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

By Minoletti, Alberto; Galea, Sandro et al. | Public Health Reviews; Rennes, July 1, 2012 | Go to article overview

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


Minoletti, Alberto, Galea, Sandro, Susser, Ezra, Public Health Reviews; Rennes


INTRODUCTION

The care of people with mental disorders is a growing public health concern in Latin America. These disorders are highly prevalent and exact a serious emotional toll on individuals, families, communities and society at large. Community-based epidemiological studies in this region have estimated rates of lifetime prevalence of mental disorders among adults ranging from 23.7 percent to 39.1 percent and 12-month prevalence rates ranging from 11.6 percent to 20.1 percent.1 Rodriguez et al estimated that mental and neurological disorders in Latin America accounted for over 20 percent of all Disability Adjusted Life Years (DALYs) in 20022; in other words, these disorders account for over 20 percent of the total "disease burden" in Latin America. Yet almost all Latin American countries still invest far less in public mental health than in other public health problems with comparable disease burden. Moreover, a large part of public mental health resources are still used to maintain a system of mental hospitals that do not offer appropriate treatment.

In this paper, we focus on community mental health care for adults with severe mental disorders in the Latin American region. As in many other regions, individuals with severe mental disorders comprise a particularly vulnerable and disadvantaged group whose needs are often overlooked, whose human rights are often violated, and who do not receive sufficient services in the communities where they live. We briefly describe the history of this field, then review its current state, and conclude by offering some thoughts about future strategies for the development of research, human capacity, and services. Although other aspects of public mental health in Latin America are beyond our scope, we believe that they require similar attention. The countries of the Latin American region, broadly defined, are many and diverse. Here we focus on countries in which Spanish, Portuguese or French is the dominant language, and following a common convention, define them as the 20 countries listed in Appendix 1.

HISTORY

As early as the 1950s and 1960s, several researchers conducted epidemiological studies that used case ascertainment and random sampling methods to assess the prevalence of mental disorders among residents of different countries.3-5 These studies prompted new public health approaches to addressing the high burden of mental disorders. The hegemonic role of mental hospitals as the main form of treatment began to be questioned,6-8 and debates arose about alternatives models based on general hospitals and primary care centers, as well as the need to build day hospitals, group homes and sheltered workshops to facilitate the social integration of people with severe mental disorders. In some Latin American countries, there were early attempts to build mental health services in the community. Innovative pilot programs were established where psychiatrists, general practitioners and other health professionals put some of these ideas into practice.6-8 Although the community model was never implemented in full, due to lack of political support and resources, these early experiences helped to raise awareness and generate learning about alternatives to mental hospitals.

Most of these innovative programs were subsequently downsized or shut down by the dictatorships that plagued much of the region during the 1970s and 1980s. Instead, more mental hospitals were built, until their number surpassed 250, with over 150,000 long stay beds. The majority of these hospitals were located outside urban centers and lacked sufficient staff and resources to provide meaningful care. Patients often were cut off from their environment with no rehabilitation programs, and subjected to intensive use of physical restraints, pharmacological sedation and other human rights violations.8,9 In some countries, these mental hospitals became virtually the only mental health service accessible to the general population. …

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