Mental health is a priority for public health in Brazil – 11/03/2023 – Equilíbrio

A Datafolha survey indicated that almost one in three Brazilians has mental health problems related to symptoms of anxiety, insomnia and changes in appetite. Another survey, carried out by the Ipsos Institute, reveals that mental health concerns 52% of Brazilians, being the main concern related to health among those interviewed.

There is a strong perception that the Covid-19 pandemic was the main determinant of a marked worsening of mental health. In fact, a growing number of studies indicate that there has been an important impact, especially on the most affected populations. However, it is likely that the pandemic also contributed to highlighting a serious situation that had already been occurring for some decades.

Since a new methodology was created to measure the impact of diseases on the world population and in different regions and countries, called the Global Burden of Diseases, it has become clear that depression, schizophrenia, chemical dependencies and other disorders have a huge negative impact on the lives of those affected, their families and society as a whole.

With this methodology, it was possible to verify that mental disorders are responsible for around 16% of the total impact of diseases on the world population and that depression is one of the main causes of years lived with disability in the world.

In Brazil, we observed an increase in data that highlights the importance of mental disorders as one of the main health challenges. An indicator used worldwide, including to compare mental health between regions and countries, is the suicide mortality rate. In Brazil, this rate has shown progressive growth since the beginning of the 21st century, while a reduction has been observed in several regions of the world.

PAHO (Pan American Health Organization) recently published a report on mental health and Covid-19 in the Americas. After contextualizing and diagnosing the severity of the situation and identifying the main social determinants of mental disorders in the region, the report brings ten recommendations for necessary actions that should be adopted by governments.

Among them, the need to place mental health as a State priority stands out, integrating actions from different sectors of government and society, increasing funding for mental health policies and programs, promoting and protecting mental health throughout the cycle of life, with special attention to childhood and adolescence, combat poverty, gender-based violence and structural racism, expand the mental health care network in the community, with specialized centers and integration of mental health into primary health care, reinforce strategies to reduce suicide, improve health information systems and expand mental health research.

The challenge of providing access to effective mental health care for all people experiencing suffering or mental disorders is enormous. Reports from the WHO (World Health Organization) indicate that only a limited proportion of people who present symptoms receive any type of care, even in rich countries.

In Brazil, data from the 2013 national health survey indicate that only one in five adults with symptoms of depression received some type of treatment and, when this occurred, it was mainly through prescription medication. The 2019 PNS indicated an improvement in this situation, with one in four adults with symptoms of depression receiving some type of mental health care, with the standard of prescribing medication remaining.

Expanding access to mental health care can be achieved through four types of actions: greater investment of financial resources in mental health care programs; increased training of specialized professionals; training of health professionals not specialized in mental health; and development and incorporation of new technologies, especially those that use digital means to expand access to mental health care.

In relation to financing for mental health programs, while rich countries invest at least 5% of resources in health, federal spending in Brazil has practically not changed in the last 20 years, remaining between 2 and 3% of total federal spending in the area. of health.

The training of mental health professionals has increased in recent decades, but the availability of professionals is still far below that observed in rich countries. Research on Medical Demography in Brazil showed that there was a significant increase in the number of psychiatrists, from 9,010 in 2015 to 13,888 in 2023. However, when we examine the number of psychiatrists per 100,000 inhabitants, we went from 4.5 in 2015 to 6 .5 in 2023, a number well below the 10 to 20 psychiatrists per 100,000 in rich countries.

The main alternative is the training of health professionals who are not specialized in mental health, especially primary health care professionals, to enable them to identify and provide effective care for the majority of people with some type of mental suffering.

A major difficulty for this to occur is the availability of protocols and instruments that help these professionals to incorporate mental health care into their routine practices, which are already quite intense, especially for workers in the immense SUS primary health care network ( Health Unic System).

In this context, we began to have digital health and telemedicine resources available, which were boosted during the pandemic. In mental health care, we observed significant changes in the form of communication between specialized professionals and their patients, moving from in-person to virtual care. In addition, numerous digital applications have emerged to assist with information and self-help techniques. Unfortunately, only a tiny proportion of these applications have undergone rigorous safety and effectiveness evaluations. These technologies, when rigorously evaluated, must be incorporated into clinical practice, especially in the SUS.

Brazil has already managed to advance in several of the necessary actions, especially those related to social determinants, such as combating poverty and any type of discrimination. It also advanced its mental health policy focused on human rights and mental health care in the community. However, the challenges are still enormous and society as a whole needs to make mental health an absolute priority.

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