Saúde mental no sistema prisional

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, 2011Introdução. A população carcerária é composta, em sua esmagadora maioria, de indivíduos oriundos de classes socialmente excluídas: pobres, com baixa qualificação profissional e desempregados. No Brasil, a regra do sistema prisional é a superlotação, ambientes altamente insalubres onde são usurpados os direitos dos detentos e se desenvolvem e proliferam diversas patologias, resultando numa total ineficácia do sistema de ressocialização. Método. Este estudo analisa as condições das unidades prisionais do estado de Santa Catarina e da aplicação das políticas de saúde voltadas para as prisões, principalmente no que tange à saúde mental. Trata-se de um estudo qualitativo, descritivo-observacional. Foram levantados dados da produção literária no assunto para revisão bibliográfica crítica. Os dados empíricos foram obtidos a partir da observação participante e análise do discurso das entrevistas semi-estruturadas conduzidas com os administradores de uma amostra representativa das unidades prisionais do estado de Santa Catarina. Resultados: A precariedade das unidades prisionais de Santa Catarina evidencia a má aplicação das políticas de saúde no sistema carcerário. A superlotação, infra-estrutura precária e déficit em recursos humanos estão relacionados a problemas de saúde nas prisões, principalmente, HIV, tuberculose e outras doenças infecciosas, doenças respiratórias, dermatoses e transtornos mentais. A desassistência na saúde compromete a segurança da unidade prisional e da sociedade, ao passo que a desassistência em saúde mental relaciona-se com maiores níveis de detenção. Discussão: A ressocialização dos detentos é indissociável das condições de saúde nas prisões. O entendimento de saúde pública e coletiva está intimamente relacionado com o sistema prisional, pois enquanto os direitos dos detentos foram negligenciados, toda a sociedade sofre as conseqüências. Noutra via, enquanto o portador de transtorno mental estiver desassistido, maiores os riscos de detenção destes indivíduosIntroduction. The prison population is composed overwhelmingly of individuals from socially excluded classes: poor, low-skilled and unemployed. In Brazil, the rule of the prison system is overcrowding, unsanitary environments where the rights of detainees are highly usurped and where develop and proliferate several diseases, resulting in a total ineffectiveness of the rehabilitation system. Method. This study analyzes the conditions of prisons in the state of Santa Catarina and implementation of health policies aimed at the prisons, especially about the mental health. It is a qualitative study, descriptive and observational. Literature data about the subject were collected were for critical review. Empirical data were obtained from participant observation and discourse analysis of semi-structured interviews conducted with administrators of a representative sample of prisons in the state of Santa Catarina. Results: The precariousness of the prisons of Santa Catarina shows the poor implementation of health policies in the prison system. Overcrowding, poor infrastructure and deficit in human resources are related with health problems in prisons, especially, HIV, tuberculosis and other infectious diseases, respiratory diseases, skin diseases and mental disorders. The lack of attendance at health compromises the security of the prison unit and society, while the lack of attendance in mental health is related to higher levels of arrest. Discussion: The rehabilitation of inmates is linked to the health conditions in prisons. Collective and public health is closely related to the prison system, because while the rights of detainees were neglected, the whole society suffers the consequences. In another way, while the mentally ill is unattended, there are greater risks of arresting for these peopl

Psychiatric legal investigation for sickness benefits due to disability at the Brazilian Federal Social Security Special Court in Florianópolis, capital city of the State of Santa Catarina, southern Brazil

Objective: To describe the profile of insured individuals that filed claims for sickness benefits and compare the results of the administrative and legal investigations.Method: This case series included 114 insured persons that filed lawsuits against the Brazilian National Institute of Social Security (Instituto Nacional de Seguridade Social, INSS). They underwent psychiatric examinations required by the Brazilian Federal Social Security Special Court in Florianópolis from August to December 2010.Results: Mean age was 47 years, and participant age ranged from 24 to 64 years. Most insured individuals were women (79%), and most were employed (67.5%) and self-employed (26.5%) workers. Mean contribution time was 99.9 months, ranging from 8 to 352 months. Mean benefit duration was 20.4 months, ranging from 2 to 97 months. The most prevalent category of workers was service workers, store and supermarket salespeople (54.4%), followed by administrative workers (19.3%).Conclusions: Only 17 participants were found to be unable to work after benefit cessation, a 14.9% mismatch between administrative and legal investigations. The most frequent diagnoses were mood disorders (59.6%) and anxiety disorders (17.5%)