Nationwide decline in psychiatric hospitalizations and costs in Brazil, 2008–2022: a retrospective descriptive study evidencing reform-driven community mental health gains

SummaryBackground Neuropsychiatric disorders are among the leading causes of disability worldwide, generating substantial healthcare utilization and costs. Brazil, which hosts the world's largest universal public health system, implemented psychiatric reform to reduce dependence on long-term hospitalization and expand community-based services. The study aimed to assess hospitalization trends in Brazil between 2008 and 2022. Methods We conducted a nationwide, retrospective analysis of administrative data from Brazil's Hospital Information System (SIH/SUS) covering all psychiatric admissions (ICD-10, Chapter V) from 2008 to 2022. Outcomes included admission rates, length of stay, diagnostic distribution, demographic and regional disparities, and total hospitalization costs, adjusted for inflation. Data were standardized using WHO population projections and Markov chain Monte Carlo. Findings Psychiatric hospitalizations declined by more than 50%, from 314, 686 admissions (315 per 100, 000 people) in 2008 to 151, 113 (151 per 100, 000) in 2022. The mean length of stay fell from 45. 1 to 22. 1 days. Schizophrenia spectrum disorders remained the leading cause of admission but decreased substantially (from 151 to 53 per 100, 000 people), while mood disorders increased particularly among female adolescents (from 12 to 16 per 100, 000 people). Males were hospitalized 70% more compared to females (males: 174; females: 102 per 100, 000 people in 2021), mainly for substance- (males: 37; females: 10 per 100, 000 people in 2021) and alcohol-related disorders (males: 32; females: 4 per 100, 000 people in 2021). Marked regional variation persisted, with slower declines in the North. Total hospitalization costs fell by over 75% between 2010 (R1, 123, 798, 345) and 2022 (R290, 769, 856), reflecting a sustained shift from hospital-based to community-based care. Interpretation Brazil's sustained reduction in psychiatric hospitalizations and costs demonstrates the long-term success of psychiatric reform and the expansion of community-based mental health care. However, regional and demographic inequities underscore the need for targeted investments to ensure equitable access and expand reform achievements amid policy fluctuations. Funding CNPq, INCT, CAPES, FAPEMIG.