Participatory intercultural adaptation of WHO’s mhGAP for Indigenous communities in Brazil

Abstract

WHO’s mhGAP provides evidence-based guidance for mental health care in non-specialist settings, but its biomedical orientation does not reflect Indigenous cosmologies, languages, developmental expectations or collective care systems. In Brazil, Indigenous adolescents experience mental health challenges shaped by territorial insecurity, cultural disruption, structural violence and limited access to culturally safe services. This presentation discusses a participatory intercultural adaptation of mhGAP for Kaingang adolescents in the Guarita Territory. Participatory action research was informed by reflexive deliberation, contextual grounding, epistemic negotiation and ethical power-sharing. An Intercultural Mental Health Team of Indigenous and non-Indigenous health workers, traditional specialists, educators, leaders and researchers co-led the process. Data were generated through discussion groups with 161 participants, interviews with traditional healers and analysis of Indigenous mental health guidance. Indigenous collaborators led interpretation and member checking to ensure cultural validity and protect sensitive knowledge. Mental health was framed through good living, linking body, mind, community, territory and spirituality. Traditional healers, elders, families, schools and Indigenous Health Agents were identified as central actors in care, alongside biomedical services. The adaptation highlighted the need to distinguish spiritual experiences from clinical symptoms, avoid pathologising culture, and address structural violence, cultural disruption and collective suffering. The process informed an intercultural guide integrating Kaingang epistemologies with mhGAP. The presentation will show how cultural adaptation can become an ethical and political process of shared decision-making, rather than a technical exercise, offering transferable lessons for culturally safe mental health care in Indigenous communities.