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Salud colectiva

Print version ISSN 1669-2381On-line version ISSN 1851-8265

Salud colect. vol.17  Lanús  2021  Epub Apr 24, 2021 


Mental health and human rights: Challenges for health services and communities

1Physician. PhD in Collective Health. Professor, Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, São Paulo, Brazil.

2PhD. Senior Policy Advisor, Department of Mental Health and Addiction Services. Director, Professor of Psychiatry, Yale Program for Recovery and Community Health, Yale School of Medicine, New Haven, USA.

3Psychiatrist. Former advisor, Pan American Health Organization. Former president, Asociación Española de Neuropsiquiatría - Profesionales de la Salud Mental, Madrid, Spain.

In the mid-twentieth century, during times of civic and social reconstruction of the societies traumatized by the Second World War, the bleak situation in which people in psychiatric hospitals lived and the therapeutic inefficacy of mental health care systems were highlighted. There were ethical and technical reasons to propel reforms that would seek the development of a more efficient therapeutic and social model for people affected by psychic suffering that would respect their dignity.

The professional, social, and political awareness of this situation has extended to all Western countries and has stimulated health service and system reforms consistent with community treatment, the fight against stigma and the social reintegration of patients1. International entities such as the World Health Organization have encouraged countries to formulate specific laws for this purpose and to reorganize care strategies, both in the health sector and in the legal frameworks that deal with the various disadvantages faced by people with mental health problems. Responding to such recommendations continues to be quite a challenge, especially in the increasingly authoritarian times many countries are experiencing.

In the Ibero-American context, plans for fiscal adjustment and the reduction of public investment have exacerbated inequities and aggravated processes of stigmatization and exclusion2,3. Issues like race, gender, and other social markers in the production of inequality in mental health gain relevance in the articulation of experiences of mental health promotion and care. Clearly, there are repercussions of mental disorders in the reproduction of cycles of exclusion and poverty in many families, as well as interrelationships between mental health and violence.

The persistence of a mortality gap for people with severe mental health problems from around the world must not be forgotten, with the elimination of this excess mortality included among the challenges for the millennium4,5. The facilitation of access to the mental health system, the care of physical health and the fight against medicalization of mental suffering could contribute to the reduction of this gap.

In the scientific field, there are still gaps in the knowledge about some practices, as well as a lack of evidence regarding the efficacy of the application in low and middle-income countries of strategies that have proved to be beneficial in central countries. Culturally sensitive and sustainable practices need to be further studied and included in training programs to develop specialized human resources.

The care of people with mental health problems requires health system and service reforms to build up proper mental health care. The challenges of the present moment continue to be immense. It is important to know the morbidity and mortality of people with serious mental health disorders, for the purpose of designing public policies to target problems with alcohol and other drugs as well as public policies of employment, education, and social security for those with mental disorders to complete the care network offered by health services. We also need to confront the worldwide trend of turning social failure into a mental health problem. The viral pandemic that we are experiencing has exposed the fragility of our health and social services and certified the inequality and precariousness of the living conditions of many people.

This collection of articles, published in the journal Salud Colectiva as part of the open call for papers “Mental health and human rights: challenges for health services and communities,” includes articles from Spain,6,7,8 Brazil,9,10,11,12 Mexico,13 and Chile.14,15 These papers present conceptual experiences and reflections on community action plans and programs, contributing toward better knowledge and development of mental health in the region


1. Davidson L, Drake RE, Schmutte T, Dinzeo T, Andres-Hyman R. Oil and water or oil and vinegar? Evidence-based medicine meets recovery. Community Mental Health Journal. 2009;45(5):323-332. doi: 10.1007/s10597-009-9228-1. [ Links ]

2. Onocko-Campos RT. Mental health in Brazil: strides, setbacks, and challenges. Cadernos de Saúde Pública. 2019;35(11):e00156119. doi: 10.1590/0102-311x00156119. [ Links ]

3. Desviat M. La reforma psiquiátrica 25 años después de la Ley General de Sanidad. Revista Española de Salud Pública. 2011;85(5):427-436. [ Links ]

4. World Health Organization. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings. Geneva: WHO; 2010. [ Links ]

5. Cook JA, Razzano LA, Swarbrick MA, Jonikas JA, Yost C, Burke L, Steigman PJ, Santos A. Health risks and changes in self-efficacy following community health screening of adults with serious mental illnesses. PLoS One. 2015;10(4):e0123552. doi: 10.1371/journal.pone.0123552. [ Links ]

6. Martínez Flores J, Pujal i Llombart M, Mora E. Ética del cuidado y atención pública en salud mental: un estudio de caso en Barcelona. Salud Colectiva. 2021;17:e2966. doi: 10.18294/sc.2021.2966. [ Links ]

7. Llort Suárez A, Clua-García R. Políticas públicas dirigidas a personas consumidoras de drogas: Estrategias para la desestigmatización y la promoción de los derechos humanos. Salud Colectiva. 2021;17:e3041. doi: 10.18294/sc.2021.3041. [ Links ]

8. Nocete Navarro L, López de Loma Osorio V, Bravo Ortiz MF, Fernández Liria A. Salud mental y derechos humanos: La experiencia de los profesionales en formación en el uso de sujeciones mecánicas en Madrid, España. Salud Colectiva. 2021;17:e3045. doi: 10.18294/sc.2021.3045. [ Links ]

9. Thiesen J, Fortes S, Cavalcanti MT. El impacto del cuidado territorial en el tratamiento de personas diagnosticadas con esquizofrenia y trastornos delirantes en una comunidad en Río de Janeiro. Salud Colectiva. 2021;17:e3020. doi: 10.18294/sc.2021.3020. [ Links ]

10. Santos DVD, Basegio D, Ditterich RG, Conciani IN, Stefanello S. ¿Qué hace un centro de atención psicosocial infanto-juvenil 24 horas en la ciudad de Curitiba-Brasil? Salud Colectiva. 2021;17:e3033. doi: 10.18294/sc.2021.3033. [ Links ]

11. Friestino JKO, Luchini Junior D, Lange Biesek L, Marcon G, Fonsêca GS. Comunicación y salud mental: características relacionadas con la empatía en médicas y médicos del primer nivel de atención en Chapecó, Santa Catarina, Brasil. Salud Colectiva. 2020;16:e3034. doi: 10.18294/sc.2020.3034. [ Links ]

12. Silva JL, Lucena M, Lyra J, Mota ML, Bessoni E, Rego CP, Silva JKJ. El Programa De Vuelta a Casa y sus repercusiones cotidianas: el acceso a un ingreso y los entrecruzamientos de los territorios existenciales en la vida comunitaria. Salud Colectiva. 2021;17:e3058. doi: 10.18294/sc.2021.3058. [ Links ]

13. Pino-Morán JA, Rodríguez-Garrido P, Zango-Martín I, Mora-Malo E. Subvertir la vulneración médica: itinerarios corporales disidentes de la discapacidad en Chile. Salud Colectiva. 2021;17:e3021. doi: 10.18294/sc.2021.3021. [ Links ]

14. Carreño A, Blukacz A, Cabieses B, Jazanovich D. “Nadie está preparado para escuchar lo que vi”: atención de salud mental de refugiados y solicitantes de asilo en Chile. Salud Colectiva. 2020;16:e3035. doi: 10.18294/sc.2020.3035. [ Links ]

15. Santillanes Allande NI. Relación entre violencia y depresión en mujeres migrantes a través de las experiencias en los servicios de atención. Salud Colectiva. 2021;17:e3054. doi: 10.18294/sc.2021.3054. [ Links ]

Received: March 16, 2021; Accepted: April 14, 2021; pub: April 24, 2021

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