title: Mental healthcare in South America with a focus on Brazil: past, present, and future.
abstract: South America and Brazil have undergone major reforms in their mental healthcare systems during the past few decades. The Caracas Declaration, formulated in Venezuela in 1990, states that mental healthcare should be directed toward community treatment rather than hospital-based models. We review how mental health services were previously organized and how they are currently provided to persons with mental illnesses.
  
  
  
  In many South American countries, the number of beds in psychiatric hospitals has been reduced (e.g., between 2001 and 2005, from 18.3 to 12.7 and from 38.7 to 25.6 per 100 000 persons in Chile and Brazil, respectively). Meanwhile, the number of psychiatric beds in general hospitals has increased slightly and more human resources are being devoted to mental health services. Nevertheless, the total number of beds is still insufficient and financing for mental health programs is far below the optimum.
  
  
  
  More than 20 years after the Caracas Declaration, much has been done but many changes are still required. Some reforms have already been proposed but not put into practice. Future efforts should include fighting against stigma and improving budgeting for mental healthcare, a lack of which might be interpreted as structural stigma.
authors.affiliation: aLaboratory of Neurosciences - LIM 27, Institute of Psychiatry, University of São Paulo, Brazil bDepartment of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.
authors.forename: Alexandre Andrade
authors.initials: AA
authors.lastname: Loch
authors.forename: Wagner Farid
authors.initials: WF
authors.lastname: Gattaz
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
mesh_terms: D001938:Brazil; D006778:Hospitals, Psychiatric / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D013020:South America