Governance in mental healthcare policies during the COVID-19 pandemic in Mexico

Abstract

The COVID-19 pandemic has become the greatest burden of disease worldwide and in Mexico, affecting more vulnerable groups in society, such as people with mental disorders (MD). This research aims to analyze the governance processes in the formulation of healthcare policies for people with MD in the face of the COVID-19 pandemic. An analytical qualitative study, based on semi-structured interviews with key informants in the healthcare system was conducted in 2020. The study followed the theoretical-methodological principles of the Governance Analytical Framework (GAF). The software ATLAS.ti-V.9 was used for inductive thematic analysis, classifying themes and their categories. To ensure the proper interpretation of the data, a process of triangulation among the researchers was carried out. The findings revealed that in Mexico, the federal Secretary of Health issued guidelines for mental healthcare, but there is no defined national policy. Decision-making involved multiple actors, with different strategies and scopes, depending on the type of key-actor and their level of influence. Majority of informants described a problem of implementation in which infection control policies in the psychiatric population were the same as in the general populations which decreased the percentage of access to healthcare during the pandemic, without specific measures to address this vulnerable population. The results suggest that there is a lack of specific policies and measures to address the needs of people with mental disorders during the COVID-19 pandemic in Mexico. It also highlights the importance of considering the role of different actors and their level of influence in the decision-making process.

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“…Mental health costs are the highest single source of global economic burden in the world [ 35 ], and adolescence is the peak time for clinical onset of most mental illnesses [ 21 ]. Yet access to mental health services are low or uneven in many countries including Mexico, where less than 1% of Mexico’s Ministry of Public Health total budget is dedicated to mental health [ 27 ]. Out of pocket expenditures in Mexico have been steadily increasing, reaching 41.3% in 2017, with higher likelihood of catastrophic healthcare expenditures for mental health issues [ 27 ].…”

“…Yet access to mental health services are low or uneven in many countries including Mexico, where less than 1% of Mexico’s Ministry of Public Health total budget is dedicated to mental health [ 27 ]. Out of pocket expenditures in Mexico have been steadily increasing, reaching 41.3% in 2017, with higher likelihood of catastrophic healthcare expenditures for mental health issues [ 27 ]. As a result, issues such as climate change that may drive economic losses and disruptions may exacerbate CMD and also create an additional financial stressor on households.…”

“…Reports cite major gaps in provision of mental health services in Mexico, and adolescents are still not a priority group for federal or state policy-makers [ 26 ]. The COVID-19 pandemic spurred the federal Secretary of Health to issue guidelines for mental healthcare but there is still no national defined policy and no focus on young people’s needs [ 27 ].…”

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