Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies

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Abstract

Background

Pathways to care are actions and strategies employed by individuals in order to get help for health-related distress and the related processes of care providers. On several systematic reviews regarding pathways to mental health care (PMHC), studies regarding South American countries were not present. This review synthesizes qualitative and quantitative research about PMHC in Brazil.

Methods

LILACS, MEDLINE and SCIELO databases were searched for papers regarding PMHC in Brazil. The results were organized in pathway stages, based on Goldberg and Huxley’s ‘model of Levels and Filters’ and on Kleinman’s framework of ‘Popular, Folk and Professional health sectors’. Analysis also considered the changes in national mental health policy over time.

Results

25 papers were found, with data ranging from 1989 to 2013. Complex social networks were involved in the initial recognition of MH issues. The preferred points of first contact also varied with the nature and severity of problems. A high proportion of patients is treated in specialized services, including mild cases. There is limited capacity of primary care professionals to identify and treat MH problems, with some improvement from collaborative care in the more recent years. The model for crisis management and acute care remains unclear: scarce evidence was found over the different arrangements used, mostly stressing lack of integration between emergency, hospital and community services and fragile continuity of care.

Conclusions

The performance of primary care and the regulation of acute demands, especially crisis management, are the most critical aspects on PMHC. Although primary care performance seems to be improving, the balanced provision and integration between services for adequate acute and long-term care is yet to be achieved.

Electronic supplementary material

The online version of this article (10.1186/s13033-018-0237-8) contains supplementary material, which is available to authorized users.

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Most cited references 63

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Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.

Philip Wang, Sergio Aguilar-Gaxiola, Jordi Alonso … (2007)

Mental disorders are major causes of disability worldwide, including in the low-income and middle-income countries least able to bear such burdens. We describe mental health care in 17 countries participating in the WHO world mental health (WMH) survey initiative and examine unmet needs for treatment. Face-to-face household surveys were undertaken with 84,850 community adult respondents in low-income or middle-income (Colombia, Lebanon, Mexico, Nigeria, China, South Africa, Ukraine) and high-income countries (Belgium, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Spain, USA). Prevalence and severity of mental disorders over 12 months, and mental health service use, were assessed with the WMH composite international diagnostic interview. Logistic regression analysis was used to study sociodemographic predictors of receiving any 12-month services. The number of respondents using any 12-month mental health services (57 [2%; Nigeria] to 1477 [18%; USA]) was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries' percentages of gross domestic product spent on health care. Although seriousness of disorder was related to service use, only five (11%; China) to 46 (61%; Belgium) of patients with severe disorders received any care in the previous year. General medical sectors were the largest sources of mental health services. For respondents initiating treatments, 152 (70%; Germany) to 129 (95%; Italy) received any follow-up care, and one (10%; Nigeria) to 113 (42%; France) received treatments meeting minimum standards for adequacy. Patients who were male, married, less-educated, and at the extremes of age or income were treated less. Unmet needs for mental health treatment are pervasive and especially concerning in less-developed countries. Alleviation of these unmet needs will require expansion and optimum allocation of treatment resources.

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Help-seeking pathways: a unifying concept in mental health care.

D. Marien Cortes, L H Rogler (1993)

The authors argue that the concept of help-seeking pathways, defined generically, oriented toward institutional structures, and put at the forefront of research, can help integrate much of what we know about the use of mental health care and how to make such care more accessible and effective among underserved populations. They focus the concept of help-seeking pathways on current issues and research findings pertinent to the onset of psychological distress, the contacting of mental health care facilities, and treatment in such facilities. Pathways are not random; they are structured by the convergence of psychosocial and cultural factors and have sufficient integrity to be studied directly as unfolding processes.

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A medicalização do sofrimento psíquico: considerações sobre o discurso psiquiátrico e seus efeitos na Educação

Renata Guarido (2007)

Este estudo analisa criticamente as mudanças observadas no tratamento do sofrimento psíquico na história recente, apontando a contribuição de fatores como: a padronização de sintomas trazida pelas sucessivas edições da série DSM (Manual Diagnóstico e Estatístico de Transtornos Mentais), os resultados de pesquisas na neurociência - que tentam fundamentar o funcionamento psíquico em bases orgânicas - e o grande desenvolvimento dos psico-fármacos, fruto de maciços investimentos financeiros. A ação desse conjunto de fatores teve por efeito a perda da noção de sentido/significado dos sintomas e dos sofrimentos subjetivos, própria da psiquiatria clássica, e a crescente medicalização dos indivíduos na sociedade contemporânea. O texto busca alinhavar como aconteceu a produção de uma nova verdade acerca dos sofrimentos psíquicos e amplia essa análise, evidenciando que os procedimentos de medicalização surgidos no cuidado da população adulta foram estendidos também para as crianças. Revê a evolução do tratamento da criança, marcando a interação da pedagogia e da medicina na constituição da psiquiatria infantil. Além disso, busca evidenciar os efeitos dessa verdade sobre os sujeitos, identificando a forma como o discurso técnico (especialmente influenciado pelo discurso médico-psicológico) tem tido lugar no mundo contemporâneo e como este tem influenciado a Educação. Trata de ressaltar, como produtos, a banalização da existência, a naturalização do sofrimento e a culpabilização dos indivíduos pelas vicissitudes da vida. Argumenta que a psicologização da escola pode ceder lugar hoje à psiquiatrização do discurso escolar. A articulação saber/verdade/poder é aqui tratada a partir dos textos de Michel Foucault.

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Author and article information

Contributors

Carlos Eduardo Amaral:

ORCID: http://orcid.org/0000-0002-1719-1080

+55 (85) 999600624 , caduamaral@gmail.com

Journal

Journal ID (nlm-ta): Int J Ment Health Syst

Journal ID (iso-abbrev): Int J Ment Health Syst

Title: International Journal of Mental Health Systems

Publisher: BioMed Central (London )

ISSN (Electronic): 1752-4458

Publication date (Electronic): 31 October 2018

Publication date PMC-release: 31 October 2018

Publication date Collection: 2018

Volume: 12

Electronic Location Identifier: 65

Affiliations

[1 ]ISNI 0000 0001 0723 2494, GRID grid.411087.b, Department of Collective Health, School of Medical Sciences, , University of Campinas, ; Campinas, Brazil

[2 ]Department of Psychology, University Centre Unicatólica of Quixadá, Quixadá, Brazil

[3 ]Unichristus, Fortaleza, Brazil

[4 ]ISNI 0000 0001 2160 0329, GRID grid.8395.7, Department of Community Health, , Federal University of Ceará, ; Fortaleza, Brazil

[5 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, , King’s College London, ; London, UK

[6 ]Fortaleza, Ceará CEP 60125-001 Brazil

Author information

Carlos Eduardo Amaral http://orcid.org/0000-0002-1719-1080

Article

Publisher ID: 237

DOI: 10.1186/s13033-018-0237-8

PMC ID: 6208112

PubMed ID: 30450125

SO-VID: 8aad5413-601e-4fec-a52e-6e327fbc7be4

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 28 February 2018

Date accepted : 11 October 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100002322, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior;

Award ID: PDSE - 88881.131570/2016-0

Award Recipient : Carlos Eduardo Amaral

Custom metadata

ScienceOpen disciplines: Neurology

Keywords: pathways to care,clinical pathways,systematic review,public health,mental health policy

Data availability:

ScienceOpen disciplines: Neurology

Keywords: pathways to care, clinical pathways, systematic review, public health, mental health policy

Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies

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Most cited references 63

Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.

Help-seeking pathways: a unifying concept in mental health care.

A medicalização do sofrimento psíquico: considerações sobre o discurso psiquiátrico e seus efeitos na Educação

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