Global Mental Health and Pharmacology: The Case of Attention Deficit and Hyperactivity Disorders in Brazil

Needs assessment for behavioral parent training for ADHD in Brazil

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is a debilitating condition affecting children and their families worldwide. Behavioral parent training is a recommended form of empirically supported non-pharmacological intervention for young children with mild to moderate ADHD. However, access to such treatment is limited in many countries. Here we identify the treatment needs of Brazilian families with children demonstrating symptoms of ADHD, and the barriers families face in accessing behavioral treatment.

Methods

A qualitative needs assessment was undertaken with parents (n = 23), educators (n = 15), and healthcare providers (n = 16). Semi-structured telephone interviews were conducted, and common themes were identified through inductive coding of participants' responses.

Results

Participants reported a lack of accessible behavioral treatment, and delays in accessing treatment when available. The majority of parents had not received behavioral parent training, despite it being a recommended form of treatment. Parents, educators and healthcare providers strongly endorsed a need for practical tools to manage the behavior of children with ADHD.

Conclusion

Existing services might not meet the needs of children with ADHD and their families in Brazil. Easily accessed behavioral parent training programs are recommended to address the identified treatment gap for Brazilian children with ADHD and their families.

[Reflexive groups with medical students from the mental health league as a strategy for change]

This paper set out to present the outcomes of qualitative research conducted with medical students of a Mental Health and Psychiatry League (LASMP). Its objectives were to sensitize them to perceive themselves as people and provide them with other rationales different from biomedical ways of thinking. The reflexive groups, within the culture circle, provided an opportunity for an exchange of ideas, time for reflection and sharing of fully formed daily experiences. They were configured as a strategy of change and awakening to rethink models of health more focused on healthcare than on diseases. Participant observation enabled revealing, through the narratives, particularities of the experiences, discourses and culture of the group itself. The analyses were carried out using the reflexivity method (Bourdieu, 2001; 2004), as it permits the systematic deepening of the contents of the narratives. Without any pretension of synthesis, the reflexive course on the narratives started from the assumptions of thought and actions to arrive at the constructed and shared meanings. They offered possibilities of transforming the way of perceiving the world of work, themselves, and the people around them; of changing the understanding of mental health beyond the individual level.

Características das prescrições de metilfenidato em ambulatório de neuropediatria

RESUMO O metilfenidato não é disponibilizado pelo Sistema Único de Saúde (SUS), pois não faz parte da Relação Nacional de Medicamentos Essenciais. Todavia, o metilfenidato 10 mg é disponibilizado pela rede pública em Maringá-PR de acordo com a Política da Assistência Farmacêutica do município. Objetivou-se analisar as características das prescrições médicas de metilfenidato para crianças em ambulatório de neuropediatria vinculado ao SUS no município. Estudo transversal observacional retrospectivo de caráter quantitativo, realizado por meio da coleta de dados dos prontuários cadastrados no Sistema Gestor da rede pública de saúde do município, pelo ambulatório de neuropediatria na Unidade Básica de Saúde, Zona 7, entre janeiro de 2017 e novembro de 2019. Analisaram-se os dados por frequência relativa e absoluta. Emitiram-se 339 prescrições pelo neuropediatra responsável do ambulatório para 107 pacientes de 6 a 11 anos. Notou-se distribuição geográfica desigual das crianças atendidas conforme bairro da cidade, o que denota influência socioeconômica na prescrição de medicamentos. Ressaltam-se picos de prescrições coincidindo com o período do ano letivo escolar. Concluiu-se que o acompanhamento especializado adequado é premissa para o tratamento, não dispensando a rede longitudinal de assistência. Ademais, evidencia-se o impacto das condições socioeconômicas, tanto na prescrição como na aquisição do medicamento.

The woman who chose the terreiro. Lay care and medical landscapes in mental health care in Rio de Janeiro

Brazilian mental health care reform understands mental health as a complex social process. There is a large literature production within the country focused on deinstitutionalization policy, social determinants of mental health and human rights, however, with little recognition beyond Latin American borders. In addition, cultural dimensions of mental suffering have been neglected in Brazilian debates which limits an expanded understanding of health care and users' inclusion. This paper aims to discuss the role of cultural determinants in mental health care in Brazil. We followed a patient in the city of Rio de Janeiro who opted for therapy based on her religious beliefs-using ayahuasca in the context of the Afro Brazilian religion of Umbanda-over the treatment-as-usual in mental health. We draw on the notions of autoatención (self, domestic, and group-care in lay contexts) and medical landscapes to examine how therapeutic negotiations reflect embodied cultural traits and both social and political determinants shaping therapeutic spaces. We argue that recognizing sociocultural differences and therapeutic negotiations are key elements in making a more inclusive health practice. Moreover, this recognition enables identifying and reasoning the broader social processes framing health practices. This debate is relevant to the Brazilian mental health context and to other scenarios, especially those where local and global knowledge and practices in mental health are entangled.

Negotiating human rights narratives in Global Mental Health: Autism and ADHD controversies in Brazil

Promoting evidence-based treatments and the human rights of people living with mental illness are the two pillars of Global Mental Health (GMH). Critics counter that human rights narratives must also include social justice frameworks. We draw on the cases of autism and ADHD in Brazil to discuss the role of human rights in mental health in the context of GMH. A human rights perspective involves citizenship rights for individuals living with mental distress and provides a framework to problematise the logic of GMH centred on individual rights and rights to treatment. We begin with an overview on human rights discussions in GMH and examine the introduction of human rights discourses in the Brazilian psychiatric reform. We then explore how autism and ADHD became priorities of GMH interventions as well as the constitution of two styles of activism and mobilisation of human rights around these conditions. One follows the universal public health logic and promotes health as a social right. The other follows the logic of parents' associations that redefined those conditions as forms of disability to advocate for specialised services and interventions. Finally, we discuss these forms of human rights mobilisation and their implications for Brazilian mental health and GMH.