Mental health care systems in Latin America and the Caribbean

Abstract

This paper summarizes a series of events that were historical milestones in Latin America and the Caribbean in the long road toward restructuring and setting up psychiatric and mental health services to shift from the old and obsolete psychiatric hospital models to other, community-based models. This has been and largely remains the principal challenge that we face. The burden of mental illness is described in terms of morbidity, mortality, and disability. In 1990, it was estimated that psychiatric and neurological disorders accounted for 8.8% of the disability-adjusted life years in Latin America and the Caribbean; in 2004 that burden had grown to 21%. However, the treatment gap (sick people who remain untreated) exceeds 60%; added to that there is a prevailing gap in funding and resources for the treatment of mental health problems. In response to these problems, the Pan American Health Organization (PAHO/WHO) has continued to strengthen its technical cooperation with the countries. The 49th Directing Council of PAHO/WHO approved the Strategy and Plan of Action on Mental Health for the region of the Americas, which constitutes a major historical landmark; for the first time, the ministries of health in every country in the hemisphere studied and approved a work programme to improve mental health care based on the experiences gained and expressing a technical and political commitment. It is a key priority to continue working to restructure mental health services and strengthen intersectoral initiatives to promote mental health; specific problems, such as care for vulnerable groups, child and adolescent mental health, suicide, alcohol abuse, and violence, also pose a great challenge for mental health programs today.

Correlates of Symptoms of Depression and Anxiety among Clinic Outpatients in Western Jamaica

“…In South Africa, a comprehensive study estimated that 9.8% of study participants had major depression while another 15.8% suffered from symptoms of anxiety disorders (5). In Latin America and the Caribbean, there was an increase in disability adjusted life years (DALYs) from 8.8% in 1999 to 21.0% in 2004 due in part to mental health disorders such as anxiety and depression (6). In studies of outpatient clinic populations conducted in China and Northern India, the prevalence of anxiety disorders was 9.8% and 11.1%, respectively (7,8).…”

Measuring social integration in a pilot randomized controlled trial of critical time: intervention-task shifting in Latin America

“…As CHC-SMD has evolved in the region, with notable exceptions such as Chile, mental health and primary care clinics have developed in parallel and the connections between services are often weak 18-20 . Mental health clinics are the main locale for provision of outpatient services to individuals with severe mental disorders; but, they generally lack general health services, do not provide in vivo community-based services, have not built strong connections to the communities that use their services, and do not involve users and their families in shaping the offered services 21,22 .…”

Spanish cross-cultural adaptation and psychometric properties of the Schizophrenia Quality of Life short-version questionnaire (SQoL18) in 3 middle-income countries: Bolivia, Chile and Peru

“…The purpose of this program was, in particular, to implement and evaluate interventions associating appropriate mental health promotion, prevention and treatment of mental disorders and rehabilitation (Rodriguez, 2010). Each intervention proposed to improve mental health care in this reform process needs to be rigorously tested and evaluated to allow the generalizability of results and supports implementation on a larger scale (Rodriguez, 2010).…”