Enhancing the capacity of the Brazilian health system to support the mental health of young people

心理健康问题影响着巴西相当大比例的年轻人，并可能产生长期的负面后果，导致学业成绩不佳、家庭关系混乱、难以保持稳定的工作以及卷入犯罪和毒品活动。在低收入和中等收入国家(LAMIC)，心理健康问题比高收入国家影响更多的年轻人。然而，像巴西这样的拉美和加勒比地区国家为年轻人提供他们所需的有效精神卫生保健的资源较少。此外，在初级保健环境中工作的卫生专业人员往往无法获得适当的培训和/或技术资源，无法向有精神健康问题的年轻人提供治疗。我们正在制定一个研究项目，旨在加强巴西卫生系统支持年轻人心理健康的能力。我们的项目包括三项活动：在第一项活动中，我们将通过分析从巴西所有五个地区收集的现有数据，估计巴西需要心理健康护理的年轻人的数量。然后，我们将估计儿童和青少年精神健康问题的经济影响，以及考虑到精神健康的改善应该会导致教育成就和就业前景的改善，以及减少药物的使用和与刑事司法的接触，国家通过为有精神健康问题的年轻人提供有效的治疗可以节省多少钱。在第二项活动中，我们将通过对现有科学文献的系统审查，得出巴西卫生系统可以实施的有效和负担得起的干预措施的证据，以支持有精神健康问题的年轻人。在第三项活动中，我们将利用活动一和活动二产生的证据，开发一套实用的工具包和培训材料，以支持卫生专业人员和政策制定者适应和实施适合当地实际的心理健康治疗。它将帮助他们估计提供这些服务的成本以及长期成本和收益。为了确保我们的结果将转化为公共卫生决策，以及我们的工具包在不同地区的适用性，我们召集了一个由多专业研究人员组成的团队，这些研究人员来自英国伦敦政治经济学院(LSE)和三所巴西大学-中西部地区的马托格罗索州立大学(UEMS)、东北部的阿拉戈斯联邦大学(UFAL)和东南部的米纳斯吉拉斯联邦大学(UFMG)。这三个地区(东北部、中西部和东南部)占巴西领土的48%，人口的77%。我们的研究团队将与利益相关者影响咨询小组(SIAG)合作，该小组将由来自巴西五个地区和行政级别(市、州和联邦)的政策制定者、公共卫生从业人员和服务用户组织的代表组成。SIAG的反馈和建议将是根据不同地区的实际和需求定制我们的工具包和培训包的基础。我们项目的一个重要成果将是每个大学的研究人员的能力建设。这将有助于在我们提交给英国医学研究理事会和巴西国家研究基金会委员会的项目三年时间框架之后，促进未来的研究以及研究人员和利益相关者团体之间的联系。

Mental health problems affect a significant proportion of young people in Brazil, and can have long-lasting negative consequences, leading to poor school achievement, troubled family relationships, difficulties in keeping stable jobs and involvement with crime and drugs. Mental health problems affect more young people in low- and middle-income countries (LAMICs), than in the high-income ones. LAMICs such as Brazil; however, have fewer resources to provide young people with the effective mental health care they need. Additionally, health professionals working in primary care settings, where most people with mental health problems could be treated, often don't have access to proper training and/or technical resources to deliver treatment to young people with mental health problems. We are developing a research project which aims to enhance the capacity of the Brazilian health system to support the mental health of young people. Our project comprises three activities: in the first activity, we will estimate the number of young people in Brazil who need mental health care through analysis of existing data collected from all five regions in Brazil. We will, then, estimate the economic impact of child and adolescent mental health problems, and how much the country would save by delivering effective treatment for young people with mental health problems, considering that improved mental health should lead to improvement in education achievement and employment prospects, and reduction in the use of drugs and contact with criminal justice.In the second activity, we will generate evidence on effective and affordable interventions that can be implemented in the Brazilian health system to support young people with mental health problems through a systematic review of existing scientific literature. We will focus our review on interventions for prevention and treatment which have been proven cost-effective in Brazil or similar countries and that are, therefore, suitable for the Brazilian context.In the third activity, we will use evidence generated through activities one and two to develop a practical toolkit and training material to support health professionals and policymakers to adapt and implement mental health treatment that is suited to the local reality. It will help them estimate how much it will cost to provide these services and what the long term costs and benefits will be.To ensure that our results will be translated into public health policymaking, and the applicability of our toolkit in different regional contexts, we have assembled a multi-professional team of researchers from the London School of Economics and Political Sciences (LSE), in the UK, and from three Brazilian universities - the State University of Mato Grosso do Sul (UEMS) in the Central-West region, Federal University of Alagoas (UFAL), in the Northeast, and Federal University of Minas Gerais (UFMG), in the Southeast. These three regions (Northeast, Central-West and Southeast) comprise 48% of Brazil's territory and 77% of the country's population. Our research team will work with a Stakeholder Impact Advisory Group (SIAG), which will comprise policymakers from Brazil's five regions and administrative levels (municipality, state and federal), public health practitioners, and representatives from service-user organizations. The SIAG's feedback and advice will be fundamental to the tailoring of our toolkit and training package according to different reginal reality and needs.One important outcome of our project will be the capacity building of researchers in each university. This will facilitate future research and links between researchers and stakeholder groups after the three-year timeframe of the project we are submitting to the UK Medical Research Council and Brazil's Council of State Research Foundations.