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Community Mental Health Services in Latin America for People with Severe Mental Disorders

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Abstract

Mental disorders are highly prevalent in Latin American countries and exact a serious emotional toll, yet investment in public mental health remains insufficient. Most countries of the region have developed national and local initiatives to improve delivery of mental health services over the last 22 years, following the technical leadership of the Pan American Health Organization/World Health Organization (PAHO/WHO). It is especially notable that PAHO/WHO facilitated the development of national policies and plans, as well as local programs, to deliver specialized community care for persons with severe mental disorders. Nevertheless, at present, the majority of Latin American countries maintain a model of services for severe mental disorders based primarily on psychiatric hospitals that consume most of the national mental health budget. To accelerate the pace of change, this article emphasizes the need to develop cross-country regional initiatives that promote mental health service development, focusing on severe mental disorders. As one specific example, the authors describe work with RedeAmericas, which has brought together an interdisciplinary group of international investigators to research regional approaches and train a new generation of leaders in public mental health. More generally, four regional strategies are proposed to complement the work of PAHO/WHO in Latin America: 1) to develop multi-country studies on community services, 2) to study new strategies and interventions in countries with more advanced mental health services, 3) to strengthen advocacy groups by cross-country interchange, and 4) to develop a network of well-trained leaders to catalyze progress across the region.

References

  1. 1.

    Rodriguez J, Kohn R, Aguilar-Gaxiola S, (editors). Epidemiología de los trastornos mentales en América Latina y el Caribe. Washington, DC: Pan American Health Organization; 2009. [In Spanish]

  2. 2.

    Rodríguez J, Kohn R, Levav I. Epidemiología de los trastornos mentales en América Latina y el Caribe. In: Rodríguez J. (editor). Salud Mental en la Comunidad. Washington, DC: Pan American Health Organization; 2009. [In Spanish]

  3. 3.

    Marconi J, Varela A, Rosenblat E, Solari G, Marchesse I, et al. A survey on the prevalence of alcoholism among the adult population of a suburb of Santiago. Q J Stud Alcohol. 1955;16:438–46.

  4. 4.

    Mariategui J, Adis Castro G, (editors). Estudios sobre epidemiología psiquiátrica en América Latina. Buenos Aires: ACTA; 1970. [In Spanish]

  5. 5.

    Mari JJ, Garcia de Oliveira Soares B, Silva de Lima M, Levav I. Organización Panamericana de la Salud: breve historia de la epidemiología psiquiátrica en América Latina y el Caribe. In: Rodriguez J, Kohn R, Aguilar-Gaxiola S, (editors). Epidemiología de los Trastornos Mentales en América Latina y el Caribe. Washington, DC: Pan American Health Organization; 2009. [In Spanish]

  6. 6.

    Minoletti A, Pemjean A. Salud mental en el norte de Chile: un desafío teórico y operacional. Acta Psiquiatr Psicol Am Lat. 1973;19:434–44. [In Spanish]

  7. 7.

    Marconi J. Política de salud mental en América Latina. Acta Psiquiatr Psicol Am Lat. 1976;22:112–8. [In Spanish]

  8. 8.

    León CA. Perspectivas de la salud mental comunitaria en Latinoamérica. Bol Oficina Sanit Panam. 1976;81:122–38. [In Spanish]

  9. 9.

    Saraceno B, Aguilar Briceno R, Asioli F, Liberati A, Tognoni G. Cooperation in mental health: an Italian project in Nicaragua. Soc Sci Med. 1990;31:1067–71.

  10. 10.

    Fusar-Poli P, Bruno D, Machado-de-Souza JP, Crippa J. Franco Basaglia. (1924–1980): three decades (1979–2009) as a bridge between the Italian and Brazilian mental health reform. Int J Soc Psychiatry 2011;57:100–3.

  11. 11.

    Gonzalez R, Levav I. Organización Panamericana de la Salud: reestructuracion de la atencion psiquiatrica. Bases conceptuales y guias para su implementacion. HPA/MND I.9I. Pan American Health Organization; 1991. [In Spanish]

  12. 12.

    Levav I, Restrepo H, Guerra de Macedo C. The restructuring of psychiatric care in Latin America: a new policy for mental health services. J Public Health Policy. 1994;15:71–85.

  13. 13.

    Caldas de Almeida JM, Horvitz-Lennon M. Mental health care reforms in Latin America: an overview of mental health care reforms in Latin America and the Caribbean. Psychiatr Serv. 2010;61:218–21.

  14. 14.

    Pan American Health Organization/World Health Organization: 43rd directing council final report. Washington, DC: PAHO/WHO; 1 October 2001.

  15. 15.

    Pan American Health Organization/World Health Organization: The Brasilia principles: guiding principles on the development of mental health care in the Americas. PAHO/WHO; 2006.

  16. 16.

    Pan American Health Organization/World Health Organization: Resolution CD49.R17 of the PAHO 49th directive council. Washington, DC: PAHO/WHO; 2 October 2009.

  17. 17.

    Caldas de Almeida JM. Estrategias de cooperación técnica de la Organización Panamericana de la Salud en la nueva fase de la reforma de los servicios de salud mental en América Latina y el Caribe. Rev Panam Salud Publica. 2005;18:314–26. [In Spanish]

  18. 18.

    Caldas de Almeida JM, Cohen A, (editors). Innovative Mental Health Programs in Latin America and the Caribbean. Washington, DC: Pan American Health Organization/World Health Organization; 2008.

  19. 19.

    Eaton J, McCay L, Semrau M, Chatterjee S, Baingana F, et al. Scale up of services for mental health in low-income and middle-income countries. Lancet. 2011;378:1592–603.

  20. 20.

    World Health Organization. Mental health atlas: Department of Mental Health and Substance Abuse, WHO; 2001.

  21. 21.

    World Health Organization: Mental health atlas: 2005. Department of Mental Health and Substance Abuse, WHO; 2005. http://www.who.int/mental_health/evidence/mhatlas05/en/index.html

  22. 22.

    World Health Organization: Mental health atlas 2011: country profiles. Department of Mental Health and Substance Abuse, WHO; 2011.

  23. 23.

    World Health Organization: Mental health atlas 2011. Department of Mental Health and Substance Abuse, WHO; 2011.

  24. 24.

    Pan American Health Organization/World Health Organization. Framework for the implementation of the regional strategy on mental health. PAHO/WHO; 2011.

  25. 25.

    Andreoli SB, Almeida-Filho N, Martin D, Mateus MD, Mari JJ. Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil. Rev Bras Psiquiatr. 2007;29:43–6.

  26. 26.

    Gonçalves RW, Vieira FS, Delgado PGG. Mental health policy in Brazil: federal expenditure evolution between 2001 and 2009. Rev Saúde Pública. 2012;46:51–8.

  27. 27.

    Minoletti A, Narváez P, Sepúlveda R, Caprile A. Chile: lecciones aprendidas en la implementación de un modelo comunitario de atención en salud mental. In: Rodríguez J, (editor). Salud Mental en la Comunidad. Washington, DC: Pan American Health Organization, PALTEX; 2009. [In Spanish]

  28. 28.

    Funk M, Faydi E, Drew N, Minoletti A. Organización de los servicios de salud mental. El modelo comunitario en salud mental. In: Rodríguez J, (editor). Salud Mental en la Comunidad. Washington, DC: Pan American Health Organization, PALTEX; 2009. [In Spanish]

  29. 29.

    Rodríguez J. Los servicios de salud mental en América Latina y el Caribe: la evolución hacia un modelo comunitario. Rev Psiquiatr Urug. 2011;75:86–96. [In Spanish]

  30. 30.

    Ministerio de Salud de Chile, Pan American Health Organization/World Health Organization. Informe WHO-AIMS sobre sistema de salud mental en Chile. Ministerio de Salud de Chile. 2006. [In Spanish]

  31. 31.

    Ministry of Health of Panama, Pan American Health Organization/World Health Organization. WHO-AIMS report on mental health system in Panama. PAHO/WHO; 2006.

  32. 32.

    Ministry of Health of Brazil, Pan American Health Organization/World Health Organization. WHO-AIMS Report on mental health system in Brazil. Brasília, Brazil: PAHO/WHO and Ministry of Health of Brazil; 2007.

  33. 33.

    Pan American Health Organization/World Health Organization, Paraguay Office. IESM-OMS Informe sobre el sistema de Salud Mental en Paraguay. PAHO/WHO, Paraguay Office; 2006. [In Spanish]

  34. 34.

    Ministry of Health of Uruguay, Pan American Health Organization/World Health Organization, Uruguay Office. WHO AIMS report on mental health system in Uruguay. PAHO/WHO, Uruguay Office; 2006.

  35. 35.

    Secretaria de Estado de Salud Pública y Asistencia Social (SESPAS) de República Dominicana, Pan American Health Organization/World Health Organization. IESM-OMS informe sobre el sistema de salud mental en República Dominicana. PAHO/WHO; 2008. [In Spanish]

  36. 36.

    Secretaría de Salud de México, Pan American Health Organization/World Health Organization. IESM-OMS informe sobre el sistema de salud mental en México. PAHO/WHO; 2011. [In Spanish]

  37. 37.

    Ministerio de Salud Pública de Cuba, Pan American Health Organization/World Health Organization. IESM-OMS informe sobre sistema de salud mental en la República de Cuba. PAHO/WHO; 2011. [In Spanish]

  38. 38.

    Ministry of Health of Belize, Pan American Health Organization/World Health Organization. WHO-AIMS Report on mental health system in Belize. PAHO/WHO; 2009.

  39. 39.

    Cayetano CE. Belice: Un ejemplo de atención de salud mental en la comunidad. In: Rodríguez J, (editor). Salud Mental en la Comunidad. Washington, DC: Pan American Health Organization, PALTEX; 2009. [In Spanish]

  40. 40.

    Rosolen Soares SR, Saeki T. El centro de atención psicosocial sobre la óptica de los usuarios. Rev Latino-am Enfermagem. 2006;14:923–9. [In Spanish]

  41. 41.

    Onoko Campos RT, Pereira Furtado J, Passos E, Ferrer AL, Miranda L, Pegolo da Gama CA. Evaluation of the network of psychosocial care centers: between collective and mental health. Rev Saúde Pública. 2009;43:S16–22.

  42. 42.

    Tomasi E, Facchini LA, Piccini RX, Thumé E, Azevedo da Silva R, Goncalves H, Silva SM. The effectiveness of psychosocial care centers for the mentally ill in a medium-sized city in southern Brazil: a stratified analysis. Cad Saúde Pública. 2010;26:807–15. [In Portuguese]

  43. 43.

    De Souza Delfini PS, Sato MT, Antoneli PP, Da Silva Guimaraes PO. Partnership between psychosocial care center and family health program: the challenge of a new knowledge construction. Cien Saúde Colet. 2009;14:S1483–92. [In Portuguese]

  44. 44.

    Aparicio V. Pan American Health Organization/World Health Organization. Cuba: mental health care and community participation. In: Caldas de Almeida JM, Cohen A, (editors). Innovative Mental Health Programs in Latin America and the Caribbean. PAHO/WHO; 2008.

  45. 45.

    León M. Cuba: los centros comunitarios de salud mental. De la ideología a la práctica. In: Rodríguez J, (editor). Salud Mental en la Comunidad. Washington, DC: Pan American Health Organization, PALTEX; 2009. [In Spanish]

  46. 46.

    Ginés A, Porciúncula H, Arduino M. El Plan de Salud Mental: veinte años después. Evolución, perspectivas y prioridades. Rev Psiquiatr Urug. 2005;69:129–50. [In Spanish]

  47. 47.

    Romano S, Novoa G, Gopar M, Cocco AM, De León B, et al. El trabajo en equipo: una mirada desde la experiencia en equipos comunitarios de salud mental. Rev Psiquiatr Urug. 2007;71:135–52. [In Spanish]

  48. 48.

    Minoletti A, Sepulveda R, Horvitz-Lennon M. Twenty years of mental health policies in Chile: lessons and challenges. Int J Ment Health. 2012;411:21–37.

  49. 49.

    Alvarado R, Minoletti A, Torres González F, Küstner BM, Madariaga C, Sepúlveda R. Development of community care for people with schizophrenia in Chile. Int J Ment Health. 2012;41:48–61.

  50. 50.

    Gutiérrez-Maldonado J, Caqueo-Urízar A. Effectiveness of a psycho-educational intervention for reducing burden in Latin American families of patients with schizophrenia. Qual Life Res. 2007;16:739–47.

  51. 51.

    Armijo J, Boyd Y, Herrera J. Reestructuración en la atención psiquiátrica: una experiencia innovadora en Panamá. Cuad. Psiquiatr Comunitaria. 2009;9:147–53. [In Spanish]

  52. 52.

    Mieses J, Gernay J, Soto I. Programa CLIPLE: Seguimiento de psicóticos en la comunidad en República Dominicana. Cuad. Psiquiatr Comunitaria. 2009; 9:187–92. [In Spanish]

  53. 53.

    Del Castillo R, Dogmanas D, Villar M. Hacia una rehabilitación psicosocial integral en el Uruguay. Psicología Conocimiento Sociedad. 2011;4:83–96. [In Spanish]

  54. 54.

    Ainstein J. Programa vuelta a casa en la provincia de Buenos Aires. Personal Communication, 2006.

  55. 55.

    Mateus MD, Mari JJ, Delgado PGG, Almeida-Filho N, Barret T, et al. The mental health system in Brazil: policies and future challenges. Int J Ment Health Sys. 2008;2:12.

  56. 56.

    Ministerio de Salud de Chile. Norma Técnica sobre Hogares Protegidos. Santiago, Chile: Ministerio de Salud, Unidad de Salud Mental; 2000. [In Spanish]

  57. 57.

    Lafferte C, Minoletti A, Flores L, Ministerio de Salud. Estudio de hogares protegidos. Santiago, Chile: Ministerio de Salud, Unidad de Salud Mental; 2000. [In Spanish]

  58. 58.

    Reyes A, Aguilar MF, Orellana M, Guifarro S, Martínez L. Casa de medio camino: experiencia en Honduras. Cuad Psiquiatr Comunitaria. 2009;9:155–66. [In Spanish]

  59. 59.

    Cohen H, Natella G. Trabajar en salud mental, la desmanicomialización en Rio Negro. Buenos Aires: Lugar Editorial; 1995. [In Spanish]

  60. 60.

    Collins PY. Argentina: waving the mental health revolution banner - psychiatric reform and community mental health in the Province of Río Negro. In: Caldas de Almeida JM, Cohen A, (editors). Innovative Mental Health Programs in Latin America and the Caribbean. Washington, DC: Pan American Health Organization/World Health Organization; 2008.

  61. 61.

    Cohen H, Natella G. Argentina: el programa de salud mental en la provincia de Río Negro. In Rodríguez J, (editor). Salud Mental en la Comunidad. Washington, DC: Pan American Health Organization, PALTEX; 2009.

  62. 62.

    Collins PY, Lumerman J, Conover S, Susser E. Using local resources in Patagonia: A model of community-based rehabilitation. Int J Ment Health. 1999;28:17–24.

  63. 63.

    World Federation for Mental Health. Integrating mental health into primary care - primary care for mental health in practice. mental health in primary care: enhancing treatment and promoting mental health. World Federation for Mental Health. 2009; 11–13.

  64. 64.

    World Health Organization. Monitoring and evaluation of mental health policies and plans. Mental Health Policies and Service Guidance Package. WHO; 2007.

  65. 65.

    RedeAmericas Network. Available from URL: http://cugmhp.org

  66. 66.

    Susser E, Valencia E, Conover S, Felix A, Tsai WY, Wyatt RJ. Preventing recurrence of homelessness among mentally ill men: a “critical time intervention” after discharge from a shelter. Am J Public Health 1997;87:256–62.

  67. 67.

    Herman D, Conover S, Gorroochurn P, Hinterland K, Hoepner L, Susser, E. A randomized trial of critical time intervention in persons with severe mental illness following institutional discharge. Psychiatr Serv. 2011;62:713–9.

  68. 68.

    Cavalcanti M, Dahl C, Araujo de Carvalho M, Valencia E. Critérios de admissão e continuidade de cuidados em centros de atenção psicosocial, Rio de Janeiro, RJ. Rev Saude Publ. 2009;43:23–8. [In Portuguese]

  69. 69.

    Cavalcanti M, Tavares M, Valéncia E, Magalhaes Dahl C, Mitkiewicz de Souza, F. Adaptation of Critical Time Intervention for use in Brazil and its implementation among users of psychosocial service centers (CAPS) in the municipality of Rio de Janeiro. Ciênc Saúde Coletiva. 2011;16:4635–42. [In Portuguese]

  70. 70.

    Baumgartner JN, Susser E. Social integration in global mental health: what is it and how can it be measured? Epidemiol Psychiatr Sci. May 2012; 25:1–9.

  71. 71.

    Baumgartner JN, Carpinteiro da Silva TF, Lovisi G, Valencia E, Susser E. Measuring social integration in a pilot randomized control trial of critical time intervention-task ahifting in Latin America. Cad Saude Colet. 2012;20:436–39.

  72. 72.

    Link B, Cullen F, Struening E, Shrout P, Dohrenwend B. A modified labeling theory approach to mental disorders: an empirical assessment. Am Soc Rev. 1989;54: 400–23.

  73. 73.

    Yang L, Valencia E, Alvarado R, Link B, Huynh N, et al. A Theoretical and Empirical Framework for Constructing Culture-Specific Stigma Instruments for Chile. Cad Saude Colet. in press.

  74. 74.

    Corrigan P, Giffort D, Rashid F, Leary M, Okeke I. Recovery as a psychological construct. Community Ment Health J. 1999;35:231–9.

  75. 75.

    Cook J, Copeland M, Jonikas J, Hamilton M, Razzano L, et al. Results of a randomized controlled trial of mental illness self-management using wellness recovery action planning. Schizophr Bull. 2011;38:57–60.

  76. 76.

    Stastny P. Introducing peer support work in Latin American mental health services. Cad Saude Colet. 2012;20:473–81.

  77. 77.

    Weingartner R, Restrepo-Toro ME. Recovery narratives: “See how far I’ve come”. Cad Saude Colet. 2012;20:448–52.

  78. 78.

    Hernandez Alvarez M, Torres-Tovar M. Colombia’s new health reform: helping keep the financial sector healthy. Soc Med. 2010;5:177–81.

  79. 79.

    De Jesus Mari J, Bressan R, Almeida-Filho N, Gerolin J, Sharan P, Saxena Shekhar. Mental health research in Brazil: policies, infrastructure, financing and human resources. Rev. Saude Publica 2006;40:161–9.

  80. 80.

    Funk M, Minoletti A, Drew N, Taylor J, Sarceno B. Advocacy for mental health: roles for consumer and family organizations and governments. Health Promo Int. 2005;21:17–20.

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Correspondence to Ezra Susser MD, DrPh.

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Key Words

  • Community mental health
  • community psychiatry
  • public health
  • Latin America
  • psychiatric epidemiology
  • global mental health