Consortium Psychiatricum (Sep 2020)
Community-based mental health services in Brazil
Abstract
Introduction. The shift from the hospital-based model of care to community-based mental health services beganthree decades ago and is still an ongoing process in Brazil. Objectives. To update data on the development of the community mental health services network in Brazil in relationto service availability and structure, manpower, pattern of service use, financing, epidemiological studies and theburden of mental disorders, research and national mental health policy. Methods. Searches were constructed to collect data on indexed databases (Medline, Scielo), as well as governmental,NGOs and medical council sources, reports and the grey literature up until 30th March, 2019. Results. Community mental health services are unevenly distributed in the country. Brazil leads the world in termsof the prevalence of anxiety disorders, ranking fifth for depression prevalence. Violence and suicide rates are twogrowing factors which exacerbate the prevalence of mental disorders prevalence. An increased reduction of thenumber of psychiatric beds in the country, in addition to the unbalanced growth of services in the community, hasresulted in treatment gaps and the underutilization of services and barriers to treating people with the most severepsychosis. Investment in mental healthcare is still scarce. However, mental health funding is not addressed accordingto the populations needs and scientific evidence, resulting in a waste of resources and inefficiency. Programmesand service interruptions are common according to each government mandate. Conclusion. Successive changes in ideological perspectives have led to the introduction of policies which have causedfragmentation in the mental health system and services. A lack of evaluation and transparency of services and costsare the main barriers to integrating multiple services and planning long-term developmental phases.
Keywords
