A Brazilian bottom-up strategy to address mental health in a diverse population over a large territorial area – an inspiration for the use of digital mental health

• Published in: Psychiatry research Vol. 311; p. 114477
• Main Authors: Mota, Natália Bezerra, Pimenta, Juliana, Tavares, Maria, Palmeira, Leonardo, Loch, Alexandre Andrade, Hedin-Pereira, Cecília, Dias, Elisa C.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.05.2022
• Subjects: Brazil - epidemiology; Computational psychiatry; Diversity; Humans; Mental Disorders - therapy; Mental Health; Mental Health Services; Mentally Ill Persons; Psychiatric rehabilitation; Public policy; Social Stigma; Brazil; Social stigma; Computational psychiatry; Psychiatric rehabilitation; Public policy; Diversity
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2022.114477

•Brazilian program of psychosocial rehabilitation based on local population/culture;.•Positive impact, and the challenges posed by a large and diverse country;.•Mental health issues in historically vulnerable populations;.•Digital solutions for unbiased evaluations;.•Comments regarding representativeness of databanks used in algorithms. Brazil is a continental country with a history of massive immigration waves from around the world. Consequently, the Brazilian population is rich in ethnic, cultural, and religious diversity, but suffers from tremendous socioeconomic inequality. Brazil has a documented history of categorizing individuals with culturally specific behaviors as mentally ill, which has led to psychiatric institutionalization for reasons that were more social than clinical. To address this, a “network for psychosocial care” was created in Brazil, that included mental health clinics and community services distributed throughout the country. This generates local support for mental health rehabilitation, integrating psychiatric care, family support and education/work opportunities. These clinics and community services are tailored to provide care for each specific area, and are more attuned to regional culture, values and neighborhood infrastructure. Here we review existing reports about the Brazilian experience, including advances in public policy on mental health, and challenges posed by the large diversity to the psychosocial rehabilitation.  In addition, we show how new digital technologies in general, and computational speech analysis in particular, can contribute to unbiased assessments, resulting in decreased stigma and more effective diagnosis of the mental diseases, with methods that are free of gender, ethnic, or socioeconomic biases.