PROJECT SUMMARY/ABSTRACT
Mental disorders are among the leading causes of disability and morbidity worldwide—conditions that are
compounded by a vast treatment gap where an estimated 70% of people who need mental health care go without
adequate or any treatment at all. In Brazil, despite having a comprehensive network of publicly-funded, free,
community-based mental health treatment, it is estimated that only 26% of people with psychiatric conditions
successfully connect to community-based care. The remaining seek treatment only under emergency or crisis
conditions, contributing to overcrowding in emergency departments, long waiting periods for psychiatric beds,
psychiatric boarding, poorer overall quality of care, and an overreliance on a hospital system that is already
overburdened (and increasingly so due to COVID-19). This problem has increasingly and disproportionately
affected people with a serious mental illness (SMI) who are poor and non-white. Goals of recovery and rebuilding
a meaningful life in the community become overshadowed by those of stabilization and symptom management.
Contributing factors to this mental health treatment gap are plenty (i.e., stigma and discrimination, workforce
shortages, economic disparities, lack of timely follow-up and engagement, discontinuous and fragmented
linkages between care settings), yet solutions are scarce. The proposed project uses a participatory research
and adaptation design that involves stakeholders, including persons living with SMI, family members, clinicians,
community services staff and administrators, throughout all stages of project development and implementation.
We hypothesize that the successful adaptation and implementation of an evidence-based model of peer support
to Brazilian culture, will contribute to enhanced levels of engagement, improved continuity of care, and
improvements in quality of life and wellbeing among persons living with SMI in Brazil. To this end, we propose
the following specific aims: 1) To work with local stakeholders in Campinas, Brazil on the cultural adaptation of
an evidence-based peer intervention targeting connections with a peer as a mediator of engagement in post-
acute mental and physical healthcare; 2) To employ an experimental therapeutics approach in determining the
degree to which multi-level targets are engaged in the pathway improved outcomes through a pilot clinical trial;
3) To assess the feasibility, acceptability, safety, tolerability, and potential for dissemination of the adapted peer
intervention at multiple levels. After this study, we will have established the feasibility, acceptability, safety and
tolerability, of adapting a low-cost, culturally-responsive, evidence-based intervention to improve quality of care
of people with SMI who access community mental health treatment. Moreover, through a Yale-University of
Campinas partnership, we will foster international collaboration as a strategy to develop an innovative technology
that would be ready for an implementation and effectiveness trial (R01) in poor communities in Latin countries.
Finally, the adaptation strategy developed in this proposal can be used in other LMICs to adapt EBPs.
