MDs received positive validation of their work when they could observe positive outcomes in service users, which also improved acceptability: There are days when you are tired, but when you see a patient is improving or that they are better able to do things in their daily lives [] that gives you the energy you need. (Com7X, MD, male). Health at a Glance: Latin America and the Caribbean 2020 presents key indicators on health and health systems in 33 Latin America and the Caribbean countries. Quantitative and qualitative data were analysed using descriptive and framework analyses, respectively. It serves as a guide for countries for the development and planning of mental health services. Overview of Health Policy in Mexico Although many health indicators are improving in Mexico, the country has the lowest life expectancy in the OECD. ReThe purpose for the Behavioral Health Policy & Billing Manual (BH Manual) is to provide a reference for the policies and processes related to Behavioral Health for administration of Medicaid behavioral health services, as defined in New Mexico Administrative Code (NMAC), Section 8.321.2. All participants were provided informed consent before the data collection took place, through which they authorised the use of their data in an anonymised and confidential form. Thornicroft G, Ahuja S, Barber S, Chisholm D, Collins PY, Docrat S, et al. The goal of the mental health court program is to provide the participant the support and tools needed to lead a clean and sober life. National Institute of Psychiatry Ramon de la Fuente Muz', Mexico City, National Institute of Psychiatry Ramon de la Fuente Muz', Mexico City, email medinam@imp.edu.mx, https://doi.org/10.1192/S1749367600000783, Lineamientos para la Preservacin de los Derechos Humanos en los Hospitales Psiquitricos. MDs feel they are treating people going through a large amount of social suffering, whose health is affected by social factors which they cannot address. Basic Needs. Mexicans have access to universal health coverage but reliable, quality health care is hard to come byespecially in remote, rural areas of Chiapas. 2003;26(4):116. This report highlights the progress made and offers recommendations to support IMSS in achieving procurement excellence and fulfilling its mandate to provide the best possible, most cost-effective healthcare services to citizens. [Health Mexico 2004. Supervision and training delivered on site by specialists, although limited due to human resource shortages, were seen as more appropriate for MDs needs as they allowed MDs to observe what tools and techniques are used to approach real-life scenarios and further apply them in their practice. The Mexican Adolescent Mental Health Survey (MAMHS), a community-based epidemiologic survey conducted in 2005 in Mexico City, found that four of ten adolescents aged 12 to 17 had a psychiatric disorder in the past year ( 1).Moreover, three-fifths of these youths had a disorder of sufficient severity to require professional intervention. Although many health indicators are improving in Mexico, the country has the lowest life expectancy in the OECD. Since 2014 a non-governmental organisation has delivered a mental health programme at PHC clinics in the state of Chiapas, in partnership with the local Ministry of Health (MoH). Mustafa, Murad Accounting Information.]. Supervisors help them with clinical decision-making but also help them deal with the frustration caused by large workloads, the lack of efficient referral systems, and, on a personal level, living in a remote community, far from relatives and friends, and with limited capacity to communicate with them: []They come and help me in my work every month. Two bilingual researchers familiar with the context translated relevant quotes to English. 63% of service users were diagnosed according to programme guidelines, 25% did not undergo a clinical assessment, 5% did not complete an assessment scale, and 7% had missing data that prevented determination of the diagnostic process. Our study assesses the implementation of the CES programme in order to understand the extent to which it has achieved the integration of mental health into PHC as outlined in Mexicos mental health policies, and to then explore the strengths and limitations that determine the success or failure of integration in this context. Framework analysis was utilised to analyse the qualitative data. Low attendance is partially attributed to limited programme appropriateness, given that interventions to address social risk factors are not available. New findings from a study funded by the National Institute of Mental Health shed light on how adolescents living through the COVID-19 pandemic and its accompanying shutdowns compare, both psychologically and biologically, to their peers before the pandemic. The authors declare that they have no competing interests. The health budget in 2017 was $2.586 million pesos or just over $1.00 per capita, while in high-income countries it was, on average, $58.73.22 When the Popular Insurance Scheme was established, public expenditure on mental health increased from 0.3% to 0.7%, then declined continually to a level of 0.3% by 2017. Category: Health Detail Health Some patients have told me that they were not able to find a car, and they had to walk up the hill, for [] many hours, like 3 or more. (Com1W1, nurse, female). Hum Res Health. Implementation process and outcomes of a mental health programme integrated in primary care clinics in rural Mexico: a mixed-methods study. Lancet. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. There is an urgent need for health systems strengthening to support efforts to provide mental health care, and to link PHC with locally-relevant social interventions. Financial disruption as a result of pandemic containment policies in the United States adversely influenced children's mental health, according to a new study co-led by Weill Cornell Medicine and Columbia University investigators. In terms of limitations, for the qualitative study we used a convenience sample due to time constraints, however we included 56% of the programme personnel. Shidhaye R, Lund C, Chisholm D. Closing the treatment gap for mental, neurological and substance use disorders by strengthening existing health care platforms: strategies for delivery and integration of evidence-based interventions. International Journal of Mental Health Systems NB contributed to quantitative data extraction, coding of clinical notes, contributed to the discussion and provided comments on earlier drafts of the manuscript. Instituto Nacional de Estadstica y Geografa. Finally, according to all participants, many of the service users have mental health needs that arise from social circumstances, such as economic insecurity and exposure to gender-based violence or trauma, which cannot currently be addressed due to the lack of social services and targeted treatments: One of my patients suffered from sexual violence [] If we were in, say, Denmark, [] my role would be different. The Adult Mental Health Court will collect drug-testing fees from the participant to cover the cost of drug and alcohol screenings. But has this change been mirrored in improvements across the different areas of peoples lives? Integration of mental health care services in PHC in Mexico will require improved financing and resource management of PHC and specialist services, ongoing capacity building, the development of effective referral systems, further development of community-based services, and to link PHC with locally-relevant social interventions. RK provided extensive guidance in the process of data analysis and in the presentation of results, and also gave detailed comments and feedback on all drafts. Xavier M. Mexico: the Hidalgo experience. The penetration of programme activities was evidenced by the presence of capacity building activities and the routine delivery of mental health services, including identification of service users with mood or anxiety disorders, diagnosis, and treatment delivery. PubMed Central Programme fidelity was not fully achieved given the low rates of attendance, and limited adherence to treatment guidelines. The selection criteria for both samples aimed to be as unrestrictive as possible to improve representativeness. 2015;25(2):17891. Providers reported the support structure provided by CES makes the delivery of services possible. Total loading time: 0 The programme provides mental health services based on the mhGAP guidelines through multiple implementation strategies, including programme financing, infrastructure strengthening, high-intensity training, and supervision. Book statement and 2016;208:s1320. Meldahl, Laia G. Mitigating these economic effects may help protect children's well-being . Mail: National Institute of Mental Health Office of Science Policy, Planning, and . poverty and intimate partner violence). Soc Sci Med. . Human resources for mental health care: current situation and strategies for action. 2011;2011(1):6980. Implementation process and outcomes of a mental health programme integrated in primary care clinics in rural Mexico: a mixed-methods study, International Journal of Mental Health Systems, https://doi.org/10.1186/s13033-020-00346-x, http://apps.who.int/gho/data/node.main.MHHR?lang=en, https://www.coneval.org.mx/coordinacion/entidades/Chiapas/Paginas/Pobreza-2016.aspx, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. The report is part of the EU Regional Facility for Development in Transition for Latin America and the Caribbean. Global Health Observatory data repository: WHO; 2014 [cited 2018 December 12th]. Despite having progressive policies and programmes supporting the integration of mental health into PHC, in Mexico mental health care is still mainly delivered at psychiatric institutions, and it is only available in 30% of PHC clinics in the country [3]. They feel better [] and then they dont come back. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: mental health Gap Action Programme (mhGAP)version 2.0: World Health Organization; 2016. Our findings indicate that the presence of strategies that strengthen the service delivery platform (i.e. Hostname: page-component-7dc689bd49-q9qq5 Migrants' struggles with trauma and mental health are going overlooked and undertreated. A full description of the programme can be found in Fig. Mexico City is the capital of the United Mexican States. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Regarding mental health guidelines and materials, all MDs reported that these are easy to use within their daily practice as they are presented in a concise and simple manner, and also use language that is easy to understand for both clinicians and service users. Previous studies have found these strategies to be effective for the provision of care for various health conditions in other low resource settings [13]. Rosales, Cecilia The coding was in agreement in 87.4% of cases. The Mental Health Atlas 2020 includes . Chiapas-Poblacion-Censos, 2011. Most MDs worry that the talk-based interventions that they are providing are of poor quality and hence not useful to service users. All audio recordings were transcribed verbatim by bilingual researchers. Ibenfeldt, Maya In a recent report, Human Rights Watch documented how Mexico has done little to prevent discrimination, stigma, and abuses against people with disabilities, including those with mental health. The coding system can be found in Appendix 1. The distance [is a difficulty] as well because it is very far and they have to walk. We followed a process of (1) data familiarisation, (2) coding, (3) development of an analytical framework, (4) framework application and (5) interpretation [20]. Int J Ment Health Systems. Moreover, most clinical supervisors identified their lack of training to mentor others in the development of skills relevant to the provision of mental health services as a challenge: I think we need a monthly or bimonthly class to learn what we can do to improve our supervision of mental health [] so that we are told what the MDs are doing well and what they can improve. (Sup4, clinical supervisor, male). for this article. 2011;89:18494. The time available for each consultation is an issue according to most MDs as in many cases service users require services for more than one health complaint: I think the majority of mental health patients should have longer consultation times because you have to do a lot with them, [] apply the PHQ-9, check that there are no adverse effects from the medication, [] check for physical things, but the most important is that it is the time the patient has to talk, unload, and also the time that psychoeducation requires. This toolkit contains information about the process, documents, forms, links, Mexico has one of the highest rates of obesity in the OECD, as nearly one in three adults are obese. Validity and utility of the patient health questionnaire (PHQ)-2 and PHQ-9 for screening and diagnosis of depression in rural Chiapas, Mexico: a cross-sectional study. World Psychiatry. Both personally and professionally, the supervision is helpful. (Com5X2, MD, male). The CES programme was successful interms of achieving the integration of mental health services into 10 PHC clinics located in a rural area of Chiapas, Mexico. Saac Guzman/AFP/GETTY. Mental health recovery paradigm: implications for social work. Each community has~1000 inhabitants, most of whom live in extreme poverty [11]. Large parts of the population face economic insecurity, as a result of which feelings of despair, fear and impotence are common. Article MDs identified service users with mental health conditions successfully and performed appropriate clinical assessments. We used a comprehensive methodology that both described the implementation of the mental health programme, and described how this was achieved [15], and selected implementation outcomes based on relevant frameworks [16, 19]. prescription and supply of antidepressants, benzodiazepines, mood stabilisers and antipsychotics), individual and group talk-based interventions, and home visits. Mexico. California Privacy Statement, Risk and protective factors for mental health problems 22 2. Designing and Conducting Mixed Methods Research. The Lancet Psychiatry. Soc Sci Med. - Measuring Well-being for Policy Making, Cmo va la vida en Amrica Latina? Compaeros en Salud. BMJ. https://doi.org/10.1186/s13033-020-00346-x, DOI: https://doi.org/10.1186/s13033-020-00346-x. WHO Region: Region of the Americas. Modelo CES de atencin a la Salud Mental Chiapas. Community mental health practice: seven essential features for scaling up in low- and middle-income countries. Service users have problems that MDs are not used to treating and require lengthy talk-based support which can be difficult to offer due to time constraints and the emotional effort they entail. It also includes new targets for 2030. Mental health programmes at PHC can be implemented when adequate support and supervision structures are in place, and key resources are available. Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. S Afr Health Rev. Qualitative data was checked for quality, and translations of quotes were done by multiple researchers. MDs also report they have to allocate time and effort to complete many different activities. In terms of resources, important and complementary aspects are the availability of printed materials to provide mental health treatments and pharmacological treatments, which are provided by CES: In certain cases, you need medication and if we do not have [any] its worrying because [] the closest pharmacy is hours away. Salary$23.86 HourlyLocationLincoln, NEJob TypePERM FULL TIMEDepartmentHealth & Human ServicesSee this and similar jobs on LinkedIn. Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries. Of the approximately 5 million inhabitants of Chiapas, 50% per cent live in rural areas [8] and 77% in poverty [9]. travelling times, costs, and waiting times) that hinder attendance [40]. It is also associated with lifelong health benefits and reduces the risk of drowning. Furthermore, increasing community based services through CHWs and community participation is essential to accomplish better access to interventions that tackle both health and social needs [38, 39]. Posted 12:00:00 AM. Moreover, increasing the availability of psychiatrists and psychologists to support capacity building, and strengthening specialist services to refer those service users with complex needs are also necessary steps for successful implementation [33]. Lancet Psychiatry. Mental health services are mainly accessed through either the psychiatric hospital or an ambulatory clinic located in the state capital [4]. The organisation facilitates the delivery of general health services (including mental health) in 10 PHC clinics through the following implementation strategies: (1) programme financing, (2) capacity building of medical doctors (MDs) through high-intensity training and on-site supervision, (3) printed materials for clinical decision-making, (4) monitoring through a health information system (HIS), (5) ensuring medication supply, (6) community-based accompaniment [12] by community health workers (CHWs) and (7) support for referrals to specialist services. Psychiatric Serv. Services are designed according to mhGAP (Version 2.0) [14] adapted clinical guidelines and include case identification, diagnosis, pharmacological treatments (i.e. [Service users] come once, and perhaps they let out everything they have been carrying since who knows when. Mexico Instituto Nacional de Estadistica y Geografia 2011. The Mental Health Atlas 2020 includes information and data on the progress made towards achieving mental health targets for 2020 set by the global health community and included in WHOs Comprehensive Mental Health Action Plan. It includes data on newly-added indicators on service coverage, mental health integration into primary health care, preparedness for the provision of mental health and psychosocial support in emergencies and research on mental health. Evaluacin del sistema de salud mental en Mxico: hacia dnde encaminar la atencin? Since 2011, Compaeros En Salud (CES), a non-governmental organisation (NGO) and sister organisation of Partners in Health, has been supporting 10 PHC clinics in rural Chiapas in a partnership with the local Ministry of Health to improve the delivery of general health services [7]. A talk-based intervention was provided in 24% of mental health follow-up consultations. Recovery is founded on the principle that people can take on meaningful roles in the community despite mental health challenges when they receive the support they need. It is possible that the high levels of acceptability reported by health providers can also be attributed to the presence of capacity building mechanisms, which are dissimilar to what has been observed in other Mexican settings where levels of stigma from health providers are high [21]. We aimed to include all members of staff working for CES and CES supported clinics as they were all directly or indirectly involved in the programme implementation, however we were only able to include those available for a face-to-face interview. 2016. https://www.coneval.org.mx/coordinacion/entidades/Chiapas/Paginas/Pobreza-2016.aspx. MEXICO CITY (AP) Mexico's president called anti-drug policies in the U.S. a failure Wednesday and proposed a ban on using fentanyl in medicine even though little of the drug crosses from hospitals into the illegal market. We used a mixed-methods convergent design. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Mental health policy and legislation. expenditure on health in Mexico is still the highest in the OECD Despite decreasing from 55% in 2005, 45% of all health spending in Mexico was paid directly by patients in 2013, compared with the OECD average of 19%. Sommanustweechai A, Putthasri W, Nwe ML, Aung ST, Theint MM, Tangcharoensathien V. Community health worker in hard-to-reach rural areas of Myanmar: filling primary health care service gaps. CHWs, to deliver non-pharmacological treatments and manage the chronic care needed by mental health service users [31, 32]. World Health Organization. Because many times there is low adherence. All authors read and approved the final manuscript. Integrating evidence-based treatments for common mental disorders in routine primary care: feasibility and acceptability of the MANAS intervention in Goa, India. What are the key strengths and remaining challenges to the implementation of the CES mental health programme? Number of mental health consultations scheduled and attended per service user (N=336). Close this message to accept cookies or find out how to manage your cookie settings. The qualitative data also provided insight into barriers to the delivery of quality services. Health Policy Plan. 2018;6:17486. Step I: Analysing mental health issues 35 Making the case 35 Establishing a coordinating process 37 Assessing mental health . According to the World Health Organization (WHO), victims suffering from schizophrenia, anxiety . 2017;7(10):e017902. Previous research indicates that rather than single trainings, apprenticeship models are required for effective implementation [29]. African migrants wait outside the Siglo XXI detention center in Tapachula, on Mexico's southern border. During the study period there were a total of 14 MDs and 13 nurses working in CES supported clinics, and 10 clinical supervisors, two programme coordinators, six administration staff and five organisation directors working for CES. In Mexico, estimates have determined that 17% of the population has at least one mental disorder, with the expectation that one in four people could suffer from an ailment once during their lifetime. Social determinants of mental disorders and the sustainable development goals: a systematic review of reviews. Acceptability from health professionals came from a sense of responsibility to provide needed pharmacological and non-pharmacological treatments. Provided by the Springer Nature SharedIt content-sharing initiative. We used qualitative data to explore health workers perspectives related to the extent to which the programme was feasible, i.e. The Mexican mental health policy promotes three main elements: (1) integrating mental health services in general health services, (2) increasing human resources, budgets and quality of mental health care, and (3) increasing health promotion and advocacy activities [4]. As a result, our garden styles reflect a more flower-filled space to create a relaxing atmosphere amongst nature rather than a plain minimalist effect. Depressive and anxiety disorders are among the top 10 causes of disability in the state [10]. Martinez W, Galvn J, Saavedra N, Berenzon S. Barriers to integrating mental health services in community-based primary care settings in Mexico City: a qualitative analysis. Article More recently, Mexicos Action Program in Mental Health (20132018) specifically aimed to improve the coverage and quality of mental health services through the integration of mental health care into primary health care (PHC) [2]. Almost half of service users only received pharmacological treatment (44.6%). Mxico: Compaeros en Salud/Partners in Health; 2017. The programme was also largely acceptable to providers, as evidenced by providers engagement and commitment to programme activities. Individuals in high-income countries are considerably more likely to report being able to swim without assistance than individuals in low-income countries. And reduces the risk of drowning TypePERM full TIMEDepartmentHealth & amp ; ServicesSee... # x27 ; struggles with trauma and mental health are going overlooked and undertreated through either the psychiatric or. To walk workers perspectives related to the World health Organization ( WHO ), victims from. 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