The S20 Brazilian Mental Health ReportThe S20 serves as the collective platform for the 19 national science academies of countries with the highest gross domestic product (GDP), along with scientific representation from the European community. The Brazilian Academy of Sciences commissioned a report on mental health to address strategies for coping with the mental health challenges in a post-pandemic world. This effort should encompass several crucial elements identified by an expert taskforce. These policies should be evidence-informed, contextually relevant, resource-efficient, culturally sensitive, and equity-promoting. These ideas are intended as proposals for discussion among all S20 participating Academies of Sciences. They do not constitute official mandatory guidelines but rather serve as a collection of ideas that can influence the future trajectory of global mental health. Some of the most important points raised by the task force are displayed as follows.
The current generation of psychiatry epidemiology research has produced evidence correlating mental health with complex social determinants, such as gender, race/ethnicity, racism, social class, social deprivation, employment, etc., and more recently, violence and social oppression. Vulnerable populations such as immigrants, black women suffering discrimination, elderly population, LGBTQIAPN+ populations, indigenous populations, those who faced losses in the pandemic, and underprivileged will need far more attention. For instance, the introduction of evidence-based psychosocial interventions administered by non-specialists is a critical strategy for expanding access to mental health. A scale-up and well-defined model of care that includes task-shifting associated with primary care health workers is fundamental to bridging mental health gap.1
An important priority in mental health is to ensure that children and adolescents are at the heart of policy strategies, recognizing their right to a healthy, fulfilling life. The early onset of mental disorders represents simultaneously a challenge and a great opportunity for action. By prioritizing promotion, prevention and early intervention, leveraging technology, and fostering community support, S20 countries can mitigate the long-term impact of mental disorders in children and adolescents. By utilizing evidence-based practices and cultivating partnerships between the health and education sectors, they can safeguard the health and safety of their student population, thus paving the way for a more promising future for the next generation.2
Dementia continues to be significantly underrecognized, especially in Low- and Middle-Income Countries, where diagnosis rates remain low. This can largely be attributed to the pervasive stigma surrounding the disease, limited public awareness, and inadequate access to healthcare services. Promoting brain health through initiatives such as increased physical activity, healthy nutrition, and cognitive stimulation can help mitigate cognitive decline, ultimately enhancing the overall well-being of older adults and reducing the risk of dementia. Also, it is needed to provide family caregivers with protection and support.
The climate crisis is deeply impacting global mental health by perpetuating chronic stressors that erode social cohesion and exacerbate vulnerabilities among already marginalized groups worldwide. There is a notable lack of research addressing resilience-building strategies and the adaptation of healthcare systems to meet the needs of young people. More research is urgently needed to comprehensively assess the impact of climate change on health and to quantify its attributable burden on mental health outcomes. For example, recent research suggests that environmental factors account for 40-50% of the risk for autism spectrum disorder (ASD). Additionally, there is emerging evidence suggesting a potential association between pesticide exposure and a heightened risk of ASD.3
Comorbidity, the simultaneous occurrence of multiple medical conditions, is a complex phenomenon characterized by interactions that can worsen mental and physical disease prognosis. Their relationship is bidirectional, where compromised physical health can impact mental well-being, and vice versa. Various factors, including lifestyle choices, socioeconomic status, and level of education, contribute to the complexity of this relationship. Neglecting the management of mental illnesses can trigger feedback loops worsening both mental and physical disorders. Recognizing comorbidity as a significant public health concern, concerted efforts are underway to identify comprehensive strategies tailored to individual needs are essential for enhancing the well-being and quality of life of individuals facing comorbidity. Reassessing the treatment settings for psychiatric patients within general hospitals, where their mental health and physical needs are addressed by a multidisciplinary team, should be prioritized in mental health policy in S20 countries. Coordinating a comprehensive approach that integrates mental and physical health care would significantly benefit patients and represent a proactive step towards improving the longevity of psychiatric patients.4
There are significant barriers preventing the widespread adoption of digital psychiatry. Those who stand to benefit the most from digital health interventions often encounter the greatest obstacles to access. Nevertheless, they play a critical role in enhancing screening and diagnosis, reducing stigma, supporting psychotherapy treatments, and integrating artificial intelligence into data collection and risk behavior surveillance. It's important to view digital tools as important and necessary supplements rather than substitutes for traditional in-person care, and they should be seamlessly integrated into existing healthcare systems.5
Digital psychiatry strategies have prompted a reassessment of prevention approaches. They are particularly promising regarding the issues of substance abuse and school violence, highlighting the necessity of strategies that integrated health and education initiatives. In terms of future directions, S20 countries can focus on evaluating the effectiveness of artificial intelligence (AI) in the identification, diagnosis, and treatment of substance use disorders. AI prototypes are currently being developed and tested to provide counseling to patients as a strategy for preventing relapse, following training by specialized professionals. Another emerging area of digital health involves wearable devices, which offer an objective means of measuring drug use and related occurrences such as overdose and withdrawal syndrome, with minimal invasiveness.
Interventional psychiatry, a growing sector within mental health, employs techniques beyond medication to address severe or treatment-resistant conditions. It operates in tandem with traditional therapies rather than as a substitute, offering a more holistic treatment approach.
Developing a holistic and comprehensive strategy that considers human rights with the aim of adapting to the specific circumstances faced by all vulnerable groups, sharing views with people with lived experiences, and employing the least coercive practices, offers the greatest potential to enhance the mental health framework.
As the S20 countries prepare for the future, we need principles that stand to advance innovation, uphold human rights, and strive for the highest standards in mental health care. Innovative mental health systems require many ingredients that traditionally don't talk with each other. They call for an integration of technology and human rights, the provision of both centralized and distributed services, the implementation of stratified care pathways, and the reinforcement of quality through continuous measurement. They also highlight the necessity of prioritizing vulnerable groups and investing in implementation science. The full report of the working group was accepted and will be published by the Brazilian Journal of Psychiatry.6,7
Acknowledgments
This paper was commissioned by the Brazilian Academy of Sciences. We extend our sincere appreciation to the Brazilian Academy of Sciences for their invaluable contribution to fostering dialogue and discourse on science policies within Brazil. Their dedication to advancing scientific knowledge is commendable and serves as a catalyst for progress in our community. It's important to note that the views expressed in this paper may not necessarily reflect those of the Academy.
References
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- 2 Kieling C, Buchweitz C, Caye A, Silvani J, Ameis SH, Brunoni AR, et al. Worldwide prevalence and disability from mental disorders across childhood and adolescence: evidence from the global burden of disease study. JAMA Psychiatry 2024;81:347-56.
- 3 Fujiwara T, Morisaki N, Honda Y, Sampei M, Tani Y. Chemicals, nutrition, and autism spectrum disorder: a mini-review. Front Neurosci. 2016;10:174.
- 4 Fiorillo A, de Girolamo G, Simunovic IF, Gureje O, Isaac M, Lloyd C, et al. The relationship between physical and mental health: an update from the WPA working group on managing comorbidity of mental and physical health. World Psychiatry. 2023;22:169-70.
- 5 Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The Lancet Commission on global mental health and sustainable development. Lancet. 2018;392:1553-98.
- 6 Mari JJ, Kieling C, Ferri CP, Castaldelli-Maia JM, Silva NR, Mello MF, et al. The S20 Brazilian mental health report for building a just world and a sustainable planet: part I. Braz J Psychiatry. 2024;46:e20243706.
- 7 Mari JJ, Kapczinski F, Brunoni AR, Gadelha A, Baldez DP, Miguel EC, et al. The S20 Brazilian mental health report for building a just world and a sustainable planet: part II. Braz J Psychiatry. 2024;46:e20243707.
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