[Mental health worldwide: commentary on the WHO 2022 Report]. / La salute mentale nel mondo: commento al rapporto OMS 2022.

We report in this issue a contribution by Benedetto Saraceno, published in Salute Internazionale (https://www.saluteinternazionale.info), commenting on the WHO 2022 report on mental health in the world. The comment highlights the progresses but also the presence, beyond declarations of principle, of large psychiatric institutions. There is still a long way to go to defend the rights of people with psychiatric problems.

Upgraded Three-Wavelength Lidar for Real-Time Observations of Volcanic Aerosol Optical and Microphysical Properties at Etna (Italy): Calibration Procedures and Measurement Tests.

An innovative mobile lidar device, developed to monitor volcanic plumes during explosive eruptions at Mt. Etna (Italy) and to analyse the optical properties of volcanic particles, was upgraded in October 2023 with the aim of improving volcanic plume retrievals. The new configuration of the lidar allows it to obtain new data on both the optical and the microphysical properties of the atmospheric aerosol. In fact, after the upgrade, the lidar is able to measure three backscattering coefficients, two extinction coefficients and two depolarisation ratios in a configuration defined as "state-of-the-art lidar", where properties such as particle size distribution and the refractive index can be derived. During the lidar implementation, we were able to test the system's performance through specific calibration measurements. A comparison in an aerosol-free region (7.2-12 km) between lidar signals at 1064 nm, 532 nm and 355 nm and the corresponding pure molecular profiles showed a relative difference of <1% between them for all the wavelengths, highlighting the good dynamic of the signals. The overlap correction allowed us to reduce the underestimation of the backscattering coefficient from 50% to 10% below 450 m and 750 m at both 355 and 532 nm, respectively. The correct alignment between the laser beam and the receiver optical chain was tested using the signal received from the different quadrants of the telescope, and the relative differences between the four directions were comparable to zero, within the margin of error. Finally, the first measurement results are shown and compared with results obtained by other instruments, with the aim of proving the ability of the upgraded system to more precisely characterise aerosol optical and microphysical properties.

Human rights of persons with mental disability: from discourse to reality.

Since 1989, the major professional organization of psychiatrists has expressed concern for the human rights of people with mental disorders: "Involuntary intervention is a great infringement of the human rights and the fundamental freedom of a patient. Therefore, specific, and carefully defined criteria and safeguards are needed for such intervention. Hospitalization or treatment against the will of a patient should not be conducted unless the patient suffers from serious mental illness. Involuntary intervention must be conducted in accordance with the least restrictive principle.

An outstanding message of hope: the WHO World Mental Health Report 2022.

The new WHO World Health Report on Mental Health includes a comprehensive and updated assessment of the current mental health situation at the global level, a critical and well-documented reflexion on the progresses achieved and the failures registered in global mental health, and an indication of the paths and strategies that should be prioritised to ensure the transformations that are urgently needed. The report offers significant enrichments on different areas like social determinants, premature mortality of persons suffering from mental disability, the negative aspects of the persistence of inpatient institutions, the role of people with lived experience as important agents of change, the importance of child and adolescent mental health. The present Editorial stresses the importance of Deinstitutionalisation as a cross-cutting element of all health policy, plans, budgeting and service organisation and draws attention to the fact that the ubiquitous persistence of large psychiatric institutions is a clear indicator that reality is far from declarations despite the UN Convention on the Rights of Persons with Disability.

Social Vulnerability and Mental Health Inequalities in the "Syndemic": Call for Action.

Covid-19 is referred to as a "syndemic," i.e., the consequences of the disease are exacerbated by social and economic disparity. Poor housing, unstable work conditions, caste, class, race and gender based inequities and low incomes have a profound effect on mental health and wellbeing. Such disparities are increasing between, among and within countries and are exacerbated by human rights violations, in institution and in society, stigma and discrimination. Social capital can mediate health outcomes, through trust and reciprocity, political participation, and by mental health service systems, which can be coercive or more open to demand of emancipation and freedom. Societal inequalities affect especially vulnerable groups, and Covid itself had a wider impact on the most socially vulnerable and marginalized populations, suffering for structural discrimination and violence. There are complex relations among these social processes and domains, and mental health inequalities and disparity. Participation and engagement of citizens and community organizations is now required in order to achieve a radical transformation in mental health. A Local and Global Action Plan has been launched recently, by a coalition of organizations representing people with lived experience of mental health care; who use services; family members, mental health professionals, policy makers and researchers, such as the International Mental Health Collaborating Network, the World Federation for Mental Health, the World Association for Psychosocial Rehabilitation, the Global Alliance of Mental Illness Advocacy Networks (GAMIAN), The Mental Health Resource Hub in Chennai, India, The Movement for Global Mental Health (MGMH) and others. The Action Plan addresses the need for fundamental change by focusing on social determinants and achieving equity in mental health care. Equally the need for the politics of wellbeing has to be embedded in a system that places mental health within development and social justice paradigm, enhancing core human capabilities and contrasting discriminatory practices. These targets are for people and organizations to adopt locally within their communities and services, and also to indicate possible innovative solutions to Politics. This global endeavor may represent an alternative to the global mental discourse inspired by the traditional biomedical model.

Barriers to mental health services utilisation in Portugal - results from the National Mental Health Survey.

BACKGROUND: The treatment gap for mental disorders remains a challenge worldwide. Identifying reasons for nontreatment may contribute to reducing this gap. AIMS: To evaluate sociodemographic and clinical factors associated with use and barriers to treatment in Portugal. METHOD: Data from the 2009 National Mental Health Survey were used. Participants reported 12-month treatment and reasons for nontreatment. Logistic regression models analysed the association between sociodemographic (education; employment; income; marital status) and clinical variables (mental disorder diagnosis; disability) with treatment and type of barriers (low perceived need; structural; attitudinal). RESULTS: The majority of participants with a mental disorder was not treated. Treatment was more common among participants with mood disorders (OR = 4.19; 95% CI: 2.72-6.46), and disability (OR = 2.43; 95% CI: 1.33-4.46), and less common among single participants (OR = 0.38; 95% CI: 0.20-0.70) and those with basic/secondary education (OR = 0.42; 95% CI: 0.24-0.73). Attitudinal barriers were more likely among participants with none/primary (OR = 2.90; 95% CI: 1.42-5.90) and basic/secondary education (OR = 1.70; 95% CI: 1.01-2.85), and less likely among those with substance use disorders (OR = 0.27; 95% CI: 0.10-0.70). Low perceived need was higher among single people (OR = 1.77; 95% CI: 1.01-3.08), and lower among those with anxiety (OR = 0.50; 95% CI: 0.28-0.90) and mood disorders (OR = 0.16; 95% CI: 0.09-0.30). Unemployed participants had higher odds of reporting structural barriers (OR = 3.76; 95% CI: 1.29-10.92). CONCLUSIONS: This study identifies factors associated with nontreatment, providing useful evidence to develop policies and effective interventions.

Factors associated with involuntary psychiatric hospitalization in Portugal.

BACKGROUND: Identifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012. METHODS: Data from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors. RESULTS: An increment of involuntary hospitalizations was associated with male gender [exp([Formula: see text]) = 1.31; 95%CI 1.06-1.62, p < 0.05], having secondary and higher education [exp([Formula: see text]) = 1.45; 95%CI 1.05-2.01, p < 0.05, and exp([Formula: see text]) = 1.89; 95%CI 1.38-2.60, p < 0.001, respectively], a psychiatric diagnosis of psychosis [exp([Formula: see text]) = 2.02; 95%CI 1.59-2.59, p < 0.001], and being admitted in 2007 and in 2012 [exp([Formula: see text]) = 1.61; 95%CI 1.21-2.16, p < 0.01, and exp([Formula: see text]) = 1.73; 95%CI 1.31-2.32, p < 0.001, respectively]. A decrease in involuntary hospitalizations was associated with being married/cohabitating [exp([Formula: see text]) = 0.74; 95%CI 0.56-0.99, p < 0.05], having experienced a suicide attempt [exp([Formula: see text]) = 0.26; 95%CI 0.15-0.42, p < 0.001], and belonging to the catchment area of three of the psychiatric services evaluated [exp([Formula: see text]) = 0.65; 95%CI 0.49-0.86, p < 0.01, exp([Formula: see text]) = 0.67; 95%CI 0.49-0.90, p < 0.01, and exp([Formula: see text]) = 0.67; 95%CI 0.46-0.96, p < 0.05 for Hospital de Magalhães Lemos, Centro Hospitalar Psiquiátrico de Lisboa and Unidade Local de Saúde do Baixo Alentejo, respectively]. CONCLUSIONS: The findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with several sociodemographic, clinical, and contextual factors. This information may help identify high-risk patients and inform the development of better-targeted preventive interventions to reduce these hospitalizations.

Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence.

BACKGROUND: Coercive treatment comprises a broad range of practices, ranging from implicit or explicit pressure to accept certain treatment to the use of forced practices such as involuntary admission, seclusion and restraint. Coercion is common in mental health services. AIMS: To evaluate the strength and credibility of evidence on the efficacy of interventions to reduce coercive treatment in mental health services. Protocol registration: https://doi.org/10.17605/OSF.IO/S76T3. METHOD: Systematic literature searches were conducted in MEDLINE, Cochrane Central, PsycINFO, CINAHL, Campbell Collaboration, and Epistemonikos from January 2010 to January 2020 for meta-analyses of randomised studies. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was classified using quantitative umbrella review criteria, and credibility of evidence was assessed using the GRADE approach. RESULTS: A total of 23 primary studies (19 conducted in European countries and 4 in the USA) enrolling 8554 participants were included. The evidence on the efficacy of staff training to reduce use of restraint was supported by the most robust evidence (relative risk RR = 0.74, 95% CI 0.62-0.87; suggestive association, GRADE: moderate), followed by evidence on the efficacy of shared decision-making interventions to reduce involuntary admissions of adults with severe mental illness (RR = 0.75, 95% CI 0.60-0.92; weak association, GRADE: moderate) and by the evidence on integrated care interventions (RR = 0.66, 95% CI 0.46-0.95; weak association, GRADE: low). By contrast, community treatment orders and adherence therapy had no effect on involuntary admission rates. CONCLUSIONS: Different levels of evidence indicate the benefit of staff training, shared decision-making interventions and integrated care interventions to reduce coercive treatment in mental health services. These different levels of evidence should be considered in the development of policy, clinical and implementation initiatives to reduce coercive practices in mental healthcare, and should lead to further studies in both high- and low-income countries to improve the strength and credibility of the evidence base.

Pandemia, Saúde Mental e Democracia / Pandemia, Salud Mental y Democracia

A pandemia de COVID-19 desencadeou processos de transformação de antigas categorias e, entre elas, uma nova consciência da ausência de democracia nos sistemas de saúde. A função reguladora dos descartes de normalidade, típica da psiquiatria institucional e prisional, certamente não desapareceu, apesar das reformas e das boas práticas: a ideia de conter as liberdades e de perder vidas ainda é válida. O ensaio problematiza os aprendizados na pandemia em relação aos cuidados em saúde mental. Nesta pandemia, vimos que muitos outros cidadãos ficaram sem voz e sem poder e, com a mesma lógica, devemos continuar a produzir processos de desinstitucionalização, ou seja, de restituição de voz, de sentido e de poder aos que estão privados deles. E teremos que fazer isso com a dureza necessária. Aula ministrada na Disciplina Análise crítica da evolução histórico-social da assistência em saúde mental e suas principais bases, do Programa de Pós-graduação Interunidades em Enfermagem EEUSP, em 07/04/2021.

How did the use of psychotropic drugs change during the Great Recession in Portugal? A follow-up to the National Mental Health Survey.

BACKGROUND: Research suggests that economic recessions might be associated with a higher use of psychotropic drugs, but literature is scarce and contradictory in identifying the most vulnerable groups. This study aims to assess possible changes in the use of psychotropic drugs due to the economic recession in Portugal, by comparing self-reported consumption in 2008/09 and 2015/16. METHODS: Data from the World Mental Health Survey Initiative Portugal (2008/09) and the National Mental Health Survey Follow-Up (2015/16) were used (n = 911). McNemar's tests were performed to estimate changes in consumption of any psychotropic drug and of antidepressants, anxiolytics, and hypnotics/sedatives. Multiple Generalised Estimating Equations models with interaction effects were used to estimate the population odds of consuming psychotropic drugs according to year, gender and age. RESULTS: An increase of 6.74% was estimated in the consumption of psychotropic drugs from 2008/09 to 2015/16. Population odds of consuming any psychotropic drugs in 2015/16 were estimated to be 1.5 times higher than in 2008/09 (OR = 1.50;95%CI:1.13-2.01), particularly for hypnotics/sedatives (OR = 1.60;95%CI:1.14-2.25). Women and older individuals presented higher odds of consuming any psychotropic drugs (OR = 2.79;95%CI:2.03-3.84, and OR = 1.80;95%CI:1.28-2.54), after adjusting for year of assessment and education. However, when evaluating the interaction effect of the year with gender and age, men and younger individuals reported higher odds of consuming any psychotropic drugs in 2015/16, when compared to 2008/09 (OR = 1.85;95%CI:1.08-3.17, and OR = 1.95;95%CI:1.32-2.90, respectively). CONCLUSIONS: The findings indicate that the period of economic recession was associated with an increased risk of psychotropic drugs use in Portugal. Consumption of psychotropic drugs remained higher among women and older individuals, but the results suggest that the economic crisis had a disproportionate impact on men and younger individuals. This identification of the most vulnerable population groups is useful to design effective and targeted public health interventions aimed at alleviating the effects of economic recessions.

Forty years without mental hospitals in Italy.

In 1978 Italy implemented Law Number 180, the reform law that blocked all new admissions to public mental hospitals. After 40 years without mental hospitals, we aim at understanding the consequences of the Italian reform in terms of mental health care facility and staff availability. We compared the organization of the Italian mental health system with that of countries belonging to the Group of 7 (G7) major advanced economies. Italy has nearly 8 psychiatrists, 20 nurses, 2 social workers and less than 3 psychologists per 100,000 population, while for example in France there were 22 psychiatrists, in Japan 102 nurses, in the United States 18 social workers, and in Canada and France more than 45 psychologists per 100,000 population. In terms of inpatient facilities, no beds in mental hospitals were available in Italy, while in the other G7 countries mental hospital beds ranged from 8 in the United Kingdom to 204 in Japan per 100 000 population. In Italy there were fewer beds for acute care in general hospitals but more beds in community residential facilities than in the other G7 countries. Service use data showed variability in the provision of mental health care throughout the country. Soon after the implementation of the Italian reform the absolute number of compulsory admissions progressively declined, from more than 20,000 in 1978 to less than 9000 in 2015. Alongside the progressive decline of psychiatric beds imposed by Law 180, the age-adjusted suicide rate remained stable, ranging from 7·1/100,000 population in 1978 to 6·3/100,000 population in 2012. The population of psychiatric patients placed in Italian forensic psychiatric hospitals progressively declined. During the last 40 years without mental hospitals, Italy has seen a progressive consolidation of a community-based system of mental health care. We highlighted, however, reasons for concern, including a decreasing staffing level, a potential use of community residential facilities as long-stay residential services, a still too high variability in service provision across the country, and lack of national data on physical restraints. At a national level, the resources allocated to mental health care are lower in Italy than in other high-income countries.

[Functioning of Psychosocial Care centers in four cities in BrazilActuación de los Centros de Atención Psicosocial en cuatro centros urbanos en Brasil]. / Atuação dos Centros de Atenção Psicossocial em quatro centros urbanos no Brasil.

OBJECTIVE: To describe the functioning of Psychosocial Care centers (CAPS) in four Brazilian cities. METHODS: In this cross-sectional study (AcesSUS), 917 CAPS users were interviewed in the cities of Campinas, São Paulo, Porto Alegre, and Fortaleza. Only CAPS focused on severe mental disorders in adults were included, that is, CAPS focusing on substance abuse and on children and adolescents were excluded. Users answered a multiple choice questionnaire about their path from primary health care services until reaching the CAPS and hospital care in relation to mental health problems. RESULTS: Care by a psychiatrist and use of medications were reported by 90.7% to 99.7% of CAPS users in association with multiprofessinal care and therapeutic groups. Access to medication was interrupted in the 6 months prior to the interview, especially in Fortaleza (70%) and Porto Alegre (50%). In all cities, less than 10% of users had a psychiatric hospital admission after treatment at the CAPS was started. CONCLUSIONS: The transition from a hospital-centered model to a community-based model is well under way in Brazil, with concrete achievements. However, there is heterogeneity among different care networks, which entails the need for contextualized analysis of each individual location, with identification of difficulties that prevent the adequate functioning of these care networks in the psychosocial paradigm.

OBJETIVO: Describir la actuación de los Centros de Atención Psicosocial (CAPS) en cuatro centros urbanos en Brasil. MÉTODOS: Se realizó un estudio transversal (AcesSUS) por medio de una entrevista a 917 usuarios en seguimiento en los CAPS de Campinas, São Paulo, Porto Alegre y Fortaleza. Se incluyeron solo los tipos de CAPS donde se tratan trastornos mentales graves en adultos, con exclusión de los centrados en el uso de sustancias y servicios para niños y adolescentes. Los usuarios respondieron a un cuestionario de opción múltiple sobre su recorrido entre los servicios de atención primaria, los CAPS y los hospitales en relación con los trastornos de salud mental. RESULTADOS: Se notificaron servicios de atención psiquiátrica y uso de medicamentos, junto con atención multiprofesional y participación en grupos terapéuticos, en una proporción de 90,7% a 99,7% de los usuarios en seguimiento en los CAPS. El acceso a medicamentos se interrumpió en los 6 meses anteriores a la entrevista, particularmente en Fortaleza (70%) y Porto Alegre (50%). En todos los municipios, menos de 10% de los usuarios estuvieron internados en instituciones psiquiátricas después de iniciar el tratamiento en los CAPS. CONCLUSIONES: La transición del modelo hospitalario al comunitario sigue en curso de implementación en Brasil, con adelantos comprobados. Sin embargo, la situación es diversa en las diferentes redes de atención, lo cual exige un análisis contextualizado de cada localidad y la determinación de las dificultades que impiden el funcionamiento adecuado de esas redes en el paradigma psicosocial.

Atuação dos Centros de Atenção Psicossocial em quatro centros urbanos no Brasil / Functioning of Psychosocial Care centers in four cities in Brazil / Actuación de los Centros de Atención Psicosocial en cuatro centros urbanos en Brasil

RESUMO Objetivo Descrever a atuação dos Centros de Atenção Psicossocial (CAPS) em quatro centros urbanos no Brasil. Métodos Realizou-se um estudo transversal (AcesSUS) com entrevista a 917 usuários acompanhados nos CAPS de Campinas, São Paulo, Porto Alegre e Fortaleza. Foram incluídas apenas as modalidades de CAPS destinadas a transtorno mental grave em adultos, sendo excluídos os CAPS voltados para uso de substâncias e para crianças e adolescentes. Os usuários responderam a questionário de múltipla escolha sobre seu percurso entre os serviços de atenção primária, CAPS e hospitais em relação aos problemas de saúde mental. Resultados Atendimento psiquiátrico e uso de medicação foram relatados em 90% a 100% dos usuários acompanhados nos CAPS, combinado com atendimento multiprofissional e grupos terapêuticos. O acesso à medicação foi interrompido nos 6 meses que antecederam a entrevista, especialmente em Fortaleza (64%) e Porto Alegre (51%). Em todos os municípios, menos de 10% dos usuários tiveram internação psiquiátrica após início do tratamento no CAPS. Conclusões A transição do modelo hospitalar para o comunitário continua em processo de efetivação no Brasil, com avanços comprovados. A situação, porém, é diversa nas diferentes redes de atenção, requerendo análise contextualizada de cada localidade, com identificação de dificuldades que impedem o adequado funcionamento dessas redes no paradigma psicossocial.

ABSTRACT Objective To describe the functioning of Psychosocial Care centers (CAPS) in four Brazilian cities. Methods In this cross-sectional study (AcesSUS), 917 CAPS users were interviewed in the cities of Campinas, São Paulo, Porto Alegre, and Fortaleza. Only CAPS focused on severe mental disorders in adults were included, that is, CAPS focusing on substance abuse and on children and adolescents were excluded. Users answered a multiple choice questionnaire about their path from primary health care services until reaching the CAPS and hospital care in relation to mental health problems. Results Care by a psychiatrist and use of medications were reported by 90.7% to 99.7% of CAPS users in association with multiprofessinal care and therapeutic groups. Access to medication was interrupted in the 6 months prior to the interview, especially in Fortaleza (70%) and Porto Alegre (50%). In all cities, less than 10% of users had a psychiatric hospital admission after treatment at the CAPS was started. Conclusions The transition from a hospital-centered model to a community-based model is well under way in Brazil, with concrete achievements. However, there is heterogeneity among different care networks, which entails the need for contextualized analysis of each individual location, with identification of difficulties that prevent the adequate functioning of these care networks in the psychosocial paradigm.

RESUMEN Objetivo Describir la actuación de los Centros de Atención Psicosocial (CAPS) en cuatro centros urbanos en Brasil. Métodos Se realizó un estudio transversal (AcesSUS) por medio de una entrevista a 917 usuarios en seguimiento en los CAPS de Campinas, São Paulo, Porto Alegre y Fortaleza. Se incluyeron solo los tipos de CAPS donde se tratan trastornos mentales graves en adultos, con exclusión de los centrados en el uso de sustancias y servicios para niños y adolescentes. Los usuarios respondieron a un cuestionario de opción múltiple sobre su recorrido entre los servicios de atención primaria, los CAPS y los hospitales en relación con los trastornos de salud mental. Resultados Se notificaron servicios de atención psiquiátrica y uso de medicamentos, junto con atención multiprofesional y participación en grupos terapéuticos, en una proporción de 90,7% a 99,7% de los usuarios en seguimiento en los CAPS. El acceso a medicamentos se interrumpió en los 6 meses anteriores a la entrevista, particularmente en Fortaleza (70%) y Porto Alegre (50%). En todos los municipios, menos de 10% de los usuarios estuvieron internados en instituciones psiquiátricas después de iniciar el tratamiento en los CAPS. Conclusiones La transición del modelo hospitalario al comunitario sigue en curso de implementación en Brasil, con adelantos comprobados. Sin embargo, la situación es diversa en las diferentes redes de atención, lo cual exige un análisis contextualizado de cada localidad y la determinación de las dificultades que impiden el funcionamiento adecuado de esas redes en el paradigma psicosocial.

Formação e educação permanente em saúde mental na perspectiva da desinstitucionalização (2003-2015) / Training and permanent education in mental health under deinstitutionalization’s perspective (2003-2015)

O texto apresenta uma discussão e problematização acerca do espaço ocupado pelas ações de formação no campo das políticas públicas em saúde, bem como sobre as iniciativas tradicionalmente desenvolvidas, com destaque para o campo da saúde mental. Apresenta uma revisão das iniciativas desenvolvidas pela Coordenação de Saúde Mental, Álcool e outras Drogas do Ministério da Saúde entre os anos de 2003 e 2015, a partir dos Relatórios de Gestão publicados pela Coordenação e do informativo periódico Saúde Mental em Dados. Os documentos apontam que as iniciativas implementadas procuraram difundir os princípios do novo modelo de atenção em saúde mental, respondendo a um cenário de expansão de novos serviços e incorporação de novos profissionais na rede de saúde. Ao longo do tempo houve o aperfeiçoamento de algumas das ações e a incorporação de outras, buscando superar desafios recorrentes sobre a participação de gestores na construção de políticas locais de formação para a saúde mental e de estratégias baseadas no saber que se produz nos espaços de trabalho, que envolvam os profissionais da Rede de Atenção Psicossocial e centradas em práticas transformadoras do cuidado cotidiano. A desinstitucionalização foi tomada como a categoria analítica chave para a análise das ações de educação continuada em saúde mental no SUS.

The paper presents a discussion about the space occupied by traininginitiatives on the health’s public policies sector, as well as initiativestraditionally developed, especially in the mental health field. It presentsa review of the initiatives developed by the Mental Health Alcohol andother Drugs Sector of the Ministry of Health, between the years 2003and 2015, based on the Management Reports released by that Sectorand the journal “Saúde Mental em Dados”. The documents indicatethat the implemented actions sought to propagate the principles of thenew model on mental health care, answering to a scenario of expansionof new services and incorporation of new professionals in the healthcare workforce. Over time, some of the initiatives were improved andothers were incorporated, seeking to overcome recurring challengesregarding the participation of public managers in the elaboration oflocal policies for training in mental health and strategies based on theknowledge generated on workspaces that involve the Psychosocial CareNetwork professionals and focus on practices that can transform dailycare. Deinstitutionalition was taken as the key concept to analyse theinitiatives of mental health education in SUS (Brazilian Unified Health System).