Mental Health in Brazilian Public Health: Advances, Challenges, and Perspectives for Comprehensive Care

Abstract

Mental health care in Brazilian public health has undergone significant transformations driven by the Psychiatric Reform, which sought to overcome the historically dominant hospital-centered model and promote a psychosocial, community-based, and rights-oriented approach. This study aims to analyze the advances, challenges, and future perspectives of comprehensive mental health care within the Unified Health System (SUS), with particular emphasis on the role of the Psychiatric Reform and the Psychosocial Care Network (RAPS). This narrative literature review synthesized national and international studies published in the last five years, retrieved from the PubMed, SciELO, and LILACS databases. The analysis focused on mental health policies, service organization, care practices, and social determinants related to comprehensive mental health care in the Brazilian context. The findings indicate that important advances have been achieved, including the expansion of community-based services, especially Psychosocial Care Centers (CAPS), and the incorporation of mental health into primary care. However, persistent challenges remain, such as regional inequalities, underfunding, workforce precarization, and the continued reliance on psychiatric hospitalizations, particularly in cases related to substance use. Recent policy shifts that revalorize institutional and coercive practices pose additional risks to the consolidation of the psychosocial care model. The study concludes that strengthening comprehensive mental health care in Brazil requires reaffirming the ethical and political foundations of the Psychiatric Reform, expanding community-based services, investing in professional training, and reinforcing intersectoral and rights-based approaches. These strategies are essential to ensuring equitable, inclusive, and sustainable mental health care within the SUS.