Enhancing the capacity of the Brazilian health system to support the mental health of young people

Lead Research Organisation: London School of Economics & Pol Sci
Department Name: LSE Health and Social Care

Abstract

Mental health problems affect a significant proportion of young people in Brazil, and can have long-lasting negative consequences, leading to poor school achievement, troubled family relationships, difficulties in keeping stable jobs and involvement with crime and drugs. Mental health problems affect more young people in low- and middle-income countries (LAMICs), than in the high-income ones. LAMICs such as Brazil; however, have fewer resources to provide young people with the effective mental health care they need. Additionally, health professionals working in primary care settings, where most people with mental health problems could be treated, often don't have access to proper training and/or technical resources to deliver treatment to young people with mental health problems.

We are developing a research project which aims to enhance the capacity of the Brazilian health system to support the mental health of young people. Our project comprises three activities: in the first activity, we will estimate the number of young people in Brazil who need mental health care through analysis of existing data collected from all five regions in Brazil. We will, then, estimate the economic impact of child and adolescent mental health problems, and how much the country would save by delivering effective treatment for young people with mental health problems, considering that improved mental health should lead to improvement in education achievement and employment prospects, and reduction in the use of drugs and contact with criminal justice.

In the second activity, we will generate evidence on effective and affordable interventions that can be implemented in the Brazilian health system to support young people with mental health problems through a systematic review of existing scientific literature. We will focus our review on interventions for prevention and treatment which have been proven cost-effective in Brazil or similar countries and that are, therefore, suitable for the Brazilian context.

In the third activity, we will use evidence generated through activities one and two to develop a practical toolkit and training material to support health professionals and policymakers to adapt and implement mental health treatment that is suited to the local reality. It will help them estimate how much it will cost to provide these services and what the long term costs and benefits will be.

To ensure that our results will be translated into public health policymaking, and the applicability of our toolkit in different regional contexts, we have assembled a multi-professional team of researchers from the London School of Economics and Political Sciences (LSE), in the UK, and from three Brazilian universities - the State University of Mato Grosso do Sul (UEMS) in the Central-West region, Federal University of Alagoas (UFAL), in the Northeast, and Federal University of Minas Gerais (UFMG), in the Southeast. These three regions (Northeast, Central-West and Southeast) comprise 48% of Brazil's territory and 77% of the country's population. Our research team will work with a Stakeholder Impact Advisory Group (SIAG), which will comprise policymakers from Brazil's five regions and administrative levels (municipality, state and federal), public health practitioners, and representatives from service-user organizations. The SIAG's feedback and advice will be fundamental to the tailoring of our toolkit and training package according to different reginal reality and needs.

One important outcome of our project will be the capacity building of researchers in each university. This will facilitate future research and links between researchers and stakeholder groups after the three-year timeframe of the project we are submitting to the UK Medical Research Council and Brazil's Council of State Research Foundations.

Technical Summary

Our research plan proposes to address health system challenges using three main activities. The first will involve generating new evidence through analysis of existing youth mental health service use data collected from all regions of Brazil to estimate the economic impact of youth mental health problems. We will use existing datasets to project regional mental health needs, services and treatments required to meet those needs and associated costs and impacts in the short and long-term. The second part will involve performing a systematic review of existing evidence for effective/cost-effective interventions for prevention and treatment of youth mental health problems. We will identify interventions which have evidence for effectiveness in Brazil or similar countries. The third part will involve synthesising the newly developed evidence from parts one and two into a practical toolkit for health and education professionals and policymakers and planners. The return on investment tool in the toolkit will expand on modelling evidence from work packages 1 and 2 on cost effectiveness. The toolkit will be built using Excel for ease of access and it will compare the costs of delivering interventions with the net potential future health and other resource costs that could be averted as a result of effective treatment or prevention of mental health problems among young people. It could also consider the value of additional positive benefits to society, e.g. increased employment participation. Following consultation with stakeholders, it will also be possible to vary estimates of selected parameters in the tool, for instance on the effectiveness, unit costs, level of uptake /use and future benefits of various interventions. We have previously used this modelling approach to estimate the case for investment and aid local and national policy making for mental health in a UK context. https://www.gov.uk/government/publications/mental-health-services-cost-effective-commissioning

Planned Impact

Impact summary

This would be the first study to use population data from Brazil to estimate the long-term economic impacts of a range of mental health problems experienced by children and young people. Through ongoing collaborations we will have access to rich and unique datasets allowing us to make robust estimates on the cost of psychiatric disorders in young people for each region in Brazil from childhood into young adulthood. Our team of researchers have excellent links and experience in using these data and we will work together to generate the research evidence and policy tools needed to support "evidence-based policy-making". This will help us to achieve our overarching objective to "enhance the current limited capacity of the Brazilian health system to prevent psychiatric disorder and treat young people with mental health problems."

Each of the collaborating research centres, in Brazil and in the UK, includes both junior and senior researchers. Training of early career researchers to develop expertise in this field, where there is currently a paucity of researchers, will also help to facilitate continuation of work in this important area. In addition to the toolkit deliverable, development of the methodology and identification of the costs associated with health service use, education, criminal justice, employment benefits for each of the cohort members and synthesising these data with both the national epidemiological dataset and SUS dataset (data on Brazilian public health services) will require a substantial amount of effort. In addition to informing the specific toolkit aims; however, we believe this will lay the groundwork for additional insightful mental health economic and policy research, for example examining the economic impact of other risk factors or for specific population subgroups. Moreover, there will also be broader benefits and learning to other areas of focus in the health system, particularly because of what we know about the high levels of comorbidities between mental and physical health problems. Thus, capacity building in these methods and in using these datasets to apply in future research will be another important outcome of this project.

Our project network will span broadly beyond just academic researchers. Through our network, we will also facilitate partnerships between academics from interdisciplinary background and with strong track records in research on child adolescent mental health, economics and policy research in Brazil and internationally, in addition to policy-makers and healthcare practitioners. Although we will focus on enhancing the capacity of the health system, we will also include relevant stakeholders from the educational system given they represent a key sector which can support identification and referral and potentially delivering interventions to children and adolescents with mental health problems. Thus, establishing more effective links and communication between sectors should support more efficient and effective delivery of mental health care and better outcomes for young people.

On completion, all the tools and research developed as part of this project will be made publicly available. All project research and policy tools will be designed so that they are easy to update and adapt, and they can continue to be useful well after the end of the project, both by the local researchers, policymakers and practitioners involved in this project, but also by other relevant stakeholders. Our findings should also lead to local recommendations which can support strengthening of child and adolescent mental health care across Brazil.

Publications

10 25 50
 
Description Meeting with Secretary of Education, in Maceió
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact Our collaborator in Brazil, Professor Claudio Miranda, met with the head of the Department of Education in Maceió to present our project and invite staff from education sector to participate in the workshop we held in Maceió in 2019. As a result, the Department of Education appointed representatives to take part in our workshop and to join our stakeholder advisory group.
 
Description Meeting with Secretary of Health in Maceió, Brazil
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact Our collaborators in Maceió had a meeting with the head of the Department of Health in Maceió to present our project and to seek support for representatives of the Health Department to participate in the workshop we held in Maceió, in 2019. As a result of the meeting, Dr Wagner Ribeiro, co-investigator of the project at LSE, was invited to give a lecture to staff at the Department of Health.
 
Description Meeting with mayor of Maceio to allow participation of health and social care practitioners to participate in project workshop
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact Professor Miranda, our collaborator in Maceio met with the mayor to get his formal support for the project. His support allowed health, education and social care professionals to attend our workshop with stakeholders.
 
Description UEMS 
Organisation Mato Grosso do Sul State University
Country Brazil 
Sector Academic/University 
PI Contribution We have provided expertise on research methodology, particularly on systematic review to help our collaborators carry out a systematic review of interventions to be implemented in Brazil. We have also provided access to scientific articles through our library services as access to scientific journals in Brazil is limited. We have also developed capacity building activities by delivering an online seminar on systematic review to students from UEMS medical school.
Collaborator Contribution Our collaborators in Brazil have assembled a team of senior and junior researchers to carry out different tasks related to the identification of interventions that can be implemented in the Brazilian public health system.
Impact We have published the protocol of our systematic review on a peer-reviewed journal. We have also provided 25 students at UEMS with training on systematic review
Start Year 2017
 
Description UFAL 
Organisation Federal University of Alagoas
Country Brazil 
Sector Academic/University 
PI Contribution Research expertise and capacity building by delivering training activities to junior researchers in the university and by supporting staff in the development of research related activities
Collaborator Contribution Researchers from the Federal University of Alagoas supported our project by promoting engagement with relevant stakeholders in the public sector. As part of our capacity-building initiatives, they have also recruited MSc and PhD students who are carrying out data collection and dissemination activities in Brazil. The University also provided equipment and facilities for the delivery of workshops with relevant stakeholders.
Impact As a result of this collaboration, we organised two consultation workshops in Brazil. The first workshop took place in 2018, in which 29 stakeholders representing different regions, levels and sectors of care participated. The second one was carried out in 2019 with the participation of 32 stakeholders. In October 2019, we also delivered a workshop on use of scientific evidence in policymaking in the Department of Health of Maceió, Alagoas. This workshop was part of our public engagement strategy
Start Year 2017
 
Description UNESC 
Organisation University of the Far South Catarinense
Country Brazil 
Sector Academic/University 
PI Contribution Our research team organised knowledge exchange activities for research staff and capacity building activities to students at UNESC, providing them with opportunity to participate in a systematic review we are carrying out.
Collaborator Contribution UNESC provided equipment and facilities to our last research team meeting in Brazil, in November 2019. They have also supported our project by providing expertise and technological support for the development of a website and mobile app we are planning to implement as part of our dissemination strategy.
Impact 51 students from UNESC received a 40-hour training on systematic review techniques provided by our research team
Start Year 2019
 
Description Lecture in Maceió Health Department 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact Lecture to staff of the Health Department in the city of Maceió, Alagoas, Brazil, on use of scientific evidence in the decision-making process. In this lecture, we discussed with professionals who are involved in the designing of health policy at different levels how to integrate scientific knowledge into their decision-making routine. Professionals reported which are the main barriers for them to access and use scientific evidence. We discussed potential pathways to promote integration between academics and policymakers/practitioners, and agreed on developing further activities to strength such integration.
Year(s) Of Engagement Activity 2019
 
Description MENTALKIT workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Following the discussion in our first consultation workshop, held in 2018, we carried out a follow-up workshop in which a template of our knowledge-translation tool was discussed with relevant stakeholders. Participants provided feedback and suggestions on how to make our toolkit meaningful so policymakers and practitioners will effectively use it. Stakeholders from different sectors/levels, including service-user representatives reported interest in helping develop and disseminate our toolkit, which they believe will be a relevant tool to help improve the provision of mental health care in the country.
Year(s) Of Engagement Activity 2019
 
Description Meeting at Criciúma Department of Health 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact A visit of our research team to the Department of Health in the city of Criciúma, Santa Catarina, Brazil. In the meeting, we presented our research initiative to the vice-mayor of Criciúma, the health secretary and staff from the Department of Health, and discussed how our project could help them improve the ability of their local health system to provide young people with the mental health care they need. The local authority offered support to the implementation of our scientific output in the city, and appointed representatives from the Department of Health to join our stakeholder advisory group
Year(s) Of Engagement Activity 2019
 
Description One day theory of change workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact 1) Local stakeholders
a. 14 professionals from Maceió Health Department (Secretaria Municipal de Saúde):
i. 3 practitioners from CAPS-I (psychologists and psychiatrists) and 1 from CAPS-AD
ii. 2 Professionals form family health program (NASF - Núcleo de Atenção à Saúde da Família)
iii. 2 professionals from primary care setting (it is not clear if they work in the health department of in primary care services)
iv. 2 professionals from sector responsible for health promotion and education (Gerência de Promoção e Educação em Saúde)
v. 1 professional from the sector responsible for adolescent health actions (Programa de Saúde do Adolescente)
vi. 1 professional from the sector responsible for child health actions (Programa de Saúde da Criança)
vii. 1 professional from the sectors responsible for primary health care (Gerência de Atenção Primária)
viii. 1 professional responsible for health planning (Gerência de Planejamento em Saúde)
b. 2 professionals from Alagoas State Health Deparment - both linked with implementation and supervision of "Atenção Psicossocial"
c. 1 Professional from Maceió Education Department responsible for spcial education
d. 2 Professionals from Maceió Social Care Department (Secretaria Municipal de Assistência Social), both working on shelters
e. 1 Conselheira Tutelar (Guardianship Counsellor)
f. 3 academics from Federal University of Alagoas, all of them developing some sort of work in partnership with the public health sector
2) Stakeholders from other regions of the country
a. 1 professional from Porto Alegre Health Department, representing the mental health coordination
b. 1 professional from Campo Grande Health Department (the vice- secretary of health)
c. 1 mental health coordinator from Amazonas State Health Department
d. 2 representatives of 3rd sector - 1 from advocacy organizations, and one from a "Organização Social" (which would be kind of the Brazilian equivalent to the trusts which run services on behalf of the government)
e. 1 academic who works on the interface between mental health and primary care
Year(s) Of Engagement Activity 2018
 
Description The symposium "New paradigms for Prevention in Mental Health: insights from Brazil-UK research collaborations" took place at the Embassy of Brazil in London, in October 2018. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Together with a Brazilian Professor and the Brazilian embassy, I organised a symposium "New paradigms for Prevention in Mental Health: insights from Brazil-UK research collaborations" took place at the Embassy of Brazil in London, on 19 October 2018. The event was also aligned with the year of science and innovation for the UK and Brazil and aimed at strengthening networks with Brazilian and UK researchers, students, policymaker, healthcare professionals, the corporate sector and mmbers of the Consulate. The event included around 60 diverse participants and provided an opportunity to present our project research and also a platform to debate and discuss next steps and to build and strengthen networks.
Year(s) Of Engagement Activity 2018
URL https://www.centreforglobalmentalhealth.org/news/embassy-of-brazil-in-london-hosts-brazil-uk-researc...