Mental health care for Brazilian juvenile offenders

This paper analyzes the use of psychoactive drugs by juvenile offenders in Brazil in socio-educational facilities (USEs). It describes the guidelines of the national public policy and the quality of mental healthcare coordination by subnational public governments. This work draws on the hypothesis that USEs vertical governance is associated with the use of psychoactive medication. This is comparative study of two cases in Rio Grande do Sul and Minas Gerais. Data resulted from a sample of medical records and interviews with key informants. The paper shows that vertical governance observed in Rio Grande do Sul is directly associated with high prevalence of mental health disorder diagnosis, use of psychoactive medication and psychiatric medicalization by juvenile offenders deprived of liberty. These findings indicate that sanctions of imprisonment for illegal acts are producing a set of medicalization decisions that undermine juveniles' health rights. The national mental health policy guidelines encourage cautious decisions. Psychotherapies and rehabilitation actions are the advocated first-line interventions. The poor management of the psychopharmacological intervention favors multiple prescriptions.