedetto Saraceno, Gulbenkian Professor of Global Health, NOVA University, Lisboa, Portugal
Itzhak Levav, Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
José Miguel Caldas de Almeida, Head, Department of Mental Health NOVA University of Lisbon, Portugal
Emiliano Albanese, Director WHO collaborating center for training and research in mental health. Department of Psychiatry University of Geneva, Switzerland.
Michaela Amering, Professor of Social Psychiatry, University of Vienna, Austria
Victor Aparicio, President Presidente Asociación Asturiana de Neuropsiquiatría y Salud Mental, España
Corrado Barbui, Professor of Psychiatry, University of Verona, Italy
Thomas Bornemann, Director, the Mental Health Program, The Carter Center, Atlanta, USA
Nick Bouras, Director Maudsley International, King’s College, London UK
John Bowis, Former UK Health Minister and Health Spokesman in the European Parliament
Giovanna Del Giudice, President Permant Conference for World Mental Health (CoppersaMM), Italy
Giuseppe Dell’Acqua, Forum Salute Mentale, Italy
Julian Eaton, Senior Mental Health Advisor, Christian Blind Mission (CBM)
Angelo Fioritti, Health Commissioner, Bologna, Italy
John Jenkins, Chief Executive International Mental Health Collaborating Network, UK
Helen Killaspy, Professor of Rehabilitation Psychiatry, University College London, UK
Michael King, Professor of Primary Care Psychiatry, Division of Psychiatry (Faculty of Brain Sciences), University College London, UK
Arthur Kleinman, Director Harvard Asia Center, Harvard, USA
Stan Kutcher, Professor st Dalhousie University, Canada
Nasser Loza, DirectorBehman Psychiatric Hospital, Cairo, Egypt
Crick Lund, Director: Alan J Flisher Centre for Public Mental Health Department of Psychiatry and Mental Health, University of Cape Town, South Africa
John Mahoney, Consultant in Mental Health WHO Liberia and formally Head of Mental Health and Social Care for England, Department of Health, United Kingdom
Nino Makhashvili, Head of Mental Health Resource Center, Ilia State University, Tbilisi, Georgia. Director of GIP-Tbilisi, Georgia
Ambrogio Manenti, Senior Adviser to WHO, Cairo Egypt
Hugo Mercer, Professor Universidad Nacional Arturo Jauretche and Universidad Nacional de San Martin, Argentina
Roberto Mezzina, Director WHO Collaborating Centre for Research and Training, Trieste, Italy
Harry Minas, Head, Global and Cultural Mental Health Unit, Director, Melbourne Refugee Studies Program, The University of Melbourne, Australia
Soumitra Pathare, Co-ordinator Centre for Mental Health Law and Policy Indian Law Society, Pune, India
Jean Luc Roelandt, WHO Collaborating Centre for Research and Training, Lille, France
Franco Rotelli, Chairman Health Committee, Regione Friuli Venezia Giulia, Italy
Sashi Sashidaran, Professor Institute of Health & Wellbeing, University of Glasgow.
Deya Saymah, adviser WHO Occupied Palestinian Territories, Gaza.
Stelios Stylianidis, Professor of Social Psychiatry Panteion University, Athens, Greece
Rangaswami Thara, Director Schizophrenia Research Foundation, Chennai, India
Robert Van Voren, Chief Executive of Federation Global Initiative on Psychiatry and Vice-President of WFMH, The Netherlands
Lakshmi Vijayakumars, Director SNEHA, Chennai, India
Henrik Wahlberg, Senior Consultant, Psychiatrist, Karolinska, University Hospital Huddinge, Stockholm, Sweden
35 years of FGIP: 35 years of commitment to mental health
Anniversary project: support the work of Nest (Sri Lanka)
In December 2015 it is 35 years ago that the Foundation Human Rights in Mental Health-FGIP was founded in Paris. Originally called “The International Association against the Political Use of Psychiatry”, it was intended to be a temporary confederation of national organizations involved in the fight against the political abuse of psychiatry in the USSR. The organization successfully lobbied national and international medical associations, human rights groups and governmental agencies and by the end of the decade the political abuse of psychiatry had indeed come to an end. However, with the USSR opening up to the outside world, a new challenge appeared on the horizon: the struggle for a humane, ethical and consumer-oriented mental health care system. The subsequent 25 years the organization, now called GIP (Geneva – and later Global – Initiative on Psychiatry) worked tirelessly to improve the lives of persons with mental illness in Central & Eastern Europe, the former USSR, and later also in Africa, Sri Lanka, Indochina and the Caribbean. Hundreds of projects were implemented, ranging van small grassroots initiatives to large-scale reform projects, and the organization received international acclaim for its efficacy and commitment.
Now that the organization exists 35 years, our work is far from over. Through its central office of the Federation Global Initiative on Psychiatry (FGIP), its member organizations in Bulgaria, Georgia and Lithuania, and its many partners all over the world the organization continues its struggle for a humane and ethical mental health care system worldwide.
One of our partner organizations in based in Sri Lanka. Set up more than 25 years ago by Sally Hullugalle, the organization has developed a wide range of activities for persons with mental health problems who need support and care. Tirelessly, the volunteers of Nest work in both hospitals and the community, and through their work they have helped hundreds of people restore their lives and become active members of society again. Nest embodies all the values that FGIP stands for: commitment and dedication, determination, putting the consumers central and helping them to become or remain part of the community and have full-bodied lives.
One of the projects focuses at the Mulleriyawa mental hospital for women, where originally more than seven hundred women were locked up for the rest of their lives and lived under horrific conditions. Thanks to Nest, more than half of the women have been reintegrated into society and the remainder is living under far better circumstances both on the hospital grounds and in houses nearby. In order to continue their work, Nest needs financial support to meet the basic needs of the women, as well as to purchase a trishaw to transport women to the market for shopping or for outings into the community. Having a trishaw would greatly enhance the efficacy of Nest and give the women of Mulleriyawa a much greater sense of mobility and independence. The total cost for a trishaw is 4,000 euro, while the annual budget for Nest operations at Mulleriyawa is approximately 6,000 euro.
Instead of presents: support to Nest
When people have a birthday, they often receive presents. And so in the case of GIP's 35th anniversary, people have asked us whether we have special wishes. GIP was founded to help people in difficult circumstances. Then our target groups were people who were incarcerated in psychiatric hospitals for non-medical reasons because of their political or religious beliefs, now they are persons with mental illness who do not get adequate treatment or are stigmatised within their society. We feel it is not GIP that deserves a present, but rather our target population. For that reason we would like to ask your financial contribution to this special anniversary project.
Help us to continue our work in the coming years – and help Nest to continue their invaluable work.
ING Bank, Amsterdam, The Netherlands
BIC code: INGBNL2A
Bank account number: NL46 INGB 0006 0707 13
att.: Human Rights in Mental Health-FGIP, Postbus 1956, 1200 BZ Hilversum (NL)
Donations from the US that are made by check should be made out to “GIP-USA” and send to our address in The Netherlands, as they will be cashed in the United States by one of our members to avoid excessive bank costs.
Brazilian mental health threatened
On 10 December 2015, on the World Day of Human Rights and after a big meeting of workers in mental health field who are responsible for coordination of programs in municipalities, Marcelo Castro, the new Minister of Health in Brazil, has announced that Roberto Tykanori Kinoshita, the current Federal Coordinator of Mental Health and one of the main leaders of Brazilian mental health reform, would be substituted. Instead of him, the new Minister announced as the new federal coordinator is Valencius Wurch Duarte Filho, a psychiatrist who publically has affirmed to be against the principles of mental health reforms and made opposition to the creation and implementation of the main law of mental health reform, approved in 2001. Also, he has been the director of one of the most horrible psychiatric hospitals of Brazil during the 1990’s, named Dr. Eiras and located in Rio de Janeiro. This psychiatric hospital, the biggest of Latin America during the 1990’s, was definitely closed in 2012, after a federal intervention due to several denounces of violation of human rights.
On 14 December 2014, Roberto Tykanori Kinoshita was dismissed and Valencius Wurch Duarte Filho was officially nominated.
It is unacceptable the nomination of this psychiatrist to be the federal coordinator of mental health. Brazil is one of the countries with the most innovative and impressive reforms in mental health field in the world, recognized by WHO. The Brazilian mental health reform should continue.
It is not easy to explain how we get to this situation for who does not accompany politics in Brazil, especially the last year and a half, as it involves a big political and very serious scenario. But, for sure, it can be said that this situation is due to advance of a conservative politics. This is affecting not only health policies in general, but all the progressist politics on which we have made advances on the last 13 years.
Now, more than ever, we are facing the necessity to struggle towards the continuity of the psychiatric reform. This means that workers, users of services, families, civil society, and others have now to get together to think about what strategies we are going to develop to face this. And, for sure, this means to recover our historical banner to fight for a society without asylums. To stop this nomination, several meetings and protests are taking place in Brazil. But we have to join forces with other countries.
Defend the Brazilian mental health reform is to advocate for a society without asylums.
Cláudia Pellegrini Braga