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International Journal of Mental Health Systems

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Open Access 01-12-2018 | Review

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

Authors: Carlos Eduardo Amaral, Rosana Onocko-Campos, Pedro Renan Santos de Oliveira, Mariana Barbosa Pereira, Éllen Cristina Ricci, Mayrá Lobato Pequeno, Bruno Emerich, Roseléia Carneiro dos Santos, Graham Thornicroft

Published in: International Journal of Mental Health Systems | Issue 1/2018

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.

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Goldberg D, Huxley P. Mental illness in the community: the pathway to psychiatric care. London: Tavistock Publications Ltd; 1980.

Pescosolido B. Illness careers and network ties: a conceptual model of utilisation and compliance. Adv Med Sociol. 1991;2:161–84.

Rogler L, Cortes D. Help-seeking pathways: a unifying concept in mental health care. Am J Psychiatry. 1993;150:554–61. https://doi.org/10.1176/ajp.150.4.554.CrossRefPubMed

Evans-Lacko S, Jarrett M, McCrone P, Thornicroft G. Clinical pathways in psychiatry. Br J Psychiatry. 2008;193:4–5. https://doi.org/10.1192/bjp.bp.107.048926.CrossRefPubMed

Cabral ALLV, Martinez-Hemáez A, Andrade EIG, Cherchiglia ML. Itinerários terapêuticos: o estado da arte da produção científica no Brasil. Cien Saude Colet. 2011;16:4433–42.CrossRef

Vanhaecht K, Panella M, van Zelm R, Sermeus W. An overview on the history and concept of care pathways as complex interventions. Int J Care Pathways. 2010;14:117–23. https://doi.org/10.1258/jicp.2010.010019.CrossRef

Gater R, Jordanova V, Maric N, Alikaj V, Bajs M, Cavic T, et al. Pathways to psychiatric care in Eastern Europe. Br J Psychiatry. 2005;186:529–35. https://doi.org/10.1192/bjp.186.6.529.CrossRefPubMed

Gater R, Sousa DBAE, Barrientos G, Caraveo J, Chandrashekar CR, Dhadphale M, et al. The pathways to psychiatric care: a cross-cultural study. Psychol Med. 1991;21:761–74.CrossRef

Morgan C, Mallett R, Hutchinson G, Leff J. Negative pathways to psychiatric care and ethnicity: the bridge between social science and psychiatry. Soc Sci Med. 2004;58:739–52.CrossRef

10.

Sartorius N, Jablensky A, Korten A, Ernberg G, Anker M, Cooper JE, et al. Early manifestations and first-contact incidence of schizophrenia in different cultures. A preliminary report on the initial evaluation phase of the WHO Collaborative Study on determinants of outcome of severe mental disorders. Psychol Med. 1986;16:909–28.CrossRef

11.

Volpe U, Mihai A, Jordanova V, Sartorius N. The pathways to mental healthcare worldwide: a systematic review. Curr Opin Psychiatry. 2015;28:299–306. https://doi.org/10.1097/YCO.0000000000000164.CrossRefPubMed

12.

Singh SP, Grange T. Measuring pathways to care in first-episode psychosis: a systematic review. Schizophr Res. 2006;81:75–82. https://doi.org/10.1016/j.schres.2005.09.018.CrossRefPubMed

13.

Anderson KK, Fuhrer R, Malla AK. The pathways to mental health care of first-episode psychosis patients: a systematic review. Psychol Med. 2010;40:1585–97. https://doi.org/10.1017/S0033291710000371.CrossRefPubMed

14.

International Monetary Fund. World Economic Outlook Database, October 2017. World Econ Outlook Database, Oct 2017. 2017.

15.

Instituto Brasileiro de Geografica e Estatística. Estimativas de população, 2017. Estim Popul 2017. 2017. https://www.ibge.gov.br/estatisticas-novoportal/sociais/populacao.html. Accessed 1 Dec 2017.

16.

World Bank. GINI index (World Bank estimate). GINI Index (World Bank Estim) 2015. https://data.worldbank.org/indicator/SI.POV.GINI?locations=BR. Accessed 1 Nov 2017.

17.

Viacava F, Bellido JG. Health, access to services and sources of payment, according to household surveys. Cien Saude Colet. 2016;21:351–70. https://doi.org/10.1590/1413-81232015212.19422015.CrossRefPubMed

18.

Cecilio LCDO, Carapinheiro G, Andreazza R. Os mapas do cuidado: o agir leigo na saúde. São Paulo: Hucitec; 2014.

19.

Ministério da Saúde. E-gestor Atenção Básica: informação e gestão da Atenção Básica. 2017. https://egestorab.saude.gov.br/paginas/acessoPublico/relatorios/relHistoricoCoberturaAB.xhtml. Accessed 1 Dec 2017.

20.

Amarante P. Loucos pela vida: a trajetória da reforma psiquiátrica no Brasil. Rio de Janeiro: Editora Fiocruz; 1995.

21.

Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews: a product from the ESRC methods programme. Lancaster: Lancaster University; 2006. https://doi.org/10.13140/2.1.1018.4643.

22.

Huxley P. Mental illness in the community: the Goldberg-Huxley model of the pathway to psychiatric care. Nord J Psychiatry. 1996;50:47–53. https://doi.org/10.3109/08039489609099730.CrossRef

23.

Kleinman A. Patients and healers in the context of culture. Berkeley: University of California Press; 1980.

24.

Paula CS, Bordin IAS, Mari JDJ, Velasque L, Rohde LA, Coutinho ESF. The mental health care gap among children and adolescents: data from an epidemiological survey from four Brazilian regions. PLoS ONE. 2014;9:e88241. https://doi.org/10.1371/journal.pone.0088241.CrossRefPubMedPubMedCentral

25.

Da Silva Carneiro US, Aquino GC, Jucá VJS. Desafios da integralidade na assistência: o itinerário terapêutico de mães com sofrimento psíquico grave. Rev Psicol. 2014;5:46–57.

26.

Paula CS, Nakamura E, Wissow L, Bordin IA, do Nascimento R, Leite ÁM, et al. Primary care and children’s mental health in Brazil. Acad Pediatr. 2009;9:249–55. https://doi.org/10.1016/j.acap.2009.02.006.CrossRefPubMed

27.

Quinderé PHD, Jorge MSB, Nogueira MSL, da Costa LFA, Vasconcelos MGF. Acessibilidade e resolubilidade da assistência em saúde mental: a experiência do apoio matricial. Cien Saude Colet. 2013;18:2157–66. https://doi.org/10.1590/S1413-81232013000700031.CrossRefPubMed

28.

Arce VAR, Sousa MFD, Lima MDG. A práxis da Saúde Mental no âmbito da Estratégia Saúde da Família: contribuições para a construção de um cuidado integrado. Physis Rev Saúde Coletiva. 2011;21:541–60. https://doi.org/10.1590/s0103-73312011000200011.CrossRef

29.

Blay SL, Furtado A, Peluso ÉTP. Knowledge and beliefs about help-seeking behavior and helpfulness of interventions for Alzheimer’s disease. Aging Ment Health. 2008;12:577–86. https://doi.org/10.1080/13607860802343050.CrossRefPubMed

30.

Lucchese R, de Oliveira AGB, Conciani ME, Marcon SR. Saúde mental no Programa Saúde da Família: caminhos e impasses de uma trajetória necessária. Cad Saúde Pública. 2009;25:2033–42.CrossRef

31.

Fatori D, Evans-Lacko S, Bordin IA, de Paula C. Child mental health care in Brazil: barriers and achievements. Lancet. 2012;379:e16–7. https://doi.org/10.1016/S0140-6736(12)60105-6.CrossRefPubMed

32.

Favero-Nunes MA, dos Santos MA. Itinerário terapêutico percorrido por mães de crianças com transtorno autístico. Psicol Reflexão E Crítica. 2010;23:208–21. https://doi.org/10.1590/S0102-79722010000200003.CrossRef

33.

Valdanha-Ornelas ÉD, dos Santos MA. O Percurso e seus Percalços: Itinerário Terapêutico nos Transtornos Alimentares. Psicol Teor E Pesqui. 2016;32:169–79. https://doi.org/10.1590/0102-37722016012445169179.CrossRef

34.

Falavina OP, Cerqueira MB. Saúde mental infanto-juvenil: usuários e suas trajetórias de acesso aos serviços de saúde. Espaço Saúde. 2008;10:34–46.

35.

Lauridsen EPP, Tanaka OY. Morbidade referida e busca de ajuda nos transtornos mentais na infância e adolescência. Rev Saude Publica. 1999;33:586–92. https://doi.org/10.1590/S0034-89101999000600010.CrossRefPubMed

36.

Mendoza-Sassi R, Béria JU, Fiori N, Bortolotto A. Prevalência de sinais e sintomas, fatores sociodemográficos associados e atitude frente aos sintomas em um centro urbano no Sul do Brasil. Rev Panam Salud Pública. 2006;20:22–8. https://doi.org/10.1590/S1020-49892006000700003.CrossRefPubMed

37.

Oliveira AM, Menezes PR, Busatto GF, McGuire PK, Murray RM, Scazufca M. Family context and duration of untreated psychosis (DUP): results from the Sao Paulo Study. Schizophr Res. 2010;119:124–30. https://doi.org/10.1016/j.schres.2009.08.018.CrossRefPubMed

38.

Borysow IDC, Furtado JP. Access, equity and social cohesion: evaluation of intersectoral strategies for people experiencing homelessness. Rev Da Esc Enferm Da USP. 2014;48:1069–76. https://doi.org/10.1590/s0080-623420140000700015.CrossRef

39.

Campanha AM, Siu ER, Milhorança IA, Viana MC, Wang Y-P, Andrade LH. Use of psychotropic medications in São Paulo Metropolitan Area, Brazil: pattern of healthcare provision to general population. Pharmacoepidemiol Drug Saf. 2015;24:1207–14. https://doi.org/10.1002/pds.3826.CrossRefPubMed

40.

Pereira MDO, Sá MDC, Miranda L. Um olhar sobre a atenção psicossocial a adolescentes em crise a partir de seus itinerários terapêuticos. Cad Saude Publica. 2014;30:2145–54. https://doi.org/10.1590/0102-311x00185113.CrossRef

41.

Portugal CM. Entre o consultório e o terreiro: mediações, ruídos e silenciamentos nos itinerários terapêuticos de adeptos do candomblé. RECIIS. 2016;10:1–14.

42.

de Carvalho MB, Val AC, Ribeiro MMF, dos Santos LG. Itinerários terapêuticos de sujeitos com sintomas anoréxicos e bulímicos. Cien Saude Colet. 2016;21:2463–74. https://doi.org/10.1590/1413-81232015218.16452015.CrossRefPubMed

43.

Oliveira GL, Caiaffa WT, Cherchiglia ML. Saúde mental e a continuidade do cuidado em centros de saúde de Belo Horizonte, MG. Rev Saude Publica. 2008;42:707–16. https://doi.org/10.1590/S0034-89102008005000038.CrossRefPubMed

44.

Corrêa GHLST, Bellato R, Araújo LFDS, Hiller M. Itinerário terapêutico de idosa em sofrimento psíquico e família. Ciência, Cuid E Saúde. 2012;10:274–83. https://doi.org/10.4025/cienccuidsaude.v10i2.10462.CrossRef

45.

Paes LG, Schimith MD, Barbosa TM, Righi LB. Rede de atenção em saúde mental na perspectiva dos coordenadores de serviços de saúde. Trab Educ e Saúde. 2013;11:395–409. https://doi.org/10.1590/S1981-77462013000200008.CrossRef

46.

Ebert M, Lorenzini E, da Silva EF. Mothers of children with autistic disorder: perceptions and trajectories. Rev Gaúcha Enferm. 2015;36:49–55. https://doi.org/10.1590/1983-1447.2015.01.43623.CrossRefPubMed

47.

Wang YP, Chiavegatto Filho ADP, Campanha AM, Malik AM, Mogadouro MA, Cambraia M, et al. Patterns and predictors of health service use among people with mental disorders in São Paulo metropolitan area, Brazil. Epidemiol Psychiatr Sci. 2017;26:89–101. https://doi.org/10.1017/S2045796016000202.CrossRefPubMed

48.

De Pinho LB, Hernández AMB, Kantorski LP. O discurso sobre o acolhimento e a acessibilidade nos serviços comunitários de saúde mental. Cogitare Enferm. 2009;14:612–9. https://doi.org/10.5380/ce.v14i4.16373.CrossRef

49.

Tomita A, Burns JK, King H, Baumgartner JN, Davis GP, Mtshemla S, et al. Duration of untreated psychosis and the pathway to care in KwaZulu-Natal, South Africa. J Nerv Ment Dis. 2015;203:222–5. https://doi.org/10.1097/NMD.0000000000000268.CrossRefPubMedPubMedCentral

50.

Dalgalarrondo P. Estudos sobre religião e saúde mental realizados no Brasil: histórico e perspectivas atuais. Arch Clin Psychiatry. 2007;34:25–33.

51.

Ishikawa RZ, Cardemil EV, Falmagne RJ. Help seeking and help receiving for emotional distress among latino men and women. Qual Health Res. 2010;20:1558–72. https://doi.org/10.1177/1049732310369140.CrossRefPubMed

52.

Morgan C, Abdul-Al R, Lappin JM, Jones P, Fearon P, Leese M, et al. Clinical and social determinants of duration of untreated psychosis in the AeSOP first-episode psychosis study. Br J Psychiatry. 2006;189:446–52. https://doi.org/10.1192/bjp.bp.106.021303.CrossRefPubMed

53.

Bergner E, Leiner AS, Carter T, Franz L, Thompson NJ, Compton MT. The period of untreated psychosis before treatment initiation: a qualitative study of family members’ perspectives. Compr Psychiatry. 2008;49:530–6. https://doi.org/10.1016/j.comppsych.2008.02.010.CrossRefPubMedPubMedCentral

54.

Paula CS, Lauridsen-Ribeiro E, Wissow L, Bordin IAS, Evans-Lacko S. How to improve the mental health care of children and adolescents in Brazil: actions needed in the public sector. Rev Bras Psiquiatr. 2012;34:334–51.CrossRef

55.

Couto MCV, Duarte CS, Delgado PGG. A saúde mental infantil na Saúde Pública brasileira: situação atual e desafios. Rev Bras Psiquiatr. 2008;30:384–9.CrossRef

56.

Brzozowski FS, de Caponi SNC. Medicalização dos desvios de comportamento na infância e adolescência: aspectos positivos e negativos. Psicol Ciência E Profissão. 2013;33:208–21.CrossRef

57.

Guarido R. A medicalização do sofrimento psíquico: considerações sobre o discurso psiquiátrico e seus efeitos na Educação. Educ E Pesqui. 2007;33:151–61.CrossRef

58.

Angermeyer MC, Matschinger H, Riedel-Heller SG. What to do about mental disorder: help-seeking recommendations of the lay public. Acta Psychiatr Scand. 2001;103:220–5. https://doi.org/10.1034/j.1600-0447.2001.103003220.x.CrossRefPubMed

59.

Bland RC, Newman SC, Orn H. Help-seeking for psychiatric disorders. Can J Psychiatry. 1997;42:935–42. https://doi.org/10.1177/070674379704200904.CrossRefPubMed

60.

BRASIL. Ministério da Saúde. Saúde Mental e Atenção Básica: o vínculo e o diálogo necessários. Brasília: Ministério da Saúde; 2003.

61.

Brasil. Ministério da Saúde. Saúde Mental. Cad Atenção Básica 2013;34.

62.

Morais APP, Tanaka OY. Apoio Matricial em Saúde Mental: alcances e limites na atenção básica. Saúde E Soc. 2012;21:161–70.CrossRef

63.

Figueiredo MD, Onocko-Campos R. Saúde Mental na atenção básica à saúde de Campinas, SP: uma rede ou um emaranhado? Cien Saude Colet. 2009;14:129–38.CrossRef

64.

Miranda L, Onocko-Campos R. Análise das equipes de referência em saúde mental: uma perspectiva de gestão da clínica. Cad Saúde Pública, Rio Janeiro. 2010;26:1153–62.CrossRef

65.

Tófoli LF, Fortes S. Apoio matricial de saúde mental na atenção primária no município de Sobral, CE: o relato de uma experiência. Sanare, Sobral. 2007;6:34–42.

66.

Craven MA, Bland R. Better practices in collaborative mental health care: an analysis of the evidence base. Can J Psychiatry. 2006;51:7S–72S.PubMed

67.

Vannucchi AMC, Carneiro Junior N. Modelos tecnoassistenciais e atuação do psiquiatra no campo da atenção primária à saúde no contexto atual do Sistema Único de Saúde, Brasil. Physis. 2012;22:963–82.CrossRef

68.

Bezerra E, Dimenstein M. Os CAPS e o Trabalho em Rede: Tecendo o Apoio Matricial na Atenção Básica. Psicol Ciência e Profissão. 2008;28:632–45.CrossRef

69.

Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007;370:841–50. https://doi.org/10.1016/S0140-6736(07)61414-7.CrossRefPubMedPubMedCentral

70.

Fleury M-J, Grenier G, Bamvita J-M, Caron J. Professional service utilisation among patients with severe mental disorders. BMC Health Serv Res. 2010;10:141. https://doi.org/10.1186/1472-6963-10-141.CrossRefPubMedPubMedCentral

71.

Barros REM, Tung TC, Mari JDJ. Serviços de emergência psiquiátrica e suas relações com a rede de saúde mental brasileira. Rev Bras Psiquiatr. 2010;32:s71–7.CrossRef

72.

Jardim K, Dimenstein M. Risco e crise: pensando os pilares da urgência psiquiátrica. Psicol Em Rev. 2007;13:169–89.

73.

Nicácio F, Campos GWDS. A complexidade da atenção às situações de crise: contribuições da desinstitucionalização para a invenção de práticas inovadoras em saúde mental. Rev Ter Ocup Da Univ São Paulo. 2004;15:71–81. https://doi.org/10.11606/issn.2238-6149.v15i2p71-81.CrossRef

74.

Willrich JQ, Kantorski LP, Chiavagatti FG, Cortes JM, Antonacci MH. Os sentidos construídos na atenção à crise no território: o Centro de Atenção Psicossocial como protagonista. Rev Da Esc Enferm Da USP. 2013;47:657–63. https://doi.org/10.1590/S0080-623420130000300019.CrossRef

75.

Onocko-Campos R, Furtado JP, Passos E, Ferrer AL, Miranda L, da Gama CAP. Avaliação da rede de centros de atenção psicossocial: entre a saúde coletiva e a saúde mental. Rev Saude Publica. 2009;43:16–22. https://doi.org/10.1590/S0034-89102009000800004.CrossRef

76.

Dimenstein M, Amorim AKA, Leite J, Siqueira K, Gruska V, Vieira C, et al. O atendimento da crise nos diversos componentes da rede de atenção psicossocial em Natal/RN. Rev P Psique. 2012;2:95–127.

77.

Dias M, Golçalves RW, Delgado PGG. Leitos de atenção integral à saúde mental em hospital geral: configuração atual e novos desafios na política de saúde mental. In: Vasconcelos EM, editor. Desafios políticos da reforma psiquiátrica Bras. São Paulo: Hucitec; 2010. p. 115–40.

78.

Thornicroft G, Tansella M. Balancing community-based and hospital-based mental health care. World Psychiatry. 2002;1:84–90.PubMedPubMedCentral

Title: Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies
Authors: Carlos Eduardo Amaral
Rosana Onocko-Campos
Pedro Renan Santos de Oliveira
Mariana Barbosa Pereira
Éllen Cristina Ricci
Mayrá Lobato Pequeno
Bruno Emerich
Roseléia Carneiro dos Santos
Graham Thornicroft
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: International Journal of Mental Health Systems / Issue 1/2018
Electronic ISSN: 1752-4458
DOI: https://doi.org/10.1186/s13033-018-0237-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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