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Foreword -- Acknowledgements -- Contents -- Contributors -- Abbreviations -- List of Figures -- Part I: Introduction of Health Economics Applied to Mental Health -- 1: Introduction to Mental Health Economics -- 1.1 Introduction to Mental Health Economics -- 1.2 The Birth of Health Economics -- 1.2.1 Economic Concepts and Principles of Health Economics -- 1.2.2 Welfare Theory -- 1.2.2.1 Scarcity of Resources -- 1.2.2.2 Opportunity Costs -- 1.2.2.3 Utility -- Box 1.1 Utilitarianism Principles: Jeremy Bentham -- 1.2.2.4 Welfare Maximization -- 1.2.2.4.1 Old Welfare Economics: Classical Utilitarianism and the Maximization of Pleasure -- 1.2.2.4.2 Neoclassic Welfare Economics: Pareto's Allocative Efficiency and Maximization of Social Welfare -- Free Market, Perfect Competition, and Marginal Utility -- 1.2.2.5 Efficiency -- Box 1.2 Definitions of Efficacy, Effectiveness, and Efficiency -- Box 1.3 Classification of Efficiency [25] -- 1.3 Application of Economic Principles to the Health Sector -- 1.4 Economic Evaluation and Cost Analysis -- 1.4.1 Cost-Analysis Studies -- 1.4.2 Economic Evaluation -- 1.4.2.1 Types of Economic Evaluation -- 1.4.3 Components of Economic Studies -- 1.4.3.1 Cost Measurement and Perspective -- 1.4.3.2 What Is a Benefit? -- 1.5 Economic Principles Applied to Mental Health -- 1.5.1 What Does "Maximization of Mental Health" Mean? -- 1.5.2 How to Measure Mental Health Gain -- 1.5.3 Which Costs Are Relevant in Mental Health? -- 1.5.4 How to Measure Benefits from Mental Health Interventions -- 1.5.5 Is Health Economics Really Helpful in the Mental Health Field? -- References -- 2: Methods for Measuring and Estimating Costs -- 2.1 What Is Cost? -- 2.2 Classification of Costs -- Box 2.1 Direct Costs -- 2.3 Costs Measurement -- 2.3.1 Study Perspective and Costs -- 2.3.2 Identification of Components of Costs

ABSTRACT BACKGROUND: Psychosocial care centers for alcohol and drug users (CAPS-ad) are reference services for treatment of drug users within the Brazilian National Health System. Knowledge of their total costs within the evidence-based decision-making process for public-resource allocation is essential. The aims here were to estimate the total costs of a CAPS-ad and the costs of packages of care (according to intensity of care); to ascertain the ratio between total CAPS-ad costs and the federal funding allocated; and to describe the methods for estimating unit costs for each CAPS-ad cost component. DESIGN AND SETTING: Retrospective study conducted in a public community mental health service. METHODS: This was a retrospective cost description study on a CAPS-ad located in a city in the state of São Paulo, using a public healthcare provider perspective and a top-down approach, conducted over a 180-day period from March 1 to August 30, 2015. RESULTS: The total mean monthly costs of the CAPS-ad were BRL 64,017.54. Healthcare staff accounted for 56.5% of total costs. The mean costs per capita and per month for intensive and non-intensive care packages were, respectively, BRL 668.34 and BRL 37.12. CONCLUSIONS: The federal budget allocation covered 62.1% of the CAPS-ad costs and the remaining 37.9% end up funded by the municipal government. The cost of the intensive package of care was 18 times greater than the non-intensive package. Developing criteria for using services and different packages of care based on patients' needs, and optimizing human resources according to specific actions, may improve people's mental health and avoid wasted resources.

OBJECTIVE: The World Health Organization Atlas Project identified important deficiencies in world mental and neurological health resources. These deficiencies, especially evident in low and middle-income countries, can be overcome by improving research capacity. The objective of this study is to assess the status of mental and neurological research in Latin American countries and identify the main difficulties encountered in conducting research, publishing results, and shaping health policies, interventions, and programs. METHOD: Semi-structured interviews were conducted with 34 key informants from 13 Latin American countries. RESULTS: Participants reported that production of mental and neurological research in Latin American countries is low. Lack of financial and human resources, including lack of support from government agencies, were identified as the main factors contributing to the dearth of local research. The few research projects that do take place in Latin American countries are often funded at researchers' personal expense. Few policies, interventions, or programs are generated from research results. To address these deficiencies, participants called for training in research methodology, mechanisms for identifying funding opportunities, and greater recognition of their research products. CONCLUSIONS: Researchers and stakeholders recognize the need to mobilize local and international efforts aimed at strengthening research capacity and results implementation. This will lead to an overall optimization of mental and neurological research in the region. ; OBJETIVO: El proyecto Atlas de la Organización Mundial de la Salud identifica importantes deficiencias en salud mental y neurológica. Estas deficiencias, especialmente evidentes en países de medianos y bajos ingresos, pueden resolverse mejorando las capacidades en investigación. El objetivo de este estudio es evaluar el estado de la investigación en salud mental y neurológica en países Latinoamericanos, e identificar las principales dificultades encontradas al hacer investigación, publicar resultados, y generar políticas, intervenciones, y programas. MÉTODO: Entrevistas semi-estructuradas fueron realizadas a 34 informantes de 13 países Latinoamericanos. RESULTADOS: La producción de investigación en salud mental y neurológica en países Latinoamericanos es escasa, debido principalmente a la carencia de recursos financieros y humanos, incluyendo el casi ausente apoyo de agencias gubernamentales. Los pocos proyectos de investigación que se llevan a cabo son financiados mayormente con recursos propios de los investigadores. Pocas políticas, intervenciones o programas son generados a partir de resultados de investigación. Resolver estas deficiencias requerirá entrenar profesionales en metodología de la investigación, identificar oportunidades de financiación y lograr un mayor reconocimiento de los productos de la investigación. CONCLUSIONES: Hay necesidad de movilizar esfuerzos locales e internacionales orientados a fortalecer las capacidades en investigación y la implementación de resultados. Esto llevará a una optimización general de la investigación. ; Universidad Peruana Cayetano Heredia Facultad de Ciencias y Filosofía Laboratorios de Investigación y Desarrollo ; Universidad Peruana Cayetano Heredia Facultad de Salud Pública ; Mayo Clinic College of Medicine Department of Psychiatry and Psychology ; Universidade Federal de São Paulo (UNIFESP) Department of Psychiatry ; University of London King's College, Institute of Psychiatry ; Universidad Peruana Cayetano Heredia Facultad de Medicina ; UNIFESP, Department of Psychiatry ; SciELO

Abstract Background Research evidence is essential to inform policies, interventions and programs, and yet research activities in mental and neurological (MN) health have been largely neglected, particularly in low- and middle-income countries. Many challenges have been identified in the production and utilization of research evidence in Latin American countries, and more work is needed to overcome this disadvantageous situation. This study aims to address the situation by identifying initiatives that could improve MN health research activities and implementation of their results in the Latin American region. Methods Thirty-four MN health actors from 13 Latin American countries were interviewed as part of an initiative by the Global Forum for Health Research and the World Health Organization to explore the status of MN health research in low- and middle-income countries in Africa, Asia and Latin-America. Results A variety of recommendations to increase MN health research activities and implementation of their results emerged in the interviews. These included increasing skilled human resources in MN health interventions and research, fostering greater participation of stakeholders in the generation of research topics and projects, and engendering the interest of national and international institutions in important MN health issues and research methodologies. In the view of most participants, government agencies should strive to have research results inform the decision-making process in which they are involved. Thus these agencies would play a key role in facilitating and funding research. Participants also pointed to the importance of academic recognition and financial rewards in attracting professionals to primary and translational research in MN health. In addition, they suggested that institutions should create intramural resources to provide researchers with technical support in designing, carrying out and disseminating research, including resources to improve scientific writing skills. Conclusion Fulfillment of these recommendations would increase research production in MN health in Latin American countries. This, in turn, will raise the profile of these health problems, and consequently will underscore the need of continued high-quality and relevant research, thus fostering a virtuous cycle in the decision-making process to improve MN health care.

Background: Research evidence is essential to inform policies, interventions and programs, and yet research activities in mental and neurological (MN) health have been largely neglected, particularly in low- and middle-income countries. Many challenges have been identified in the production and utilization of research evidence in Latin American countries, and more work is needed to overcome this disadvantageous situation. This study aims to address the situation by identifying initiatives that could improve MN health research activities and implementation of their results in the Latin American region.Methods: Thirty-four MN health actors from 13 Latin American countries were interviewed as part of an initiative by the Global Forum for Health Research and the World Health Organization to explore the status of MN health research in low- and middle-income countries in Africa, Asia and Latin-America.Results: A variety of recommendations to increase MN health research activities and implementation of their results emerged in the interviews. These included increasing skilled human resources in MN health interventions and research, fostering greater participation of stakeholders in the generation of research topics and projects, and engendering the interest of national and international institutions in important MN health issues and research methodologies. in the view of most participants, government agencies should strive to have research results inform the decision-making process in which they are involved. Thus these agencies would play a key role in facilitating and funding research. Participants also pointed to the importance of academic recognition and financial rewards in attracting professionals to primary and translational research in MN health. in addition, they suggested that institutions should create intramural resources to provide researchers with technical support in designing, carrying out and disseminating research, including resources to improve scientific writing skills.Conclusion: Fulfillment of these recommendations would increase research production in MN health in Latin American countries. This, in turn, will raise the profile of these health problems, and consequently will underscore the need of continued high-quality and relevant research, thus fostering a virtuous cycle in the decision-making process to improve MN health care. ; Global Forum for Health Research ; World Bank ; Univ Peruana Cayetano Heredia, Fac Ciencias & Filosofia, Labs Invest & Desarrollo, Lima, Peru ; Univ Peruana Cayetano Heredia, Fac Salud Publ & Adm, Dept Salud Publ, Lima, Peru ; Mayo Clin, Coll Med, Dept Psychiat & Psychol, Rochester, MN USA ; Universidade Federal de São Paulo, Dept Psychiat, São Paulo, Brazil ; Global Forum Hlth Res, Res & Programmes, Geneva, Switzerland ; Univ Peruana Cayetano Heredia, Fac Med, Dept Psiquiatria, Lima, Peru ; Universidade Federal de São Paulo, Dept Psychiat, São Paulo, Brazil ; Web of Science

This paper provides guidance on the steps, obstacles and mistakes to avoid in the implementation of community mental health care. The document is intended to be of practical use and interest to psychiatrists worldwide regarding the development of community mental health care for adults with mental illness. The main recommendations are presented in relation to: the need for coordinated policies, plans and programmes, the requirement to scale up services for whole populations, the importance of promoting community awareness about mental illness to increase levels of help-seeking, the need to establish effective financial and budgetary provisions to directly support services provided in the community. The paper concludes by setting out a series of lessons learned from the accumulated practice of community mental health care to date worldwide, with a particular focus on the social and governmental measures that are required at the national level, the key steps to take in the organization of the local mental health system, lessons learned by professionals and practitioners, and how to most effectively harness the experience of users, families, and other advocates. ; Kings Coll London, Inst Psychiat, Hlth Serv & Populat Res Dept, London, England ; Univ Addis Ababa, Fac Med, Dept Psychiat, Addis Ababa, Ethiopia ; Univ Fed Sao Paulo, Dept Psychiat, Sao Paulo, Brazil ; Dartmouth Psychiat Res Ctr, Lebanon, NH USA ; Natl Ctr Neurol & Psychiat, NIMH, Tokyo, Japan ; Douglas Mental Hlth Univ Inst, Montreal, PQ, Canada ; McGill Univ, Montreal, PQ, Canada ; New Zealand Mental Hlth Commiss, Wellington, New Zealand ; Schizophrenia Res Fdn SCARF, Chennai, Tamil Nadu, India ; Univ Fed Sao Paulo, Dept Psychiat, Sao Paulo, Brazil ; Web of Science

This paper provides guidance on the steps, obstacles and mistakes to avoid in the implementation of community mental health care. The document is intended to be of practical use and interest to psychiatrists worldwide regarding the development of community mental health care for adults with mental illness. The main recommendations are presented in relation to: the need for coordinated policies, plans and programmes, the requirement to scale up services for whole populations, the importance of promoting community awareness about mental illness to increase levels of help-seeking, the need to establish effective financial and budgetary provisions to directly support services provided in the community. The paper concludes by setting out a series of lessons learned from the accumulated practice of community mental health care to date worldwide, with a particular focus on the social and governmental measures that are required at the national level, the key steps to take in the organization of the local mental health system, lessons learned by professionals and practitioners, and how to most effectively harness the experience of users, families, and other advocates.