IDEAS home Printed from https://ideas.repec.org/p/pra/mprapa/108658.html
   My bibliography  Save this paper

The Effects of a Large-Scale Mental-Health Reform: Evidence from Brazil

Author

Listed:
  • Dias, Mateus
  • Fontes, Luiz Felipe

Abstract

This paper studies the Brazilian psychiatric reform, which reorganized mental healthcare provision by the public system building a network of community-based services centered on the Psychosocial Care Centers (CAPSs). Our research design exploits the roll-out of CAPSs in a differences-in-differences framework. We show that these centers improved outpatient mental healthcare utilization and reduced hospital admissions due to mental and behavioral disorders. Those reductions were more pronounced for long-stay admissions and among patients with schizophrenia. Additionally, centers delivering substance abuse treatment reduced deaths caused by alcoholic liver disease. Finally, we also find that this shift away from inpatient care increased homicides.

Suggested Citation

  • Dias, Mateus & Fontes, Luiz Felipe, 2020. "The Effects of a Large-Scale Mental-Health Reform: Evidence from Brazil," MPRA Paper 108658, University Library of Munich, Germany, revised Jun 2021.
  • Handle: RePEc:pra:mprapa:108658
    as

    Download full text from publisher

    File URL: https://mpra.ub.uni-muenchen.de/108658/8/MPRA_paper_108658.pdf
    File Function: original version
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Ludwig, Jens & Marcotte, Dave E. & Norberg, Karen, 2009. "Anti-depressants and suicide," Journal of Health Economics, Elsevier, vol. 28(3), pages 659-676, May.
    2. Bladimir Carrillo & Jose Feres, 2019. "Provider Supply, Utilization, and Infant Health: Evidence from a Physician Distribution Policy," American Economic Journal: Economic Policy, American Economic Association, vol. 11(3), pages 156-196, August.
    3. Hannes Schwandt, 2018. "Wealth Shocks and Health Outcomes: Evidence from Stock Market Fluctuations," American Economic Journal: Applied Economics, American Economic Association, vol. 10(4), pages 349-377, October.
    4. Wiley-Exley, Elizabeth, 2007. "Evaluations of community mental health care in low- and middle-income countries: A 10-year review of the literature," Social Science & Medicine, Elsevier, vol. 64(6), pages 1231-1241, March.
    5. Anne Case & Angus Deaton, 2017. "Mortality and Morbidity in the 21st Century," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 48(1 (Spring), pages 397-476.
    6. Mattos, Enlinson & Mazetto, Debora, 2019. "Assessing the impact of more doctors’ program on healthcare indicators in Brazil," World Development, Elsevier, vol. 123(C), pages 1-1.
    7. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    8. Sebastian Galiani & Paul Gertler & Ernesto Schargrodsky, 2005. "Water for Life: The Impact of the Privatization of Water Services on Child Mortality," Journal of Political Economy, University of Chicago Press, vol. 113(1), pages 83-120, February.
    9. Petra Persson & Maya Rossin-Slater, 2018. "Family Ruptures, Stress, and the Mental Health of the Next Generation," American Economic Review, American Economic Association, vol. 108(4-5), pages 1214-1252, April.
    10. Dalsgaard, Søren & Nielsen, Helena Skyt & Simonsen, Marianne, 2014. "Consequences of ADHD medication use for children's outcomes," Journal of Health Economics, Elsevier, vol. 37(C), pages 137-151.
    11. Achyuta Adhvaryu & James Fenske & Anant Nyshadham, 2019. "Early Life Circumstance and Adult Mental Health," Journal of Political Economy, University of Chicago Press, vol. 127(4), pages 1516-1549.
    12. Christopher J. Ruhm, 2018. "Deaths of Despair or Drug Problems?," NBER Working Papers 24188, National Bureau of Economic Research, Inc.
    13. Ariaster B. Chimeli & Rodrigo R. Soares, 2017. "The Use of Violence in Illegal Markets: Evidence from Mahogany Trade in the Brazilian Amazon," American Economic Journal: Applied Economics, American Economic Association, vol. 9(4), pages 30-57, October.
    14. Romero Rocha & Rodrigo R. Soares, 2010. "Evaluating the impact of community‐based health interventions: evidence from Brazil's Family Health Program," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 126-158, September.
    15. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    16. Kevin Milligan & Mark Stabile, 2011. "Do Child Tax Benefits Affect the Well-Being of Children? Evidence from Canadian Child Benefit Expansions," American Economic Journal: Economic Policy, American Economic Association, vol. 3(3), pages 175-205, August.
    17. Douglas Almond & Bhashkar Mazumder, 2011. "Health Capital and the Prenatal Environment: The Effect of Ramadan Observance during Pregnancy," American Economic Journal: Applied Economics, American Economic Association, vol. 3(4), pages 56-85, October.
    18. John Roy & Stefanie Schurer, 2013. "Getting Stuck In The Blues: Persistence Of Mental Health Problems In Australia," Health Economics, John Wiley & Sons, Ltd., vol. 22(9), pages 1139-1157, September.
    19. Lawrence F. Katz & Jeffrey R. Kling & Jeffrey B. Liebman, 2001. "Moving to Opportunity in Boston: Early Results of a Randomized Mobility Experiment," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 116(2), pages 607-654.
    20. Cornelius Christian & Lukas Hensel & Christopher Roth, 2019. "Income Shocks and Suicides: Causal Evidence From Indonesia," The Review of Economics and Statistics, MIT Press, vol. 101(5), pages 905-920, December.
    21. Bhalotra, Sonia R. & Rocha, Rudi & Soares, Rodrigo R., 2019. "Does Universalization of Health Work? Evidence from Health Systems Restructuring and Expansion in Brazil," IZA Discussion Papers 12111, Institute of Labor Economics (IZA).
    22. Rafael Dix-Carneiro & Rodrigo R. Soares & Gabriel Ulyssea, 2018. "Economic Shocks and Crime: Evidence from the Brazilian Trade Liberalization," American Economic Journal: Applied Economics, American Economic Association, vol. 10(4), pages 158-195, October.
    23. Rasmus Landersø & Peter Fallesen, 2021. "Psychiatric hospital admission and later crime, mental health, and labor market outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 30(1), pages 165-179, January.
    24. David E. Bloom & Elizabeth Cafiero & Eva Jané-Llopis & Shafika Abrahams-Gessel & Lakshmi Reddy Bloom & Sana Fathima & Andrea B. Feigl & Tom Gaziano & Ali Hamandi & Mona Mowafi & Danny O’Farrell & Emre, 2012. "The Global Economic Burden of Noncommunicable Diseases," PGDA Working Papers 8712, Program on the Global Demography of Aging.
    25. Christopher J. Ruhm, 2000. "Are Recessions Good for Your Health?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(2), pages 617-650.
    26. Paul Frijters & David W. Johnston & Michael A. Shields, 2014. "The Effect Of Mental Health On Employment: Evidence From Australian Panel Data," Health Economics, John Wiley & Sons, Ltd., vol. 23(9), pages 1058-1071, September.
    27. Sarah Baird & Jacobus de Hoop & Berk Özler, 2013. "Income Shocks and Adolescent Mental Health," Journal of Human Resources, University of Wisconsin Press, vol. 48(2), pages 370-403.
    28. Silver, E. & Arseneault, L. & Langley, J. & Caspi, A. & Moffitt, T.E., 2005. "Mental disorder and violent victimization in a total birth cohort," American Journal of Public Health, American Public Health Association, vol. 95(11), pages 2015-2021.
    29. Luiz Felipe Campos Fontes & Otavio Canozzi Conceição & Paulo de Andrade Jacinto, 2018. "Evaluating the impact of physicians' provision on primary healthcare: Evidence from Brazil's More Doctors Program," Health Economics, John Wiley & Sons, Ltd., vol. 27(8), pages 1284-1299, August.
    30. Steven Raphael & Michael A. Stoll, 2013. "Assessing the Contribution of the Deinstitutionalization of the Mentally Ill to Growth in the U.S. Incarceration Rate," The Journal of Legal Studies, University of Chicago Press, vol. 42(1), pages 187-222.
    31. Swensen, Isaac D., 2015. "Substance-abuse treatment and mortality," Journal of Public Economics, Elsevier, vol. 122(C), pages 13-30.
    32. Victoria Baranov & Sonia Bhalotra & Pietro Biroli & Joanna Maselko, 2020. "Maternal Depression, Women's Empowerment, and Parental Investment: Evidence from a Randomized Controlled Trial," American Economic Review, American Economic Association, vol. 110(3), pages 824-859, March.
    33. Andrew Goodman-Bacon, 2018. "Difference-in-Differences with Variation in Treatment Timing," NBER Working Papers 25018, National Bureau of Economic Research, Inc.
    34. Victoria Baranov & Johannes Haushofer & Chaning Jang, 2020. "Can Positive Psychology Improve Psychological Well-Being and Economic Decision-Making? Experimental Evidence from Kenya," Economic Development and Cultural Change, University of Chicago Press, vol. 68(4), pages 1345-1376.
    35. Anne Case & Angua Deaton, 2015. "Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century," Working Papers 15078.full.pdf, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
    36. Ruhm, Christopher J., 2019. "Drivers of the fatal drug epidemic," Journal of Health Economics, Elsevier, vol. 64(C), pages 25-42.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Matías Mrejen & Rudi Rocha, 2021. "Hiring Mental Health Professionals: Evidence from a Large-Scale Primary Care Policy in Brazil," Institutional Studies 03, Instituto de Estudos para Políticas de Saúde.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Charris, Carlos & Branco, Danyelle & Carrillo, Bladimir, 2024. "Economic shocks and infant health: Evidence from a trade reform in Brazil," Journal of Development Economics, Elsevier, vol. 166(C).
    2. Marta Golin, 2022. "The effect of broadband Internet on the gender gap in mental health: Evidence from Germany," Health Economics, John Wiley & Sons, Ltd., vol. 31(S2), pages 6-21, October.
    3. Chan Yu, 2023. "Newborns during the crisis: Evidence from the 1980s′ farm crisis," Health Economics, John Wiley & Sons, Ltd., vol. 32(8), pages 1836-1867, August.
    4. Fjolla Kondirolli & Naveen Sunder, 2022. "Mental health effects of education," Health Economics, John Wiley & Sons, Ltd., vol. 31(S2), pages 22-39, October.
    5. Dow, William H. & Godøy, Anna & Lowenstein, Christopher & Reich, Michael, 2020. "Can Labor Market Policies Reduce Deaths of Despair?," Journal of Health Economics, Elsevier, vol. 74(C).
    6. Colantone, Italo & Crinò, Rosario & Ogliari, Laura, 2019. "Globalization and mental distress," Journal of International Economics, Elsevier, vol. 119(C), pages 181-207.
    7. Michaela Paffenholz, 2024. "Adolescents’ Mental Health and Human Capital: The Role of Socioeconomic Rank," CRC TR 224 Discussion Paper Series crctr224_2024_526, University of Bonn and University of Mannheim, Germany.
    8. Fernández Guerrico, Sofía, 2021. "The effects of trade-induced worker displacement on health and mortality in Mexico," Journal of Health Economics, Elsevier, vol. 80(C).
    9. Ilaria Natali & Mathias Dewatripont & Victor Ginsburgh & Michel Goldman & Patrick Legros, 2023. "Prescription opioids and economic hardship in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(9), pages 1473-1504, December.
    10. Rodríguez-González, Ana, 2021. "The Impact of the Female Advantage in Education on the Marriage Market," Working Papers 2021:5, Lund University, Department of Economics.
    11. Buckles, Kasey & Evans, William N. & Lieber, Ethan M.J., 2023. "The drug crisis and the living arrangements of children," Journal of Health Economics, Elsevier, vol. 87(C).
    12. Aliprantis, Dionissi & Fee, Kyle & Schweitzer, Mark E., 2023. "Opioids and the labor market," Labour Economics, Elsevier, vol. 85(C).
    13. Wookun Kim, 2024. "Baby Bonus, Fertility, and Missing Women," CESifo Working Paper Series 11215, CESifo.
    14. Luca Braghieri & Ro'ee Levy & Alexey Makarin, 2022. "Social Media and Mental Health," American Economic Review, American Economic Association, vol. 112(11), pages 3660-3693, November.
    15. Tamara Bischof & Boris Kaiser, 2021. "Who cares when you close down? The effects of primary care practice closures on patients," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2004-2025, September.
    16. Courtney C. Coile & Mark G. Duggan, 2019. "When Labor's Lost: Health, Family Life, Incarceration, and Education in a Time of Declining Economic Opportunity for Low-Skilled Men," Journal of Economic Perspectives, American Economic Association, vol. 33(2), pages 191-210, Spring.
    17. Wookun Kim, 2023. "Baby Bonus, Fertility, and Missing Women," Departmental Working Papers 2308, Southern Methodist University, Department of Economics.
    18. Diogo G. C. Britto & Paolo Pinotti & Breno Sampaio, 2022. "The Effect of Job Loss and Unemployment Insurance on Crime in Brazil," Econometrica, Econometric Society, vol. 90(4), pages 1393-1423, July.
    19. Leonardo Becchetti & Gianluigi Conzo, 2021. "Avoiding a “despair death crisis” in Europe: the drivers of human (un)sustainability," International Review of Economics, Springer;Happiness Economics and Interpersonal Relations (HEIRS), vol. 68(4), pages 485-526, December.
    20. Malmendier, Ulrike M. & Borgschulte, Mark & Guenzel, Marius & Liu, Canyao, 2020. "CEO Stress, Aging, and Death," CEPR Discussion Papers 14933, C.E.P.R. Discussion Papers.

    More about this item

    Keywords

    Mental Health; Community care; Psychiatric Reform; CAPS;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:pra:mprapa:108658. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Joachim Winter (email available below). General contact details of provider: https://edirc.repec.org/data/vfmunde.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.