Trends in Psychiatry and Psychotherapy

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Trends • Trends Psychiatry Psychother. 47 • 2025 • https://doi.org/10.47626/2237-6089-2023-0674 linkcopy

Addressing mental health needs in low- and middle-income countries: the case of São Caetano do Sul, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

São Caetano do Sul, a city in southeastern Brazil, boasts exemplary social indicators and healthcare services, with a population of 162,763 and a density of 9,736.03 inhabitants/km². Allocating 25% of its budget to healthcare, the city's mental healthcare services adhere to the National Mental Health Policy. Structured services include a Center for Psychosocial Care (Centro de Atenção Psicossocial [CAPS])-II, CAPS-Alcohol and Drugs (CAPS-AD), outpatient teams, and teams in various locations. Initiatives since 2000 include inaugurating a CAPS-AD in 2006, a psychiatric emergency service in 2010, and a CAPS-II in 2016, relocating CAPS-AD in 2019, and establishing the Cuca Legal project in 2022. São Caetano do Sul has a Mental Health Risk Classification Protocol (Protocolo de Classificação de Risco à Saúde Mental) to aid clinical decision-making. Developing care lines for various groups, it offers programs like smoking prevention, school psychology, and obesity support. Collaborating with community centers, these facilities serve as teaching environments. The mental health care network focuses on five axes: Communication, Care, Prevention, Management, and Education, with specific proposed actions and competencies. Despite progress, challenges remain. Expanding access, reducing stigma, and implementing robust monitoring are crucial. São Caetano do Sul's experience offers valuable insights for similar urban settings in low- and middle-income countries (LMICs) developing mental health programs.

Keywords:
Brazil; mental health; services; LMIC; psycho-social

Program name	Description
Programa de Prevenção e Tratamento do Tabagismo¹⁵-¹⁷	Implementation of support groups and pharmacological intervention, with the help of a multidisciplinary team, to provide means to quit smoking. The service that was previously provided at the CAPS-AD (psychosocial care center) has been expanded, and now six UBSs conduct support groups, thus expanding access.¹⁸-²⁵
Cuca Legal	School psychology – Institutional supervision work that offers support to the school technical staff in managing and preventing child and adolescent mental health in school units.
Programa Saúde nas Escolas²⁶	A program that aims to contribute to the full development of public school students in basic education, through the coordination between primary care health professionals and education professionals.
Programa de Prevenção da Violência Infantil	Multidisciplinary care for children and adolescents who are victims of violence/sexual abuse residing in São Caetano do Sul, in the age range from zero to 17 years and 11 months and their families, aiming to prevent emotional, psychological, and psychiatric complications that affect the development of this specific population.
Juntas Somos Mais Fortes	Women in vulnerable situations – Constitution of an outpatient team in the perspective of expanding the offer of specialized mental health care to meet the demand for care for a public of women in situations of psychological suffering due to physical, sexual, and/or psychological violence.
INCLUARTE	Solidarity economy – Constitutes an alternative way to organize social relations according to principles that value the human being, work, justice, solidarity, and sustainability. This program is directed towards patients of CAPS-II and CAPS-AD in São Caetano do Sul.
Grupo Diário de Saúde	Groups that offer support and nutritional, sports, and psychological guidance, aiming to improve the quality of life of the city's population that is in an obesity situation.
Apoio e Orientação Familiar	Supporting, strengthening, and equipping families to fulfill their parental duties together with the State and society, in terms of protection and care provided to children and adolescents at each stage of development.

Facility name	Description
CISEs	Through joint actions in the areas of health, education, leisure, social issues, and citizenship, the CISEs are responsible for the care of the elderly population in the municipality that leads the country in terms of longevity, according to the Atlas of Human Development in Brazil (Atlas do Desenvolvimanto Humano no Brasil).²⁸
Fundação das Artes	An institution of education and research in the arts that offers technical and free courses in the areas of visual arts, dance, music, and theater. It provides its students with experiences of artistic creation and dissemination aimed at collective practice, through cultural action in its headquarters and in various locations within and outside the city.
EMNOVA	The school, with its course offerings, fosters access to technology knowledge as a strategy for qualifying educational processes, professional development, solving family demands, and digital inclusion.²⁹
Clubs	São Caetano do Sul has 14 municipalized clubs that offer sports activities in various modalities for the child, youth, and elderly population of the city.

Proposed actions		Competence
Communication axis
	Conduct awareness campaigns for the population about prevention and symptoms of mental health problems through social media and printed materials.	Communications Section of the Health Department (Seção de Comunicação da Secretaria de Saúde) / Mental Health Section of the Health Department (Seção de Saúde Mental da Secretaria de Saúde)
	Establish a frequency for publishing posts on city hall social media with content aimed at providing clarification on prevention and symptoms.	Communications Section of the Health Department (Seção de Comunicação da Secretaria de Saúde) / Mental Health Section of the Health Department (Seção de Saúde Mental da Secretaria de Saúde)
	Produce graphic materials for health units such as posters and leaflets with content focused on prevention and symptoms.	Communications Section of the Health Department (Seção de Comunicação da Secretaria de Saúde) / Mental Health Section of the Health Department (Seção de Saúde Mental da Secretaria de Saúde)
	Semana Municipal de Saúde Mental	Communications Section of the Health Department (Seção de Comunicação da Secretaria de Saúde) / Mental Health Section of the Health Department (Seção de Saúde Mental da Secretaria de Saúde)
	Keep information updated on city hall portals.	Communications Section of the Health Department (Seção de Comunicação da Secretaria de Saúde) / Mental Health Section of the Health Department (Seção de Saúde Mental da Secretaria de Saúde)
Assistance axis
	Registration of 100% of CAPS users in the strategic health program of the primary care family health (AB).	Specialized services/AB
	Increased active search for patients.	Specialized services/AB
	Expansion of the multidisciplinary care offer.	Health Department (Secretaria de Saúde), especially the Mental Health Section (Seção de Saúde Mental)
	Strengthening the socio-assistance network aimed at socio-family monitoring and inclusion of children, adolescents, and young people who use alcohol and other drugs in social reintegration programs.	Department of Assistance and Social Integration (Secretaria de Assistência e Integração Social)
	Encouraging the creation and participation in vocational training courses, leisure, cultural, and sports activities.	Department of Health, Education, Assistance and Social Integration, and Culture (Secretaria de Saúde, Educação, Assistência e Integração Social e Cultura)
	Strengthening the solidarity economy in the social inclusion and work of alcohol and other drug users.	Specialized services
Preventive axis
	Provide continuous drug prevention programs for children and adolescents in the education system.	Department of Health, Education, Safety (Secretaria de Saúde, Educação, Segurança), and Conselho Municipal de Drogas (City Drug Counsel)
	Identify and discuss cases of children and/or adolescents with learning, emotional, behavioral problems, and their family dynamics in a network.	Connected territory
	Strengthen the discussion of issues related to human development, social vulnerability, and topics related to drug use as a transversal and interdisciplinary theme within the school curriculum.	Department of Health and Education (Secretaria de Saúde e Educação)
Management and guidelines axis
	Annually conduct educational contests on the theme of alcohol and other drugs in the education system.	Department of Health, Education (Secretaria de Saúde, Educação), and Conselho Municipal de Drogas (City Drug Counsel)
	Develop an intersectoral action plan to incorporate leisure, cultural, and sports activities in areas of greater vulnerability, aiming to prevent the use of psychoactive substances and mental health issues.	Health Department (Secretaria de Saúde), especially the Mental Health Section (Seção de Saúde Mental)
	Strengthen the Municipal Mental Health Program (Programa Municipal de Saúde Mental).	Health Department (Secretaria de Saúde)
	Annually update and publicize the list of services provided by the municipality's RAPS.	Mental Health Section of the Health Department (Seção de Saúde Mental da Secretaria de Saúde)
Continued education axis
	Ensure a space for sharing and monthly meetings to exchange experiences among professionals in the intersectoral service network.	Mental Health Section of the Health Department (Seção de Saúde Mental da Secretaria de Saúde)
	Ensure that the decentralization of services occurs according to the demand's needs.	Mental Health Section of the Health Department (Seção de Saúde Mental da Secretaria de Saúde)
	Create flows and procedures for the joint action of health, social assistance, and education services and workers, to be validated and agreed upon by workers, managers, and service users.	Mental Health Section of the Health Department (Seção de Saúde Mental da Secretaria de Saúde)
	Encourage the participation of representatives from civil society through broad dissemination of the Councils and educational campaigns on popular participation.	Mental Health Section of the Health Department (Seção de Saúde Mental da Secretaria de Saúde)
	Ensure the training of councilors (representatives of government and civil society) through participation in congresses, courses, lectures, forums, etc.	Mental Health Section of the Health Department (Seção de Saúde Mental da Secretaria de Saúde)
	Ensure that any legislation project related to the theme is submitted for consideration to the Legislative Chamber.	Mental Health Section of the Health Department (Seção de Saúde Mental da Secretaria de Saúde)
	Ensure the ongoing training of specialized health teams and primary care.	Health Department (Secretaria de Saúde), especially the Mental Health Section (Seção de Saúde Mental)
	Mobilize and ensure the participation of staff in courses, seminars, lectures, etc., related to the subject.	Health Department (Secretaria de Saúde), especially the Mental Health Section (Seção de Saúde Mental)
	Promote educational activities with the staff.	Health Department (Secretaria de Saúde), especially the Mental Health Section (Seção de Saúde Mental)

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Associação de Psiquiatria do Rio Grande do Sul Av. Ipiranga, 5311/202, 90610-001 Porto Alegre RS/ Brasil, Tel./Fax: (55 51) 3024 4846 - Porto Alegre - RS - Brazil
E-mail: trends@aprs.org.br

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