Brazil’s public health system (SUS) has added extended-release lithium on tolerability and adherence grounds, and the Dominican health-insurance regulator, the Superintendency of Health and Occupational Risks (SISALRIL), is studying wider mental health and medicines cover, while the Pan American Health Organization (PAHO) reports a 2.1% median budget share for mental …
POLICY & MARKETS · MENTAL HEALTH · OCTOBER 22, 2026 · LATIN AMERICA
Brazil has approved an extended-release lithium tablet for its public health system, and the Dominican Republic’s health-insurance regulator is studying how to pay for more mental health care, including medicines. Both moves land in a region where governments still devote a small slice of health budgets to mental health.
The Pan American Health Organization (PAHO) and the Organization of American States (OAS) used Inter-American Mental Health Week, held on October 5–9, to press for action beyond the health sector. PAHO says more than 185 million people in the Americas live with a mental health condition. “[M]ost do not receive the care they need,” said PAHO Director Jarbas Barbosa in the organization’s October 6 statement. In June 2026 the OAS General Assembly, meeting in Panama City, adopted a declaration on improving mental health through whole-of-government action.
2.1%
Median share of the health budget that countries in the Americas allocate to mental health, according to PAHO, citing WHO’s Mental Health Atlas 2024. PAHO adds that 42% of that spending goes to psychiatric hospitals rather than community-based services.
Money is flat while need is rising
WHO’s Mental Health Atlas 2024, published in September 2025 with data from 144 countries, found that the global median share of government health spending on mental health was 2.1%, the same level reported in 2017 and 2020. The global median workforce was 13.5 specialized mental health workers per 100,000 people.
Demand indicators point the other way. Health at a Glance: Latin America and the Caribbean 2026, published on September 29 by the Organisation for Economic Co-operation and Development (OECD), the Inter-American Development Bank (IDB) and the World Bank, reports that anxiety prevalence across the region rose from 6,632.7 cases per 100,000 people in 2021 to 7,173.7 in 2024. These figures are Institute for Health Metrics and Evaluation (IHME) estimates, and the increase is roughly 8% by our calculation. Brazil had the highest rate in the region, at 11,376 per 100,000. Suicide mortality across 25 countries in the region rose 11.7% between 2010 and 2023 (or latest year), while it fell 16.7% in OECD countries. Guyana (25.9 per 100,000) and Uruguay (21.2) recorded the highest rates in 2023.
Worldwide, formal coverage is not the main gap for medicines. In the Atlas, 81% of responding countries said publicly funded schemes include mental health care. In at least half of responding countries, patients pay little or nothing (5% or less) for psychotropic medication. Psychological therapy is a different story: 28% of responding countries reported that patients pay a high share of its cost.
Where coverage is opening
Brazil offers the clearest recent case of a coverage decision. On September 14, 2026 the Ministry of Health signed Portaria SCTIE/MS No. 56, an ordinance of its Secretariat of Science, Technology and Innovation in Health (SCTIE), which adds extended-release lithium carbonate 450 mg for bipolar disorder to the Unified Health System (SUS). The ministry’s National Committee for Health Technology Incorporation (Conitec) had recommended it on August 5. Eurofarma filed the request. Conitec’s evaluators found no meaningful difference in efficacy against the immediate-release 300 mg tablet that SUS already supplies, but did find less frequent and less severe tremor. They rated the certainty of the evidence low to very low. In its final recommendation, Conitec said it weighed mainly the expected clinical benefits, such as better tolerability and adherence. Eurofarma’s economic model estimated annual treatment cost at about R$594 per patient, against R$628 for the current tablet, a saving of about R$34 a year. Conitec’s partner unit put the five-year incremental budget impact at R$6.3m–7.7m. The ordinance, published on September 17, gives the ministry up to 180 days to make the drug available.
Brazil is also spending on capacity. Under the New Growth Acceleration Program (Novo PAC), the Ministry of Health lists 204 new Psychosocial Care Centers (CAPS) from the 2023 selection, worth R$449m. It lists 130 more from the 2025 selection, worth R$324m, for a combined 334 centers and R$773m by our count.
In the Dominican Republic, the Superintendency of Health and Occupational Risks (SISALRIL) said on October 8 that it is studying ways to improve the financing of mental health care. It is also drafting a proposal to expand coverage of certain services, “including the medicines that members require” (our translation), within the Dominican Social Security System (SDSS). SISALRIL has not published a timetable, a list of services or a list of drugs.
What to Watch
- Whether SUS starts supplying extended-release lithium by mid-March 2027, when the 180-day deadline set by Portaria SCTIE/MS No. 56 runs out by our count, and at what tender price.
- The content of SISALRIL’s proposal: which mental health services and which medicines it adds to the SDSS benefit plan, and how it funds them.
- How OAS member states turn the June 2026 Panama City declaration into budget lines, and whether the 2.1% median moves in the next Atlas round.
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For companies with central nervous system (CNS) portfolios, the Brazilian decision is a signal about what clears the bar. Conitec backed a reformulation of an established molecule on tolerability and adherence grounds, with low-certainty evidence, even though Eurofarma’s cost-effectiveness model showed only a small saving per patient and both Conitec’s partner unit (R$6.3m–7.7m) and Eurofarma’s own revised estimate (R$0.1m–2.2m) projected a five-year incremental budget cost. The committee also noted that competition among manufacturers could change the final price. Our reading: in systems that spend about 2% of health budgets on mental health, the next wins for antidepressants, antipsychotics and newer therapies are likely to go to products that keep incremental budget impact small, make a tolerability or adherence case, and fit community services such as CAPS. Products that rely on hospital-based delivery or on specialists who remain scarce will find it harder.
Why this is relevant
Patients
People with bipolar disorder in Brazil gain a lithium option linked to fewer tremors within SUS once supply begins. In the Dominican Republic, enrollees may see wider cover for mental health medicines if SISALRIL’s proposal advances.
Industry
Conitec backed a reformulation without proven superior efficacy, citing tolerability and adherence. Its evaluators priced the existing tablet at the government’s average purchase price (R$0.22, versus the R$0.32 the sponsor used). Our reading: CNS dossiers should benchmark against public tender prices.
Payers
With psychotropic copays already low in at least half of responding Atlas countries, the larger gaps lie in psychological therapy, for which 28% of responding countries report high out-of-pocket costs, and in community services.
Regulators
PAHO’s “mental health in all policies” approach lists finance among the sectors it engages. Our reading: the OAS declaration and PAHO’s call raise pressure on finance ministries, not just on health ministries, to fund mental health beyond the 2.1% median.
Sources: PAHO: Inter-American Mental Health Week calls for intersectoral action (Oct 6, 2026) · PAHO: Mental Health topic page · WHO: Over a billion people living with mental health conditions (Sep 2, 2025) · WHO: Mental Health Atlas 2024 · OECD/IDB/World Bank: Health at a Glance: Latin America and the Caribbean 2026, Mental health · Ministério da Saúde: Portaria SCTIE/MS No. 56 (Sep 14, 2026) · Conitec: Relatório para Sociedade No. 726, extended-release lithium carbonate 450 mg · Ministério da Saúde: Novo PAC, Centros de Atenção Psicossocial · Conitec: Relatório de Recomendação No. 1,128, extended-release lithium carbonate 450 mg · SISALRIL: SISALRIL trabaja iniciativas para fortalecer atención en salud mental (Oct 8, 2026)
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