We used pre-established definitions of implementation outcomes [19] to develop the analytical framework. This first Health at a Glance publication to cover the Latin America and the Caribbean region was prepared jointly by OECD and the World Bank. Higher than 15 other states. The data that support the findings of this study are available from Compaeros En Salud but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Madhivanan, Purnima The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work. The report is part of the EU Regional Facility for Development in Transition for Latin America and the Caribbean. We used quantitative and qualitative data to explore the extent of penetration of the CES mental health programme, defined as the extent to which the programme activities have been integrated into the organisation and the PHC clinics. MDs at CES supported PHC clinics identified service users with potential mood or anxiety disorders, and made diagnoses. If I do not listen to them, no one else will. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Our findings also indicate that recruiting CHWs might be necessary to decrease the workload of PHC providers and deliver talk-based interventions more effectively (i.e. The Hidden Mental Health Crisis at Mexico's Border. We extracted de-identified routinely collected service user data from the organisations HIS for the period between December 2016 and December 2017. Or you can have the best medications available but if you are not trained to know how to use it, then it is useless. (Com10X, MD, female). World Health Organization. 2013;33(4):253. PubMedGoogle Scholar. Mexico: INEGI, 2017. The 7 measures that make up the Adult Ranking include: Adults with Any Mental Illness (AMI) Adults with Substance Use Disorder in the Past Year Adults with Serious Thoughts of Suicide Adults with AMI who Did Not Receive Treatment Adults with AMI Reporting Unmet Need Adults with AMI who are Uninsured Mental health policy and legislation. What are the key strengths and remaining challenges to the implementation of the CES mental health programme? Depressive and anxiety disorders are among the top 10 causes of disability in the state [10]. statement and 2015;25(2):17891. To appropriately tackle the social needs of service users we will need to develop targeted interventions that address gender-based violence, income and food insecurity, and other structural issues in these and other similar settings [36]. - Medicin del bienestar para la formulacin de polticas pblicas, Panorama de la Salud 2019 - Indicadores de la OCDE, Health at a Glance 2019 - OECD Indicators, Health at a Glance: Latin America and the Caribbean 2020, Panorama de la Salud: Latinoamrica y el Caribe 2020, Launch of the Study: The Heavy Burden of Obesity: The Economics of Prevention, Presentacin del estudio: La Pesada Carga de la Obesidad: La Economa de la Prevencin, Second Public Procurement Review of the Mexican Institute of Social Security (IMSS) - Reshaping Strategies for Better Healthcare, Segundo Estudio de la OCDE sobre Contratacin Pblica en el Instituto Mexicano del Seguro Social (IMSS) - Rediseando las Estrategias para Mejorar el Cuidado de la Salud. Hostname: page-component-7dc689bd49-q9qq5 Of the 1770 mental health follow-up consultations delivered, MDs used a scale to assess symptoms in 76% of consultations, and further explored key symptoms and relevant life events in 52% and 41% of consultations respectively. Previous studies have also shown that the use of CHWs for the delivery of talk-based interventions is satisfactory and acceptable to service users [24], which can increase adherence [31]. Key challenges included the limited availability of training and on-site supervision by specialists, as well as limited time due to the numerous tasks that providers are responsible for, and the large patient loads at the clinics. According to the World Health Organization (WHO), victims suffering from schizophrenia, anxiety . Previous research indicates that rather than single trainings, apprenticeship models are required for effective implementation [29]. Thornicroft G, Ahuja S, Barber S, Chisholm D, Collins PY, Docrat S, et al. For mental health, a coordinator oversees the delivery of mental health services and capacity building activities, and provides support for the management of complex cases. could be implemented within this particular health setting and context. 2011;378(9803):165463. Previous studies have found these strategies to be effective for the provision of care for various health conditions in other low resource settings [13]. Mail: National Institute of Mental Health Office of Science Policy, Planning, and . 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. During the study period, health providers delivered mental health consultations to 486 adults diagnosed with a mood or anxiety disorder. Mental health recovery paradigm: implications for social work. MexicoChiapas: The Institute for Health Metrics and Evaluation; 2017 [cited 2019 18/03/2019]. The New Mexico Human Services Department (HSD)/Behavioral Health Services Division (BHSD) has created this Provider Toolkit for those interested in becoming an agency providing behavioral health services in New Mexico. Less than 1% of data was missing. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Garca-Pacheco, Jos ngel Int J Ment Health Systems. https://doi.org/10.1186/s13033-020-00346-x, DOI: https://doi.org/10.1186/s13033-020-00346-x. 2023 BioMed Central Ltd unless otherwise stated. Both personally and professionally, the supervision is helpful. (Com5X2, MD, male). 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. Join. The Meadows Mental Health Policy Institute is now accepting applications for our 9th annual Summer Internship Program, which will be conducted Shared by Gladys J Snchez, LPC-S @renewingmindsccs The courses. Summary of findings according to implementation outcomes. Individuals in high-income countries are considerably more likely to report being able to swim without assistance than individuals in low-income countries. HTML view is not available for this content. The majority were women (84.4%), around a third were between 18 and 29years old (34.5%), and two-thirds were living less than 30min away from the clinics (66.3%). We followed a process of (1) data familiarisation, (2) coding, (3) development of an analytical framework, (4) framework application and (5) interpretation [20]. 2011;5(1):30. Health Soc Work. 2011;38(2):6576. Mxico: Compaeros en Salud/Partners in Health; 2017. What are public health practice and policy implications for healing historical trauma among mestizo populations?" Methodology and Approach: We analyzed the discourse from two community projects--focus groups and ethnographic field notes from a study in the U.S.-Mexico border region (2012-2014) and field notes and digital stories We also ensured high quality of quantitative data by using several techniques, including cross checking between the HIS and other data collection tools, and double-coding of fidelity scores. Lwe B, Decker O, Mller S, Brhler E, Schellberg D, Herzog W, Herzberg PY. The data collection was performed by researchers who spent at least a year in the field, which increased familiarity with the context and buy-in from the programme staff. All service users attended their first consultation, but only 20%37% of subsequent consultations were attended (Fig. Framework analysis was utilised to analyse the qualitative data. This is especially relevant in remote and rural settings with high-levels of poverty where even PHC clinics can be too hard to reach [41]. For the qualitative data collection, we used a convenience sample. 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]. Health at a Glance 2021 - How do Latin American countries compare. This is due to unhealthy lifestyles with higher risk factors to health leading to chronic diseases and mortality, but also to persisting barriers of access to high-quality health care services. Migrants' struggles with trauma and mental health are going overlooked and undertreated. Chircop A, Bassett R, Taylor E. Evidence on how to practice intersectoral collaboration for health equity: a scoping review. 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. Panorama de la Salud presenta comparativos de indicadores clave de salud pblica y el desempeo de los sistemas de salud de los pases miembros de la OCDE, candidatos y pases socios. Another barrier is the shortage of behavioral health workers, Humphrey said. Of the approximately 5 million inhabitants of Chiapas, 50% per cent live in rural areas [8] and 77% in poverty [9]. We included all service users registered in the HIS (i.e. What are the perspectives of programme managers and providers regarding its penetration, fidelity, acceptability, appropriateness, and feasibility? 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. By using this website, you agree to our Modelo CES de atencin a la Salud Mental Chiapas. 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. Campbell C, Burgess R. The role of communities in advancing the goals of the Movement for Global Mental Health. 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. 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. The current study has several strengths. GME was the lead researcher and was responsible for the study design, data collection, data analysis, and the writing of the manuscript. Implementation process and outcomes of a mental health programme integrated in primary care clinics in rural Mexico: a mixed-methods study. 7-item Generalized anxiety disorder scale. BJPsych International Country Profiles Collection, http://www.who.int/mental_health/evidence/atlas/(last. There was no funding source for this study, but it was carried out as part of the doctoral studies of GME, which are funded by the Mexican Council of Science and Technology. We conducted two focus groups and 24 semi-structured interviews with health providers and managers to ascertain implementation outcome data: penetration, fidelity, acceptability, appropriateness and feasibility. MDs mainly expressed concerns regarding the delivery of talk-based interventions, since these require skills for which they have not been trained. Posted 12:00:00 AM. 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]. Google Scholar. Informe de la evaluacin del sistema de salud mental en Mxico utilizando el Instrumento de Evaluacin para Sistemas de Salud Mental de la Organizacin Mundial de la Salud (IESM-OMS) Mexico: Organizacin Panamericana de la Salud/Organizacin Mundial de la Salud, 2011. Poverty and common mental disorders in low and middle income countries: a systematic review. All audio recordings were transcribed verbatim by bilingual researchers. 2013;13(1):117. The incidence of overweight and obesity among the Mexican population has reached alarming levels. Several topics were discussed: the extent to which mental health guidelines and materials fit the needs of MDs in the clinic and during the consultation, the fit between capacity building needs of MDs and actual training and supervision available, and the appropriateness of the programme for the needs of service users. Each community has~1000 inhabitants, most of whom live in extreme poverty [11]. Delivering mental health services at included PHC clinics was deemed feasible to a certain extent. 2015;9(1):40. 2016. https://www.coneval.org.mx/coordinacion/entidades/Chiapas/Paginas/Pobreza-2016.aspx. Come for the community, stay for the affordable, top-tier care Mexico's Ker Clinic is the ideal destination for those seeking alternative mental health treatments. We included people diagnosed with a mood or anxiety disorder as the CES programme specifically targeted this group, and 95% of the programmes service users received treatments for these disorders [7]. 2021. "useRatesEcommerce": false This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits noncommercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. MDs identified service users with mental health conditions successfully and performed appropriate clinical assessments. Adherence to treatment guidelines by MDs was limited, as talk-based interventions were not provided in the majority of consultations. To calculate the rate of non-attendance, we analysed data for 335 service users that were enrolled in the programme during the study period. Of the 72% (N=350) service users that were not delivered treatment according to guidelines, in the majority of cases this was due to a lack of talk-based interventions (Fig. They feel better [] and then they dont come back. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Provided by the Springer Nature SharedIt content-sharing initiative. Mexico is a culturally, socially and economically heterogeneous country, with a population of over 100 million. Limited skills from MDs to deal with these challenges led to a sense of low self-efficacy, which affected acceptability: I asked the questions, but I felt my patients did not find anything that I was doing helpful. Br J Psychiatry. Collaborative care models have been promoted as a solution to make more efficient use of resources and redistribute workloads [30]. Resource constraints are important barriers to the improvement of mental health care in Mexico, where only 2% of the health budget is allocated to mental health [3], there are 0.67 psychiatrists per 100,000 people [6], and the few services are hampered by staff and medication shortages [4]. Prior to this, mental health services were only available more than 6h away in the state capital [4, 7]. Treatment was allocated in full accordance with guidelines for 28% of service users. the extent to which the programme was delivered as intended. BMJ. However, talk-based interventions, an important element of programme guidelines, were rarely delivered. Gilson L, Daire J. Secretara de Salud de Mxico, Organizacin Panamericana de la Salud, Organizacin Mundial de la Salud. Google Scholar. FRC advised on the study design and data collection, contributed to the data analysis and discussion, and provided comments earlier drafts of the manuscript. 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. Viksveen, Petter Guides for data collection can be found in Additional file 1: Appendix S2. Large parts of the population face economic insecurity, as a result of which feelings of despair, fear and impotence are common. Chatterjee S, Chowdhary N, Pednekar S, Cohen A, Andrew G, Araya R, et al. Coding system to assess programme fidelity. Published online by Cambridge University Press: An initial chapter summarises the comparative performance of countries before the crisis, followed by a special chapter about addressing wasteful health spending that is either ineffective or does not lead to improvement in health outcomes so that to direct saved resources where they are urgently needed. Extracted data included sociodemographic indicators (sex, age, and community of residence), clinical characteristics (diagnosis, PHQ-9 and GAD-7 scores, presence of comorbid conditions, treatment allocated, medication prescriptions, and months in treatment) and clinical notes (MDs records at diagnosis and follow-up consultations). 2013;97:826. In the case of Mexico, despite a growing population, the expenditure budget designated to mental health programs has been reduced in recent years, decreasing from 3.35 billion Mexican pesos. One of the reasons that Gateway stopped admitting children with mental health issues is because children were being left at the hospital for as long as six months. Fidelity to guidelines is constrained by the lack of mental health training MDs receive related to mental health in their professional education and the limited availability of mental health specialists to provide mentorship. Padmanathan P, De Silva MJ. 3). The mental health care system in Mexico is underdeveloped and underfunded, and for the approximately 40% of the population with no insurance, access to and quality of care are particularly poor . The current study aimed to contribute to the scarce evidence base on implementation of mental health programmes integrated in PHC platforms in low resource settings, which is needed given the difficulties in translating policy into practice. 2). The selection criteria for both samples aimed to be as unrestrictive as possible to improve representativeness. 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