Community mental healthcare services in São Paulo, Brazil

Since 2002 community mental healthcare services ( Centros de Atenção Psicossocial – CAPS) are the principal resources for healthcare of people with severe and persistent mental illnesses in Brazil. These services are unequally distributed within the country, and more specifically in large cities like São Paulo. The aim of this study was to describe the structure, process and results of care offered by 22 CAPS for treatment of adults in São Paulo, between April 2007 and May 2008.

 Methods:
We conducted an ethnographic observation (during one week) of each CAPS, followed by interviews with staff and care workers and applied standardized questionnaires to the patients of the CAPS. After one year, patients were interviewed again to access their prognosis.

 Results:
CAPS are heterogeneous in terms of structure (facilities, furniture, staff composition, etc.) and process of care, with several kinds of group activities. We assessed 457 group activities performed with patients inside CAPS, classified in:
(1) Art and cultural activities (24.7%).
(2) Activities to promote social integration (18.4%).
(3) Group psychotherapies, (17.9%).
(4) Manual activities (11.6%).
(5) Activities to improve self care and daily routines (10.1%).
(6) Activities to improve psycho-physical integration (7.7%).
(7) Activities to activate personal income (3.3%).
(8) Others (6.3%).

 The schedule of the activities of each CAPS frequently depends on the abilities and wishes of the care workers, and not on the patients’ characteristics. All schedules included external activities.  Many of these activities were performed in partnership with libraries, cultural centers and other community resources. The CAPS are using different approaches of psychosocial rehabilitation. We interviewed 494 patients, many of them were schizophrenics with previous psychiatric hospitalizations. The principal community resource used by the patients are religious institutions. Many patients remained in treatment within the CAPS over many years due to lack of mental care in other health services.