Implementation of early psychosis services in Latin America: A scoping review

Abstract

Aim The evidence of the effectiveness and cost‐effectiveness of early intervention for psychosis (EIP) services has motivated their implementation worldwide. However, complex interventions of such EIP services require local adaptations to successfully match population needs and cultural differences. Latin America is a heterogenous region where EIP services are progressively being adopted. Our aim is to map such initiatives in the region with a focus on implementation outcomes. Methods A scoping review following the Preferred Reporting Items for Systematic review and Meta‐Analysis extension for Scoping Reviews guidelines was conducted. International and regional databases were searched for publications describing EIP programmes in the region. Besides mapping the services, we described implementation outcomes based on the Standards for Reporting Implementation Studies Checklist. Results Ten articles describing seven EIP initiatives from the region were found. Four countries were represented: Argentina, Brazil, Chile and Mexico. The implementation outcomes reporting was heterogenous, although it was possible to ascertain EIP services are feasible and adequate for the region's context. Also, there is some evidence of effectiveness in terms of reducing hospitalizations and improving symptoms. Information about fidelity measures was scarce and there was no information about costs or cost‐effectiveness. Conclusions Only a small proportion of Latin American countries have adopted EIP services. Although these programmes seem to be feasible and effective, data on other implementation outcomes, such as fidelity, cultural appropriateness, cost‐effectiveness and affordability are not available. This might in part explain why this effective approach has not been yet scaled‐up at nationwide levels.

Public health primary prevention implemented by clinical high-risk services for psychosis

“…The level of research and evidence in LMICs is still modest and should become a mainstream topic on the future research agenda. In Latin America, EI services are in their early stages of development and mostly focused on FEP rather than CHR-P users [ 101 , 102 ].…”

Early intervention in psychosis in emerging countries: Findings from a first‐episode psychosis programme in the Ribeirão Preto catchment area, southeastern Brazil

“…We assessed the implementation and performance of a Brazilian EIP, expecting point similarities and particularities to other Brazilian, Latin American and global similar experiences. As far as we know (Aceituno et al, 2020), our study comprised the largest sample reported in Latin America. Most patients in our retrospective cohort were young males, single and white and were mainly referred by tertiary care facilities.…”

“…A decade ago, there were only seven of such services in Latin America, most of which were in Brazil (Brietzke et al, 2011). A recent service implementation review highlighted the persistent failure in scaling up this strategy (Aceituno et al, 2020).…”

“…Latin America and other LMICs deal with open veins in many social struggles configured as risk factors for psychosis-deprivation, inequality, violence, early-life stressors, social instability and a high level of psychoactive substance abuse. However, restricted health care budgets and a lack of human resources pose significant challenges to EIP implementation (Aceituno et al, 2020).…”

Consent, decisional capacity and guardianship in mental health research

“…Because early intervention significantly improves response to treatment and long-term global functioning 2,3 , it has become a public health priority in first-episode psychosis (FEP) 2,4 . In LMICs, implementation of this approach faces significant hurdles, including a scarcity of resources, weak infrastructure, absence of mental health policies, few trained clinicians, and stigma 5,6 .…”