The mental health system in Brazil: Policies and future challenges

Mateus, Mário Dinis; Mari, Jair J.; Delgado, Pedro Gabriel Godinho; Almeida-Filho, Naomar; Barrett, Thomas J.; Gerolin, Jerônimo; Goihman, Samuel; Razzouk, Denise; Rodríguez, Jorge; Weber, Renata; Andreoli, Sérgio Baxter; Saxena, Shekhar

doi:10.1186/1752-4458-2-12

Cited by 107 publications

(76 citation statements)

References 19 publications

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“…7 Before the 21st century, psychiatric care in Brazil was mainly based on a centralized model with large psychiatric hospitals, longer length of stay, and poor community care, provided mostly by outpatient clinics, with exiguous psychiatric care in general hospitals. Changes in Brazilian healthcare policies led to the implementation of deinstitutionalization programs, financing of new community centers (such as Psychosocial Community Centers [CAPS], which provide day hospital care for severe mental disorders 11 ), cuts in hospital care expenses, and use of high-priced medications in outpatient care. 12 However, there is still a shortage of psychiatric beds in the Brazilian public health sector.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of inpatients with severe mental illness: a naturalistic descriptive study

Nuernberg

Baeza

Fleck

et al. 2016

Rev. Bras. Psiquiatr.

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Objective: To describe and evaluate the response and predictors of remission during inpatient treatment in a psychiatric unit in a general hospital based on symptomatology, functionality, and quality of life (QoL). Methods: Patients were admitted to a psychiatric unit in a tertiary general hospital in Brazil from June 2011 to December 2013 and included in the study if they met two of the severe mental illness (SMI) criteria: Global Assessment of Functioning (GAF) p 50 and duration of service contact X 2 years. Patients were assessed by the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI) Severity Scale , GAF, the World Health Organization Quality of Life Instrument -Abbreviated version (WHOQOL-Bref), and specific diagnostic scales. Results: A total of 239 patients were included. BPRS mean scores were 25.54611.37 at admission and 10.9668.11 at discharge (p o 0.001). Patients with manic episodes (odds ratio: 4.03; 95% confidence interval: 1.14-14.30; p = 0.03) were more likely to achieve remission (CGI p 2 at discharge) than those with depressive episodes. Mean length of stay was 28.95619.86 days. All QoL domains improved significantly in the whole sample. Conclusion: SMI patients had marked improvements in symptomatic and functional measures during psychiatric hospitalization. Patients with manic episodes had higher chance of remission according to the CGI.

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Section: Introductionmentioning

confidence: 99%

Outcomes of inpatients with severe mental illness: a naturalistic descriptive study

Nuernberg

Baeza

Fleck

et al. 2016

Rev. Bras. Psiquiatr.

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“…58 Among the alternative units proposed within the reform of the Brazilian mental health assistance, 59 a prominent role is occupied by the psychosocial attention centers (CAPS, in the Portuguese acronym). 60 There are few studies assessing the relationship of this service with the mental health network in general 61 and the impact of such centers on PESs is little understood. Notwithstanding, the CAPS III deserves special attention in the context of psychiatric emergency, performing the broader function of managing emergency situations 24 hours a day.…”

Section: Psychiatric Emergency and Outpatient Servicesmentioning

confidence: 99%

Serviços de emergência psiquiátrica e suas relações com a rede de saúde mental Brasileira

Barros

Teng

Mari

2010

Rev. Bras. Psiquiatr.

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Objective: To review the literature concerning the role and the inclusion of psychiatric emergency services in mental health networks. Method: We performed a search in online databases (PubMed and SciELO) for empirical articles and reviews about psychiatric emergency services and networks of mental health services. Results: Psychiatric emergency services are a crucial part of well-structured mental health networks, both due to their role in the management of emergencies proper and to their function in the regulation of the network they belong to. Emergency psychiatric services are related to all inpatient and outpatient services, which enables them to organize the flow of admissions and to prevent the overload of the mental health network. The functions of emergency psychiatric services are broad and go beyond the simple referral for hospitalization, encompassing the clinical stabilization of acute cases and the provision of psychosocial support. In Brazil, these functions were expanded after the mental health reform and the overload of the mental health network resulting from the difficulties and limitations of inpatient and outpatient services. Conclusion: Emergency psychiatric services must be valued and expanded; especially those located in general hospitals. It is suggested that investment in psychiatric emergency services be a priority in Brazilian public health policies to improve mental health care. Descriptors

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“…those mental disorders that are most prevalent among the population (Mateus et al, 2008). Poor adherence to medication is growing and is recognized as a significant source of waste in the Brazilian health care system.…”

Section: Difficulty In Taking Medicationmentioning

confidence: 99%

Evaluation of adherence to treatment by patients seen in a psychosocial care center in northeastern Brazil

Souza

Silva

Onofre

et al. 2011

Braz. J. Pharm. Sci.

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In the treatment of mental disorders, nonadherence to medication, the main cause of psychiatric morbidity, is observed in about 50% of the cases and is responsible for numerous losses. This study evaluated adherence to drug treatment by patients seen in a Psychosocial Care Center (CAPS) in northeastern Brazil. Adherence to treatment was evaluated using the Haynes-Sackett and Morisky-Green-Levine tests. All patients registered in the CAPS were included in the study (n= 101). Only 11.88% of the patients adhered to drug treatment. The main reasons not to use medication were: oblivion (68.83%), feeling unwell after taking the medication (54.22%), not having money to buy the medication (43.83%), not finding the medication in the public health service (39.94%) and fear of harm that might be caused by the drug (28.90%). Furthermore, 85.1% of the patients did not know their diseases, 88.1% did not know their treatment, 86.4% did not feel good when they took their medication, and 88.1% took their medication incorrectly. The results revealed that the lack of information about diseases and drugs used, the nuisance posed by drug therapy and the low access to medications reduce adherence to treatment and, consequently, treatment effectiveness.Uniterms: Treatment adherence. Drug therapy/adherence to treatment. Mental health. Psychosocial Care Center.No tratamento de desordens mentais, a não-adesão ao tratamento ocorre em cerca de 50% dos casos e é responsável por inúmeros prejuízos, além de ser a principal causa de morbidade psiquiátrica. O presente estudo objetivou avaliar a adesão ao tratamento medicamentoso de pacientes atendidos em um Centro de Atenção Psicossocial (CAPS) no Nordeste do Brasil. A avaliação da adesão ao tratamento foi feita através dos testes de Haynes-Sackett e Morisky-Green-Levine. Todos os pacientes cadastrados no CAPS foram incluídos no estudo (n = 101). Observou-se que apenas 11,88% dos pacientes aderiram ao tratamento medicamentoso. As principais razões para o não uso dos medicamentos foram: esquecimento (68,83%), sentir-se mal após a ingestão de medicamentos (54,22%), não ter dinheiro para comprar medicamentos (43,83%), não encontrar os medicamentos no serviço público de saúde (39,94%) e medo dos danos causados pelos medicamentos (28,90%). Além disso, observou-se que 85,1% dos pacientes não conheciam suas doenças, 88,1% não conheciam seus tratamentos, 86,4% não se sentiam bem quando usavam medicamentos e 88,1% usavam os medicamentos incorretamente. Os resultados demonstram que a falta de informação sobre doenças e medicamentos, os danos decorrentes da terapia medicamentosa e o baixo acesso aos medicamentos comprometem a adesão ao tratamento e, consequentemente, a eficácia do tratamento. INTRODUCTIONPoor adherence to medications prescribed for chronic conditions has been cited as a global problem that may lead to increased morbidity and mortality (WHO, 2003; NEHI, 2009). It increases the costs within healthcare systems and contributes to substantial worsening of disease control and quality of life ...

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The mental health system in Brazil: Policies and future challenges

Abstract: Background: The aim of this paper is to assess the mental health system in Brazil in relation to the human resources and the services available to the population.

Cited by 107 publications

References 19 publications

Outcomes of inpatients with severe mental illness: a naturalistic descriptive study

Outcomes of inpatients with severe mental illness: a naturalistic descriptive study

Serviços de emergência psiquiátrica e suas relações com a rede de saúde mental Brasileira

Evaluation of adherence to treatment by patients seen in a psychosocial care center in northeastern Brazil

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