Healthcare Coverage Index in the Psychosocial Care Network (iRAPS) as a tool for critical analysis of the Brazilian psychiatric reform

Nearly 20 years after the implementation of Brazil's psychiatric reform, the country has a hybrid model of mental health care, in which asylum services are part of the network that should replace them. This study aimed to critically analyze the supply of mental health services in Brazil in order to verify whether there is actually a replacement of asylum-based services by community-based services. A retrospective longitudinal study was performed on the supply of mental health services in Brazil from 2008 to 2017, building a single database on 5,570 municipalities (counties). As an ancillary tool for critical analysis of the psychiatric reform, we developed the Health Coverage Index for the Psychosocial Care Network (iRAPS, in Portuguese), considering the services legal parametrization. The results showed an increase in the supply of community-based services and a reduction in asylum services. However, the iRAPS tool found that 77% of the Brazilian population lives in areas with low or nonexistent coverage of community services. Small towns, with 16% of the Brazilian population, were those with the greatest increase in iRAPS. Only 439 cities, 7.9% of the total, showed total coverage by the Psychosocial Care Network (RAPS, in Portuguese), expressing only 6.69% of the national population. The metropolises, with 46% of the Brazilian population, did not show an increase in community services. The analysis of the supply of mental health services based on the iRAPS tool showed that the increase in community services did not occur homogeneously across the country.