Integrated mapping of local mental health systems in Central Chile

Abstract

Objective To describe the availability of local mental health (MH) services in small MH catchment areas in Central Chile, using a bottom-up approach. Methods MH services of 19 small MH catchment areas in five health districts of Central Chile that provide health care to more than 4 million inhabitants were assessed using DESDE-LTC (Description and Evaluation of Services and Directories in Europe for Long-Term Care), a tool for standardized description and classification of LTC health services, in a study conducted in 2012 (“DESDE-Chile”) designed to complement other studies conducted in 2004 and 2012 at the national and regional level using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS). Key informants from national, regional, and local health authorities were contacted to compile a comprehensive list of MH services or facilities (health, social services, education, employment, and housing). The analysis of local care provision covered three criteria—service availability, placement capacity, and workforce capacity. Results The study detected disparities in all three criteria (availability and placement and workforce capacity) across the five health districts, between urban and rural areas, and between neighboring urban areas. Analysis of service availability revealed differences in the weight of residential services versus day and outpatient care. The Talcahuano area could be considered a benchmark of MH care in Central Chile, based on its service provision patterns, and the criteria of the community care model. The list of MH services identified in this study differed from the one generated in the 2012 WHO-AIMS study. Conclusions This survey of local MH service provision in small catchment areas using the DESDE-LTC tool provided MH service provision data that complemented information collected in other studies conducted at the national/regional level using the WHO-AIMS tool. The bottom-up approach applied in this study would also be useful for the assessment of equity and accessibility and local planning.

Service availability and capacity in rural mental health in Australia: Analysing gaps using an Integrated Mental Health Atlas

“…This study is intended to improve information on the local healthcare ecosystem, defined as a network of interrelated sub-systems such as natural and socioeconomic contexts, providers, organisations, health suppliers, regulations and consumers in a specific region (Serbanati et al, 2011). Comparison across jurisdictions and countries using the same method, terminology and tools (Chung et al, 2018; Gutiérrez-Colosía et al, 2019; Sadeniemi et al, 2018; Salinas-Perez et al, 2018) has favoured the modelling of local efficiency and resource allocation tailored to the particular needs of every area in urban planning (García-Alonso et al, 2019). In future, the extension of comparative research on local patterns of service delivery and resource utilisation in rural areas should facilitate the development of specific models of rural mental health care, replace the traditional ‘ one size fits all ’ approach to rural health by tailored local planning and enable a better analysis of factors related to geographical accessibility such as out-of-pocket costs of transportation, equity of access, the impact of distance on help-seeking behaviour, and social adherence and fragmentation.…”

“…These atlases are called ‘ integrated ’ because they incorporate a standard description of all services available in a defined area for a target population group including health, social, employment, education, justice and housing sectors. Visual maps of rural mental health services in Australia have been developed for Western Australia and New South Wales at different levels of geographical aggregation (Furst et al, 2018a; Hopkins et al, 2017a, 2017b; Salvador-Carulla et al, 2016), as well as for various rural and urban areas in Europe and Chile (Fernandez et al, 2015; Gutiérrez-Colosía et al, 2019; Salinas-Perez et al, 2018; Salvador-Carulla et al, 2008, 2015).…”

Standardised description of health and social care: A systematic review of use of the ESMS/DESDE (European Service Mapping Schedule/Description and Evaluation of Services and DirectoriEs)

“…Twenty-two articles (31%) received funding from national, regional or local governmental agencies. Two papers mentioned the use of the ESMS/DESDE terminology and coding structure in the development of other major international classification and service assessment tools such as the International System of Health Accounts (SHA 2.0) [96, 42]; and the WHO Assessment Instrument for Mental Health Systems ( WHO-AIMS) [38, 94].…”

“…The mental health improvement and its relationship to the regional plan was analysed in Catalonia (Spain) in 2002, 2006 and 2010 [81]. Two health districts in Central Chile were evaluated in 2004/05 [69], 2008/09 [95] and 2012 [94]. Three hospital districts in Finland were assessed in 2004 [71], 2011/12 [33] and 2012/14 [84].The area of Verona (Italy) has been analysed in 2002 and 2010 [89]; and the areas in Northwest Russia and Northern Norway in 2004/05 and 2011/12 [64,88].…”

Patterns of Mental Health Care in Remote Areas: Kimberley (Australia), Nunavik (Canada), and Lapland (Finland): Modèles de soins de santé mentale dans les régions éloignées: Kimberley (Australie), Nunavik (Canada) et Laponie (Finlande)

“…20 These comparisons are based on the standard description of services by using the Description and Evaluation of Services and Direc-toriEs for Long Term Care (DESDE-LTC), 21 in combination with analyses of socioeconomic context, health and service use, and geographical maps. So far over 25 atlases and standardized directories of services have been developed in different countries, including Australia, [22][23][24] Chile, 25 Finland, 26,27 and Spain. 28 This study aims to analyze the provision of MH care in the health areas of the Kimberley region (Australia), Nunavik (Canada), and Lapland (Finland).…”