Abstract
Global Mental Health (GMH) is the field of study, research, and intervention, which aims at improving access to mental health worldwide. It is based on the global burden of disease research program and on the existence of a large “treatment gap” between the need and availability of mental health services, displaying individual and social costs of undiagnosed and untreated mental disorders, especially in low- and middle-income countries (LMIC). Few academic publications in Brazil dialogue directly with the field of GMH, although several issues drawn from its agenda have been the subject of mental health policies in the country. Brazil can be classified as a middle-income country with a well-structured national health system. This system is oriented toward primary health care, which integrates both community mental health services and the broader health care network. The debate between GMH advocates and critics has unearthed old controversies in psychiatry such as universality or cultural specificity of mental disorders, their expressions, and their relationship with social and economic factors. We intend to examine how these controversies reverberate in the Brazilian mental health scenario, taking as an illustration the debates around Attention Deficit Hyperactivity Disorder (ADHD) in the country. ADHD discussions oppose those who argue that the condition is underdiagnosed and undertreated, and those who claim that there is overdiagnosis and overtreatment and thus, medicalization of childhood. This article presents the current status of the Brazilian mental health literature on ADHD, with emphasis on tensions around diagnosis, prevalence and interventions. Our aim is to highlight how the differential in discourse shapes the debate on ADHD in Brazil and how this may contribute to the GMH agenda. This goal will be undertaken in three steps. First, we will briefly examine studies around GMH and ADHD. Secondly, we address Brazilian studies on this theme, considering the specificities regarding the constitution of the mental health field. Finally, we will examine the debate of treatment gap vs. medicalization in the country in order to underscore the potentials and limitations of each perspective.
Highlights
Global Mental Health (GMH) is a field of study, research and practice, which aims at improving access and ensuring equity in mental health care for all people in the world (Patel and Prince, 2010)
Researchers have examined the obstacles to achieve this goal in low- and middle-income countries (LMIC), such as limited resources and lack of mental health specialists, and have proposed that diagnosis and treatments may be achieved by raising awareness and empowering community health care teams, educators and school counselors along with other lay agents in the community (Flisher et al, 2010)
Our aim is to highlight how different discourses shape the debate on Attention Deficit Hyperactivity Disorders (ADHD) in the country and how they can contribute to the GMH agenda
Summary
Global Mental Health (GMH) is a field of study, research and practice, which aims at improving access and ensuring equity in mental health care for all people in the world (Patel and Prince, 2010). The GMH agenda has raised important criticism especially from transcultural psychiatrists and anthropologists Overall, such objections outline the biology vs culture controversies and denounce the neglect of social, political, and economic processes associated to mental health diagnostics, treatments, and research (Summerfield, 2012; Clark, 2014; Kirmayer and Swartz, 2014; Ortega and Wenceslau, 2020). The regionalized structure of SUS starts at the municipal level with relative autonomy to define its own health policies and structures of care This will have important consequences for the field of ADHD in the country, as we will show. On a constitutional and legal basis, Brazil has a universal public health system, though in practice, health financing is mostly private due to the underfinancing of the public system and the absence of clear limits to the participation of private health companies (Oliveira and Dallari, 2016)
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