Mental health and psychiatric care in Bolivia: what do we know?

Abstract

BackgroundRecently Bolivia has implemented a universal health system, but their mental health policy is still emerging.ObjectivesTo investigate the current state of the mental health care system in Bolivia and discuss challenges for structuring a coordinated network of services that can effectively meet the needs of the Bolivian population.MethodsThis review was conducted by searching for scholarly articles through the databases Lilacs, Medline OPS, HISA and IBECS REPIDISCA via the search portal in the Virtual Health Library - NLM (http://www.bireme.br).ResultsBolivia has a National Mental Health Plan that is intended to guide mental health promotion, prevention, treatment and rehabilitation of mental illness, but the resources for this area of health are limited. There are 1.06 psychiatrists and 0.46 psychologists per 100, 000 inhabitants. Information on psychiatric morbidity in Bolivia and the impact of mental disorders on the global burden of disease is scarce. Admission statistics reported by psychiatric hospitals in the country show that the main cause of hospitalization is substance abuse (30%). Alcohol consumption is responsible for 90% of these admissions, in addition to being a major cause of deaths in traffic and one of the main risk factors for domestic violence. Almost one in two women in Bolivia (47%) experienced some form of violence from their partner in the last year. Nineteen percent of women living with a partner reported being physically abused, while 7% were sexually abused by their partners. Isolated studies report that suicide rates are disproportionately high in Bolivia.ConclusionsAlthough there is a shortage of epidemiological data in Bolivia, it is clear the impact of alcohol addiction in psychiatric admissions, domestic violence and traffic accidents. Violence against women and suicides are important issues to be tackled. Among the proposed strategies to afford human resources for mental health in Bolivia, “task shifting”, the delegation of tasks to non-specialists should be extensively adopted in the country to improve mental health care.

Establishing an Independent Mobile Health Program for Chronic Disease Self-Management Support in Bolivia

“…Even when insurance is available, supply and infrastructure constraints limit healthcare access (36, 37). Bolivia has 1.2 doctors and 2.1 nurses per 1000 inhabitants (36), and of the 2875 primary care centers, 45% do not have a physician (2007 data) (35). …”

Meeting the communication support needs of children and young people with intellectual disabilities in the Bolivian Andes

“…Jaen-Varas et al (2014) found a similar profile in a review of mental health services in Bolivia. Although a universal health care system has been in place since 2007, 77% of the population has been excluded from access to it due to economic, social, geographical and cultural barriers.…”

Feasibility of an interactive voice response system for monitoring depressive symptoms in a lower-middle income Latin American country

“…However, in recent years, mental health care has received increased attention from the Bolivian government including the implementation of a national plan ( Plan Nacional de Salud Mental 2009–2015), the goal of which is to increase prevention, early detection, and timely treatment of psychological, neurological, and substance use disorders [ 12 ]. SAFCI ( Salud Familiar Comunitaria Intercultural , or Program for Intercultural Family Health Care in the Community) is the major program for providing primary care throughout the country, and includes mental health promotion in its scope [ 12 , 14 ].…”

“…Generally speaking, however, the health system in Bolivia, as in other LMICs, lacks the human resources needed to provide adequate care, including monitoring and self-management support, to patients with depression in primary care settings [ 12 , 14 ]. Mobile health (mHealth) tools may help fill this gap, yet mHealth solutions have been largely overlooked in efforts to improve the reach of mental health care in poorer countries [ 15 ].…”