Addressing mental health needs in low- and middle-income countries: the case of São Caetano do Sul, Brazil

Abstract São Caetano do Sul, a city in southeastern Brazil, boasts exemplary social indicators and healthcare services, with a population of 162,763 and a density of 9,736.03 inhabitants/km². Allocating 25% of its budget to healthcare, the city's mental healthcare services adhere to the National Mental Health Policy. Structured services include a Center for Psychosocial Care (Centro de Atenção Psicossocial [CAPS])-II, CAPS-Alcohol and Drugs (CAPS-AD), outpatient teams, and teams in various locations. Initiatives since 2000 include inaugurating a CAPS-AD in 2006, a psychiatric emergency service in 2010, and a CAPS-II in 2016, relocating CAPS-AD in 2019, and establishing the Cuca Legal project in 2022. São Caetano do Sul has a Mental Health Risk Classification Protocol (Protocolo de Classificação de Risco à Saúde Mental) to aid clinical decision-making. Developing care lines for various groups, it offers programs like smoking prevention, school psychology, and obesity support. Collaborating with community centers, these facilities serve as teaching environments. The mental health care network focuses on five axes: Communication, Care, Prevention, Management, and Education, with specific proposed actions and competencies. Despite progress, challenges remain. Expanding access, reducing stigma, and implementing robust monitoring are crucial. São Caetano do Sul's experience offers valuable insights for similar urban settings in low- and middle-income countries (LMICs) developing mental health programs.