Systematic review of pathways to mental health care in Brazil

Systematic review of pathways to mental health care in Brazil

Full 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 and Graham Thornicroft.

This systematic review discusses aspects affecting the pathways to mental health care in Brazil including performance of primary care, crisis and acute care, regulation of acute demands, service coverage, availability of adequate treatment and shared management of cases with specialized services.


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.


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.


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.


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.


Research summaries and systematic reviews
Treatment, care and rehabilitation
All mental health conditions
South America
Primary care