Global health. The current scenario and future perspectives

175 Since the mid-20 th century, there has been a significant shift in how healthcare is organized for individuals with mental health problems. It has transitioned from a model centered around psychiatric hospitals to one based on community services and care. Latin America has also undergone this change as part of healthcare reforms in the region (OPS, 1990). Efforts have been made to decrease psychiatric hospitals and reduce long-term stays in these facilities. Additionally, the development of new community- based initiatives, such as day hospitals, community centers and community residences, has been encouraged. These efforts have been largely framed within the Primary Care strategy, especially in low- and middle-income countries (Caldas de Almeida & Horvitz-Lennon, 2010). Simultaneously, in recent decades, there has been an emphasis on creating instruments that provide regulatory frameworks to support the aforementioned changes. Many countries in the region have enacted laws, regulations and/or national mental health plans, to strengthen the development of community services and ensure resources for their functioning (Agrest et al., 2018). Additionally, many of these initiatives seek to protect the human and civil rights of those with mental disorders and recognize the heavy stigma they bear. Stigma is currently considered one of the main causes of their social exclusion (Mascayano et al., 2015). Some elements of the current context From an epidemiological standpoint, the estimation in 2010 revealed that 7.4% of the global burden of disease, measured in disability-adjusted life years, could be attributed to mental and substance-use disorders, primarily due to the disability they induce. In absolute terms, this burden had increased by 37.6% over 20 years, which is partially attributable to population aging (Whiteford et al., 2013). The situation in Latin America mirrors this global trend. Mental disorders, including specific neurological disorders, substance abuse and suicide, represent one-fifth of the total disease burden in the region. Major depressive disorders, as the primary cause of disability, contribute to 3.4% of the total disease burden, followed by anxiety disorders at 2.1% (OPS, 2018). Furthermore, there is a growing concern regarding the impact of mental health issues on children, exacerbated by the ongoing Covid-19 pandemic (United Nations Children’s Fund (UNICEF), 2021). In all countries, the healthcare budget allocated to mental health significantly lags in percentage terms compared to what would be expected