[Is it possible to make municipal basic income programs universal in Brazil? An estimate with municipal finance data].

Schizophrenia is a severe mental disorder that follows a chronic course and is marked by regular relapse events following the first episode of schizophrenia (FES). These relapses have profound psychosocial consequences for both the affected individual and their family members, including disrupted interpersonal relationships, loss of employment and limited educational opportunities. Relapse events also impose a significant burden on constrained and often resource-limited healthcare systems in lower middle-income countries (LMICs) such as South Africa. Given that schizophrenia is ranked as the 12th most disabling disorder in terms of a chronic non-communicable disease globally, the public health implications are substantial. Recurrent relapses are associated with illness progression, increased functional impairment and a greater likelihood of treatment resistance over time. Investigating factors contributing to relapse other than treatment non-adherence, particularly among affected individuals with repeated episodes, presents considerable challenges. High-risk individuals with schizophrenia residing in LMICs often face a complex combination of social, economic and healthcare system barriers that impede consistent follow-up and limit research engagement. Frequent difficulties in maintaining regular contact with mental health services, including missed appointments and fragmented care, contribute to the underrepresentation of this vulnerable population in research and increase their risk of being excluded from or lost to the healthcare system. As a result of deinstitutionalisation, the care of individuals with schizophrenia has largely shifted to family members and informal caregivers. Family members therefore often face considerable emotional, physical and social burdens, while managing financial strain and competing responsibilities. Limited access to psychoeducation further exacerbates these challenges, straining family relationships. Without adequate support systems, and in the context of unemployment and pervasive community stigma, people with schizophrenia face heightened relapse risk and social exclusion. These conditions frequently fuel substance misuse and criminal behaviour, creating environments that substantially increase relapse risk. In LMIC settings, unemployed men, unmarried individuals and those who misuse substances are disproportionately underrepresented in healthcare services. These findings highlight the need to explore this underrepresented group in LMICs with frequent schizophrenia relapse, because the challenges that shape relapse risk, also contribute to their exclusion from research aimed at informing clinical practice.