Towards comprehensive mental health care: experiences and challenges of psychosocial care in Brazil

Abstract

Background Recommendations are in place for mental health (MH) care to be developed into a comprehensive, people-centred perspective and organised primarily through community services. In recent decades, Brazil has promoted psychiatric reform aimed at transforming the hospital-centred model into a psychosocial model of MH. However, current political and economic changes threaten this reform. This article analyses the comprehensive MH care offered by a Psychosocial Care Network (Rede de Atenção Psicossocial – RAPS) in Brazil. Methods The study involved semi-structured in-depth interviews with 33 stakeholders (policymakers, health professionals, and MH service users) and direct observation of MH services members of the RAPS. Data were analysed using framework analysis with the following dimensions: mental health services access, long-term mental health care, comprehensive mental health care, and crisis patient care. Results Results indicated progression towards comprehensive MH care provision. We identified MH care provided primarily by community services, featuring an ‘open door’ policy, development of localised actions and a search for autonomy. Deinstitutionalisation principles and the psychosocial model support a comprehensive view of MH by policy makers, MH professionals, and users. However, difficulties in providing comprehensive care remain, with the main challenges being insufficient services offered and difficulties in user access at all levels of care, fragile integration between services, lack of clear definitions of the responsibilities of each service, discontinuity of care, limitations in family support, and fragility in crisis patient care. Conclusion We highlight the need to increase funding and services of RAPS, qualification of staff professional, family support, and development of strategies for integrating services. Support and expansion of MH care depend on strengthening the Brazilian health system, which is in danger of being dismantled.

Cultural adaptation of the mental health first aid guidelines for depression in Brazil: a Delphi expert consensus study

“…Mental health problems like depression are treated in the Brazilian public health care system mainly through community mental health services known as "Centers for Psychosocial Care (CAPS)". CAPS were created during the Brazilian psychiatric reform process in 2001, when there was a major shift from a psychiatric hospital-based model of care, to a psychosocial model, centered around community-based mental health services [4]. However, the increase in community services since then has not been paralleled by a rise in public investment in mental health services [5], shown by a scarcity of community centers and the lack of resources where these centers exist [5,6].…”

Evaluation of access and welcoming at the center of psychosocial attention / Avaliação do acesso e acolhimento no Centro de Atenção Psicossocial

“…The scientific literature points to the need to institute processes of continuing education and professional qualification as a way to advance in effective care practices and in line with the psychosocial model, avoiding the manicomial discourses and practices in substitutive mental health services. 9,[17][18][19][20] It is understood that it is necessary to innovate in processes of continuing education in CAPS and RAPS, and it is up to professionals and managers to take on the commitment to activate training spaces, identify partners in the intersectoral network, and maintain continuing education as part of the work activities.…”

“…Such difficulties contribute to the maintenance of the existing gap between the demands for care and the supply in mental health. [9][10] Thus, the study is justified by the challenge of ensuring full access to health care as a Brazilian constitutional right. The objective is to evaluate the user's access from the reception process in a Psychosocial Care Center.…”

Post-occupancy evaluation and codesign in mental healthcare buildings: User’s input as a driver for functional and technical adaptations in post COVID-19 reality

“…The models created during the codesign activity had different configurations, but they all sought to follow the guidelines of an opendoor care policy. "Open door" refers to the deinstitutionalization of patients and the development of actions promoting patient autonomy and community insertion (Sampaio and Bispo Júnior, 2021). In architecture, "open door" refers to large openings, free-flowing circulation, open-plan dayrooms, and many outdoor and indoor communal and living spaces.…”