Community Mental Health Services in Latin America for People with Severe Mental Disorders

Abstract

Mental disorders are highly prevalent in Latin American countries and exact a serious emotional toll, yet investment in public mental health remains insufficient. Most countries of the region have developed national and local initiatives to improve delivery of mental health services over the last 22 years, following the technical leadership of the Pan American Health Organization/World Health Organization (PAHO/WHO). It is especially notable that PAHO/WHO facilitated the development of national policies and plans, as well as local programs, to deliver specialized community care for persons with severe mental disorders. Nevertheless, at present, the majority of Latin American countries maintain a model of services for severe mental disorders based primarily on psychiatric hospitals that consume most of the national mental health budget. To accelerate the pace of change, this article emphasizes the need to develop cross-country regional initiatives that promote mental health service development, focusing on severe mental disorders. As one specific example, the authors describe work with RedeAmericas, which has brought together an interdisciplinary group of international investigators to research regional approaches and train a new generation of leaders in public mental health. More generally, four regional strategies are proposed to complement the work of PAHO/ WHO in Latin America: 1) to develop multi-country studies on community services, 2) to study new strategies and interventions in countries with more advanced mental health services, 3) to strengthen advocacy groups by cross-country interchange, and 4) to develop a network of well-trained leaders to catalyze progress across the region.

Keywords: Community mental health; Latin America; community psychiatry; global mental health; psychiatric epidemiology; public health.

Fig. 1

Presence of mental health policy, plan and legislation in Latin American countries and world low-and-middle income (LMIC) and high income countries. Source: WHO’s Project Atlas: Resources for Mental Health 2011^,

Fig. 2

Median percentage of health budget allocated to mental health in Latin American countries and world countries by World Bank income groups. Source: WHO’s Project Atlas: Resources for Mental Health 2011^,

Fig. 3

Fig. 4

Average rate of psychiatric beds in Latin America 2001-2011 by level of implementation of comunity-based services and type of hospital (per 100,000 population)^-,-