Child and adolescent mental health services in Brazil: Structure, use and challenges

Objectives: To examine the state of Child and Adolescent Mental Health (CAMH) services and to compare the availability and use of CAMH services across the five regions of Brazil. Methods: the Mental Health Matrix Model was used as a framework to describe the state of CAMH services. Documents and administrative datasets were consulted, covering the whole country and the five Brazilian regions as separate levels. This enabled cross-region comparisons and combination with the three temporal dimensions (Input, Process and Outcome) Results: although there are national policies regulating CAMH, along with an integral protection doctrine, scarcity of services was unequally distributed across the regions. A number of trends relating to social development and mental health (e.g. intellectual disability treated prevalence) were also identified. Conclusions: substantial advances in CAMH policy characterize the contemporary Brazilian CAMH system, especially regarding the implementation of community based mental health services for children and adolescents. However, the data reveals great inequalities and geographic variation regarding social indicators, service structure and use.