Principles that should guide mental health policies in low-and middle-income countries (LMICs): lessons from the Brazilian experiment

Gentil, Valentim

doi:10.1590/s1516-44462011000100003

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…At the time of the study, there were 5 stand-alone psychiatric hospitals, 10 general hospitals with psychiatric beds, 43 CAPS, and 546 UBS operating in the city ( 23 ). According to studies published in the last decade, though there are critical issues regarding mental healthcare resources organization in Brazil ( 22 ), figures are similar to that of other developed countries where a psychiatric reform was conducted ( 24 – 26 ).…”

Section: Methodsmentioning

confidence: 60%

“…It is the largest Brazilian metropolis and the sixth most populous city in the world, with an estimated population of 11 million inhabitants ( 19 ). As in most parts of the world, a major mental health care reform has been carried out over the last 20 years in the country ( 20 , 21 ): a national public health system was created (Sistema Unico de Saude, SUS); the number of psychiatric hospital beds has been drastically reduced; and many Centers for Psychosocial Care (Centro de Atenção Psicossocial, CAPS), community outpatients services, were created ( 21 , 22 ). CAPS are supposed to be intensive outpatient services, where individuals in more need of assistance can attend the service more than once a week.…”

Section: Methodsmentioning

confidence: 99%

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Religious Affiliation as a Predictor of Involuntary Psychiatric Admission: A Brazilian 1-Year Follow-Up Study

Casella

Loch

2014

Front. Public Health

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Objective: The aim of this study was to analyze factors associated with the legal status at psychiatric admission of individuals with psychosis or bipolar disorder in a Latin-American cultural setting.Methods: Prospective observational study was conducted in São Paulo, Brazil. We analyzed 169 individuals with bipolar or psychotic disorder in need of hospitalization. Sociodemographic data, data on the psychiatric disorder, information about the hospital stay, and data at time of discharge were collected. Their families were also contacted by telephone and interviews were conducted at 1, 2, 6, and 12 months post-discharge as a follow-up.Results: Eighty-eight patients (52%) had a voluntary admission and 81 (48%) had an involuntary admission (IA). The average length of admission was similar in both groups (17.4 vs. 17.3 days, p = 0.22). It was significantly more common for IA patients to be admitted because of other-directed aggressiveness (47.7 vs. 65.4%, p = 0.02). The percentage of individuals that needed physical restraint during hospital stay among IA patients was also significantly higher (11.4 vs. 25.9%, p = 0.01). Having any religious affiliations was significantly related to an IA status as well (OR = 4–6.48).Conclusion: Our results suggest that cultural factors related to religious affiliations might play an important role in determining psychiatric hospitalization legal status. Religion might possibly influence someone’s judgment and insight about his/her psychiatric disorder. This study restates the importance of dealing with the subject of religion with patients.

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Section: Methodsmentioning

confidence: 60%

Section: Methodsmentioning

confidence: 99%

Religious Affiliation as a Predictor of Involuntary Psychiatric Admission: A Brazilian 1-Year Follow-Up Study

Casella

Loch

2014

Front. Public Health

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“…As this process is not being conducted very carefully, it leads to a patient overload of outpatient services and long waiting lists for psychiatric hospital treatments 49 . Many of these destabilized patients insufficiently treated in outpatient settings also contribute to this negative picture of psychiatric patients held by psychiatrists starting their career in this kind of setting.…”

Section: Discussionmentioning

confidence: 99%

O estigma atribuído pelos psiquiatras aos indivíduos com esquizofrenia

Loch¹,

Hengartner²,

Guarniero³

et al. 2011

Rev. psiquiatr. clín.

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Background: Literature on how the general population stigmatizes individuals with mental disorders has increased considerably over the last decades. But the question remains if psychiatrists also stigmatize their patients. Objective: The present study aimed to assess Brazilian psychiatrists' attitude towards individuals with schizophrenia. Methods: Out of the approximately 6,000 participants of the 2009 National Psychiatry Congress in Brazil, 1,414 psychiatrists agreed to undergo the survey. Face-to-face interviews were conducted using a questionnaire that assessed stigma in three dimensions: stereotypes, social distance and prejudice towards a person with schizophrenia. Their opinion on psychotropic drugs and tolerance of side-effects were also assessed. Socio-demographic and professional data were collected. Results: Brazilian psychiatrists tend to negatively stereotype individuals with schizophrenia. More negative stereotypes correlated with a positive opinion on psychotropic drugs and with a higher tolerance of side-effects. Higher age was correlated with positive stereotyping and with less prejudice.

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“…This burden weighs more heavily on underdeveloped countries as they do not have the infrastructure needed to manage the consequences of substance use [7]. The World Mental Health Survey showed that 76% to 85% of the patients with severe mental illnesses (e.g., substance use disorders, anxiety or mood) in low- and middle-income countries (LMICs) received no treatment for their conditions over 12 months [8].…”

Section: Introductionmentioning

confidence: 99%

Motivational Interviewing Interventions for Harmful Substance Use Amongst Adults in Low- and Middle-Income Countries (LMICs): A Systematic Review

Adams,

Williams,

Stein

et al. 2023

Preprint

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Background: Harmful substance use is a major challenge globally with far reaching detrimental effects on social, economic and health systems. This burden weighs more heavily on underdeveloped countries as they do not have the infrastructure needed to manage the consequences of substance use. In high-income countries, several evidence-based brief intervention models are used for HSU including Motivational Interviewing (MI). However, fewer studies have been conducted in low-resource settings. Aim: In this review, we systematically reviewed studies utilising motivational interviewing as a component of interventions with adults presenting with harmful substance use in LMICs. Methods: Adhering to Cochrane and PRISMA guidelines, we systematically searched for studies published between 2010 and 2022. The search was conducted in PubMed, EBSCOhost, Web of Science, the Cochrane Library, clinicaltrials.gov and the GSK Clinical Study Register. A narrative analysis was done, and The Joanna Briggs Institute (JBI) Critical Appraisal Tools were used to assess the quality of the studies included. Results: The search yielded 518 publications. Eleven studies from five different countries met inclusion criteria. These consisted mainly of RCTs with some employing qualitative or mixed methods approaches. The focus of the interventions varied, with most targeting alcohol use, while a few addressed opioids, and other drugs. The interventions used different strategies, including MI blended with other interventions (such as CBT, BA, and imaginal desensitization) or using MI-informed approaches. Overall, MI was shown to improve substance use outcomes in seven of the 11 studies with significant reduction in substance use based on outcomes measured. Conclusions: This review highlights that, interventions incorporating MI demonstrated positive effects in improving substance use outcomes in the majority of the studies reviewed. Further research with larger sample sizes and more rigorous study designs is necessary to strengthen the evidence base and address potential sources of bias.

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Principles that should guide mental health policies in low-and middle-income countries (LMICs): lessons from the Brazilian experiment

Cited by 8 publications

References 4 publications

Religious Affiliation as a Predictor of Involuntary Psychiatric Admission: A Brazilian 1-Year Follow-Up Study

Religious Affiliation as a Predictor of Involuntary Psychiatric Admission: A Brazilian 1-Year Follow-Up Study

O estigma atribuído pelos psiquiatras aos indivíduos com esquizofrenia

Motivational Interviewing Interventions for Harmful Substance Use Amongst Adults in Low- and Middle-Income Countries (LMICs): A Systematic Review

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