Mental Health in Latin America and Caribbean

Joana GodinhoHealth Sector ManagerMarch 2014

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 gapCaldas 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.

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 legislationCaldas de Almeida JM 2013. Mental health services development in Latin America and the Caribbean: achievements, barriers and facilitating factors. International Health 5:15-18.

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.

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

PHCCaldas 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.

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

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

Burden of Mental & Substance Abuse Disorders in LAC

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.

Prevalence of mental health disorders in LAC

Disorder Prevalence %

Alcohol abuse 5.7

Depression 4.9

Anxiety 3.4

Dysthymia 1.7

OCD 1.4

Non-affective psychoses

1

Panic disorder 1

Bipolar 0.8

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 Panam Salud Publica 18(4/5):229-240.

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.

Mental & substance abuse disorders

DALYs%

Depression 40.5

Anxiety 14.6

Illicit drug use 10.9

Schizophrenia 7.4

Bipolar 7.0

Pervasive developmental disorders

4.2

Childhood behavior disorders 3.4

Eating disorders 1.2

Global Burden of Mental & Substance Abuse Disorders

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.

Mental Health Treatment Gap in LAC

Disorder Prevalence Treatment GapAlcohol abuse 5.7 71.4

Depression 4.9 58.9

Anxiety 3.4 63.1

Dysthymia 1.7 58.8

OCD 1.4 59.9

Non-affective psychoses

1 37.4

Panic disorder 1 52.9

Bipolar 0.8 64.0

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 Panam Salud Publica 18(4/5):229-240.

Mental Health Treatment Gap in LAC

Lynskey MT, 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.

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

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.

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 MoH stewardship 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: Saraceno B 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.

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