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Mental Health in Latin America and Caribbean

Mental Health in Latin America and Caribbean. Joana Godinho Health Sector Manager March 2014. Opportunities for Mental Health Care Reform in LAC. Significant mental health care reforms in Argentina (provincial level), Brazil, Caribbean, Central America and Chile

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Mental Health in Latin America and Caribbean

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  1. Mental Health in Latin America and Caribbean Joana Godinho Health Sector Manager March 2014

  2. Opportunities for Mental Health Care Reform in LAC • Significant mental health care reforms in Argentina (provincial level), Brazil, Caribbean, Central America and Chile • Democratization & economic growth • Right to health agenda • 1990 Caracas Declaration • Protection of human rights of people with mental disabilities • shift from psychiatric hospital care to community-based care • Integration of mental health care into PHC • Approval of mental health policies, plans & regulations • Mental health nurses partially filled the skills gap Caldas de Almeida JM 2013. Mental health services development in Latin America and the Caribbean: achievements, barriers and facilitating factors. International Health 5:15-18. Caldas de Almeida JM, Horvitz-Lennon M. 2010. Mental health care reforms in Latin America: An overview of mental health care reforms in Latin America and the Caribbean. Psychiatr Serv. Mar 61(3):218-21.

  3. Opportunities for Mental Health Care Reform in the Americas • Protection of human rights of mental patients • By 2005, 75% countries had enacted mental health legislation and developed mental health plans • By 2011, 66% countries had reviewed their plans • By 2011, 39% countries had enacted/reviewed mental health legislation • Mechanisms for monitoring human rights in mental health services • Integration of international recommendations into national legislation Caldas de Almeida JM 2013. Mental health services development in Latin America and the Caribbean: achievements, barriers and facilitating factors. International Health 5:15-18.

  4. Opportunities for Mental Health Care Reform in LAC • From hospital to community-based care • Psychiatric hospitals improved, downsized or closed and replaced by new models of care since 2005 • Greatest regional decrease in psychiatric hospital beds 2005-2011 • Appropriate mental health interventions • 74% countries have referral procedures from tertiary/secondary care to PHC • 64% countries provide psychosocial interventions • 39% countries have manuals on management & treatment available on PHC • 38% countries PHC doctors trained • 35% countries provide follow up community care • 30% countries nurses trained Caldas de Almeida JM 2013. Mental health services development in Latin America and the Caribbean: achievements, barriers and facilitating factors. International Health 5:15-18.

  5. Opportunities for Mental Health Care Reform in LAC • Argentina: Buenos Aires and Rio Negro Province • Network of community-based services • Rio Negro replaced psychiatric hospital with psychiatric beds in general hospitals • Belize • Implemented national network of community services • Closed down an old psychiatric hospital • Brazil • Reallocation of resources from mental hospitals to community services • Chile • Comprehensive national reform implemented & evaluated • Developed community care & integrated mental health into PHC Caldas de Almeida JM 2013. Mental health services development in Latin America and the Caribbean: achievements, barriers and facilitating factors. International Health 5:15-18. Caldas de Almeida JM, Horvitz-Lennon M. 2010. Mental health care reforms in Latin America: An overview of mental health care reforms in Latin America and the Caribbean. Psychiatr Serv. Mar 61(3):218-21.

  6. Challenges to Mental Health Care Reform in LAC • Almost ¼ of BOD due to mental and substance abuse disorders in LAC • Alcoholism especially among men, depression especially among women, epidemic of prescription drugs and aging • Unemployment, disasters, violence • Indigenous people, children & adolescents • Significant gaps • Data, M&E, research • Financing • Treatment • Lack of • MOH stewardship • public health knowledge among mental health community • Incomplete decentralization • No focus on mental health at PHC level • No PHC staff training on mental health

  7. Burden of Mental & Substance Abuse Disorders in LAC • Depression & anxiety are leading causes of disability in LAC, largely mirroring global trends • Anxiety is one of the top 10 causes of disability in all regions, but ranks highest in LAC and MNA • Drug use disorders were larger causes of disability in LAC, in contrast to global trends • Schizophrenia and bipolar disorder appear among the top 20 causes of disability in many regions Institute for Health Metrics and Evaluation, Human Development Network, The World Bank 2013. The Global Burden of Disease: Generating Evidence, Guiding Policy – Latin America and Caribbean Regional Edition. Seattle, WA: IHME.

  8. Prevalence of mental health disorders in LAC Kohn R, Levav I, Caldas de Almeida JM, Vicente B, Andrade L, Caraveo-AnduagaJJ, Saxena S, Saraceno B 2005. Mental disorders in Latin America and the Caribbean: a public health priority. Rev PanamSaludPublica 18(4/5):229-240.

  9. Global Burden of Mental & Substance Abuse Disorders Whiteford HA et al 2013. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet, 382, 9904, 1575 - 1586, 9 November 2013.

  10. Shifts in ranking of DALYs in LAC 1990-2010 Institute for Health Metrics and Evaluation, Human Development Network, The World Bank 2013. The Global Burden of Disease: Generating Evidence, Guiding Policy – Latin America and Caribbean Regional Edition. Seattle, WA: IHME.

  11. Mental Health Treatment Gap in LAC Kohn R, Levav I, Caldas de Almeida JM, Vicente B, Andrade L, Caraveo-Anduaga JJ, Saxena S, Saraceno B 2005. Mental disorders in Latin America and the Caribbean: a public health priority. Rev PanamSaludPublica 18(4/5):229-240.

  12. Mental Health Treatment Gap in LAC • Access to mental health treatment in the previous year • Brazil: 34.5% • Colombia: 27.7% • Mexico: 25.8% 76–85% of individuals with serious mental disorders do not have access to treatment in developing countries LynskeyMT, Strang J 2013. The global burden of drug use and mental disorders The Lancet, 382, 9904, 1540-1542, 9 November 2013. WHO World Mental Health (WMH) Surveys.

  13. Mental Health Financing Gap in LAC • 73% countries allocate 1-5% of health budget to mental health • In 2011, the median percentage allocated to mental health was 1.53% • Brazil: 2.35% • Chile: 2.14% • 67% mental health expenditures on mental hospitals • 14 countries allocate +80% mental health budget to hospitals • 20 countries allocate +50% mental health budget to hospitals Caldas de Almeida JM 2013. Mental health services development in Latin America and the Caribbean: achievements, barriers and facilitating factors. International Health 5:15-18. PAHO 2013. WHO-AIMS: Report on Mental Health Systems In Latin America And The Caribbean. WDC: PAHO.

  14. Recommendations for developing countries on mental health • Advocacy for people with mental diseases, de-stigmatization • Political will for the organization of accessible and humane mental health care • Increase in, and decentralization of financial & human resources • MoHstewardship role on mental health • Surveillance, M&E and research linked to mental health practice • Increase in the capacity of mental health community • Development of community mental health services • Investments in PHC for mental health • Use of modern technology • Participation of user (52%) & family(60%) associations Based on: SaracenoB et al 2007. Barriers to improvement of mental health services in low-income and middle-income countries. The Lancet, 370, 9593, 1164-1174, 29 September.

  15. Recommendations for the Bank on mental health • In the context of UHC • Knowledge • Alcohol taxation study • Expenditure reviews & costing studies • Equity studies • C/E studies • Convening services • Community of practice on mental health under the umbrella of right to health initiative • Financing • Policy Development, RAS and investment on • mental health financing • Community-based mental health service delivery using new technologies • multisector action for mental health

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