Community-based mental health services in Brazil

Razzouk, Denise; Caparroce, Daniela Cheli; Sousa, Aglaé

doi:10.17650/2712-7672-2020-1-1-60-70

Cited by 3 publications

(2 citation statements)

References 36 publications

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“…Mental healthcare in Brazil has undergone significant development in the last three decades. Since 1988, universal free mental healthcare has been available under the Unified Health System (SUS), although one third of Brazilians utilise private healthcare [22]. The number of inpatient psychiatric beds has continually been below government targets (0.12 beds per 1,000 people in 2016 vs. a target of 0.45), however, there has been large upscaling of community mental healthcare, with the number of Centres of Psychosocial Care multiplying by over sevenfold, between 2004 and 2018 [22].…”

Section: Introductionmentioning

confidence: 99%

“…Since 1988, universal free mental healthcare has been available under the Unified Health System (SUS), although one third of Brazilians utilise private healthcare [22]. The number of inpatient psychiatric beds has continually been below government targets (0.12 beds per 1,000 people in 2016 vs. a target of 0.45), however, there has been large upscaling of community mental healthcare, with the number of Centres of Psychosocial Care multiplying by over sevenfold, between 2004 and 2018 [22]. Studies show however that utilisation of mental healthcare in Brazil, is still affected by socioeconomic inequality, with higher use in those with greater education, and lower use in areas with higher homicide rates [23,24].…”

Section: Introductionmentioning

confidence: 99%

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Interpersonal violence and depression in Brazil: A cross-sectional analysis of the 2019 National Health Survey

Harding

Pitcairn

Machado³

et al. 2022

PLOS Glob Public Health

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Depression and interpersonal violence are issues of increasing public health concern globally, especially in low-and-middle income countries. Despite the known relationship between interpersonal violence and an increased risk of depression, there is a need to further characterise the experience of depression in those who have experienced violence, to better develop screening and treatment interventions. A cross-sectional analysis was conducted on responses from the 2019 Brazilian National Health Survey. The prevalence of depression (both clinician-diagnosed, and Patient Health Questionnaire (PHQ-9) screened) were estimated by type of violence experienced in the preceding 12 months (none, physical violence, sexual violence, physical and sexual violence, or threat of violence). Logistic regression models assessed the associations between violence and depression after adjusting for socioeconomic and demographic factors. Of 88,531 respondents, 8.1% experienced any type of violence. Compared to those not experiencing violence, those who experienced any type of violence had a higher prevalence of clinician-diagnosed or PHQ-9-screened depression (e.g. the prevalence of clinician-diagnosed depression was 18.8% for those experiencing sexual violence compared to 9.5% for those not experiencing violence). Both undiagnosed and untreated depression were also more prevalent in those experiencing any type of violence. In logistic regression models, any experience of violence was associated with a higher odds of depression (e.g. aOR = 3.75 (95% CI: 3.06–4.59) for PHQ-9-detected depression). Experiencing violence was also associated with a higher likelihood of having depression which was undiagnosed (e.g. in those who experienced sexual violence: aOR of 3.20, 95% CI 1.81–5.67) or untreated (e.g. in those who experienced physical and sexual violence: aOR = 8.06, 95% CI 3.44–18.9). These findings highlight the need to consider screening for depression in those affected by violence, and to prioritise mental healthcare in communities affected by violence.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Interpersonal violence and depression in Brazil: A cross-sectional analysis of the 2019 National Health Survey

Harding

Pitcairn

Machado³

et al. 2022

PLOS Glob Public Health

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Barriers and Facilitators to Integrating Depression Treatment Within a TB Program and Primary Care in Brazil

Sweetland

Mann

Fernandes

et al. 2023

Health Promotion Practice

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Tuberculosis (TB) and depression is common and is associated with poor TB outcomes. The World Health Organization End TB Strategy explicitly calls for the integration of TB and mental health services. Interpersonal Counseling (IPC) is a brief evidence-based treatment for depression that can be delivered by non-mental health specialists with expert supervision. The goal of this study was to explore potential barriers and facilitators to training non-specialist providers to deliver IPC within the TB Control Program and primary care in Itaboraí, Rio de Janeiro state. Data collection consisted of six focus groups (n = 42) with health professionals (n = 29), program coordinators (n = 7), and persons with TB (n = 6). We used open coding to analyze the data, followed by deductive coding using the Chaudoir multi-level framework for implementation outcomes. The main structural barriers identified were poverty, limited access to treatment, political instability, violence, and social stigma. Organizational barriers included an overburdened and under-resourced health system with high staff turnover. Despite high levels of stress and burnout among health professionals, several provider-level facilitators emerged including a high receptivity to, and demand for, mental health training; strong community relationships through the community health workers; and overall acceptance of IPC delivered by any type of health provider. Patients were also receptive to IPC being delivered by any type of professional. No intervention-specific barriers or facilitators were identified. Despite many challenges, integrating depression treatment into primary care in Itaboraí using IPC was perceived as acceptable, feasible, and desirable.

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Impact of Legal Traditions on Forensic Mental Health Treatment Worldwide

2022

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BackgroundForensic psychiatry is a subspecialty dealing with the diagnosis and treatment of mentally ill offenders. However, forensic treatment standards vary. Differences arise among forensic treatment standards, due to variations in either the legal framework, the general psychiatric treatment standards, or the forensic training standards. Thus, to date there is no evidence-based pattern for how forensic services should be organized and provided.AimsThe aim of this article is to compare forensic services in various countries in order to contribute to the current debate on international forensic treatment standards, by informing about existing differences in available policies.MethodsThis scoping review was conducted by reviewing the academic literature regarding forensic treatment around the world. Studies were identified from Pub-Med and Google-Scholar. Keywords for the search included “forensic psychiatry,” “mentally ill offenders,” “legal framework,” “jurisdiction,” and the names of geographical regions.ResultsForensic treatment admission varies significantly around the world. There are countries that do not recognize forensic psychiatry as a subspecialty, whereas other countries apply insufficient forensic training. Most countries provide inpatient treatment for mentally ill offenders. However, service organization varies, including where the services are delivered (prisons, high-security hospitals, and general psychiatric departments). Forensic services are mainly centralized, although the need for outpatient care is emerging.DiscussionDifferences may originate mainly from variations in the legal tradition. These differences combined with the limited evidence on the effectiveness of the intervention imply the need for the optimization of forensic treatment standards on an international level. Therefore, further follow-up studies are needed.

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Community-based mental health services in Brazil

Cited by 3 publications

References 36 publications

Interpersonal violence and depression in Brazil: A cross-sectional analysis of the 2019 National Health Survey

Interpersonal violence and depression in Brazil: A cross-sectional analysis of the 2019 National Health Survey

Barriers and Facilitators to Integrating Depression Treatment Within a TB Program and Primary Care in Brazil

Impact of Legal Traditions on Forensic Mental Health Treatment Worldwide

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