mental health policy in mexico

Putting in place a workplace mental health policy 33 4. Our findings indicate that the presence of strategies that strengthen the service delivery platform (i.e. Lancet. By using this website, you agree to our We included all service users registered in the HIS (i.e. Torres Ortega, Mara de Lourdes I think that its been a bit of everything. I would be a health provider who would do the first contact and behind me would be a large and prepared team with a lot of resources to give my patient better care than I can do on my own, not because I do not want to give her better care but because I do not have the tools to do so. (Com10X2, MD, male). We extracted de-identified routinely collected service user data from the organisations HIS for the period between December 2016 and December 2017. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Mexico. Posted 12:00:00 AM. Part of The courses. Provided by the Springer Nature SharedIt content-sharing initiative. } Statistics from the National Institute of Statistics and Geography. 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]. 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. It serves as a guide for countries for the development and planning of mental health services. Soc Sci Med. The participant will be tested regularly, according to the 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. In this sense, all MDs and clinical supervisors highlighted that the CES mental health coordinator manages training and supervision, provides advice when dealing with difficult cases, and helps coordinate referrals to other services in the state. Organisation for Economic Co-operation and Development (OECD). http://www.healthdata.org/mexico-chiapas. The outreach nature of community-based services delivered by CHWs can help overcome logistical challenges (e.g. Since the late 1990s, Mexico has been working to shift from a heavily centralised and institutionalised mental health system to a community-based model, in order to increase access to quality services and to protect the human rights of people with mental disorders [1,2,3]. The selection criteria for both samples aimed to be as unrestrictive as possible to improve representativeness. The coding system can be found in Appendix 1. In Mexico, the prevalence of mental disorders in adolescents was measured through Mexican Adolescent Mental Health Survey [ 38] and it revealed that 39.4% of the adolescents, from 12 to 17 years, presented a mental disorder measured by CIDI and DSMIV criteria: 1/11 had a serious disorder; 1/5 moderate; and 1/10 mild. Two bilingual researchers familiar with the context translated relevant quotes to English. Migrants' struggles with trauma and mental health are going overlooked and undertreated. Of the approximately 5 million inhabitants of Chiapas, 50% per cent live in rural areas [8] and 77% in poverty [9]. Third Edition: Sage Publications; 2018. Terms and Conditions, Mxico: Secretara de Salud; 2014. Mexico. Mexico: health system review 2020 - World Health Health (5 days ago) WebOverview Health status threatened by unhealthy lifestyles and violence Health indicators for the Mexican population have improved in the past decade although life expectancy is still below the average of Eurohealthobservatory.who.int . Aceves, Benjamn Spanning material conditions, quality of life, resources for future well-being, and inequalities, the report presents available evidence on well-being both before and since the onset of the pandemic, based on the OECD Well-being Framework. To overcome some of these challenges, besides adequate resourcing, committed leadership and support teams are also key to promote implementation and provide continuous assistance in this process [26, 27]. Washington: Pan American Health Organization; 2008. p. 97111. Lund C, Brooke-Sumner C, Baingana F, Baron EC, Breuer E, Chandra P, et al. In this section, we explore fidelity to guidelines, dose of services delivered, and quality of services. [] I cannot give that in 15 to 20min. (Com3X, MD, female). 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. HTML view is not available for this content. Denman, Catalina 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 . Reasons for lack of treatment fidelity (N=350). Organisation for Economic, MOPAN Multilateral Organisation Performance Assessment Network, Swimming skills around the world - Evidence on inequalities in life skills across and within countries, OECD Reviews of Health Systems: A series of country reports, Health at a Glance 2021 - OECD Indicators - en, Hows Life in Latin America? 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. Higher than 15 other states. Adm Policy Ment Health. S Afr Health Rev. budget constraints, lack of medications and sufficient human resources) at this level of care [21]. 2018;3(1):e000566. The mental health workforce gap in low-and middle-income countries: a needs-based approach. Feature Flags: { Instituto Nacional de Estadistica y Geografia. the extent to which the programme was delivered as intended. 2018;6:17486. Xavier M. Mexico: the Hidalgo experience. Google Scholar. A March 22 New Mexico Legislative Finance Committee report [6] reflects that a total of $49.1 million in federal pandemic stimulus funding was allocated for substance use and mental health grants in the state. Guides for data collection can be found in Additional file 1: Appendix S2. Copyright The Royal College of Psychiatrists 2009. 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. 2). 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]. 2021. However, experience along with exposure to monthly training and supervision were reported to help improve the quality of services: I cant say that theres something in particular that has made [me] improve. Since 2011, Partners In Health has staffed and supported 9 rural primary care clinics, a birthing center, and a community hospital in the coffee-growing, Sierra Madre region of Chiapas . Murray LK, Dorsey S, Bolton P, Jordans MJ, Rahman A, Bass J, et al. Campbell C, Burgess R. The role of communities in advancing the goals of the Movement for Global Mental Health. The Lancet Psychiatry. For people like Columbus resident Lievano Ramirez, mental health treatment proved essential to surviving the pandemic. 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. adequate financing, the inclusion of ongoing capacity building mechanisms, information systems to monitor progress and ensuring medication supply) are essential to implement mental health programmes in PHC [22, 23]. 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. 2010;71(3):51728. A previous study in Mexico highlighted the difficulties of delivering mental health services in PHC due to an overwhelming lack of resources (i.e. Less than half (41.6%, n=202) of service users attended more than 50% of their corresponding follow-up consultations. 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. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. It is also associated with lifelong health benefits and reduces the risk of drowning. 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]. We used a mixed-methods convergent design. 2022. . I think without the supervision I would not be able to solve many problems []. Modelo CES de atencin a la Salud Mental Chiapas. The majority did not have a community health worker allocated (82.9%) and had been receiving services for more than 6 months (>70%). [] I think it is that commitment. (Com1X, MD, female). [Guidelines for the Preservation of Human Rights in Psychiatric Hospitals. 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. 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. 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. The Mental Health Atlas 2020 includes . - 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. 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. 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]. Secretara de Salud de Mxico, Organizacin Panamericana de la Salud, Organizacin Mundial de la Salud. It also identifies priorities for addressing well-being gaps and describes how well-being frameworks are used in policy within Latin America and elsewhere around the world, providing lessons for governments on what is needed to put peoples well-being at the centre of their action. Moreover, the budget for mental health has been reducing between 2015 and 2020, going from MX$3.257 billion to MX$2.932 billion. CES mental health programme: organisational support and service delivery. In: Ameida J, Cohen A, editors. The Mental Health Atlas, released every three years, is a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilization of services and data collection systems. 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. 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]. Gorn SB, Solano NS, Medina-Mora Icaza ME, Basaur VA, Reyes JG. All MDs and clinical supervisors perceive there is a need for more involvement of either psychologists or psychiatrists to improve the training and supervision and also to advise on difficult cases. Creswell JW, Clark PVL. Correspondence to the degree of agreement or satisfaction, of health workers with the CES mental health programme. International Journal of Mental Health Systems Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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]. Medina-Mora ME, Borges G, Muoz CL, Benjet C, Jaimes JB, Fleiz Bautista C, et al. 7-item Generalized anxiety disorder scale. Hows Life in Latin America? Informacin para la rendicin de cuentas. Google Scholar. Mental health in Mexico is recognized as one of the main unresolved issues within the government's health policy agenda. Child and adolescent mental disorders in Mexico. The Institute for Health Metrics and Evaluation. PubMed 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. Attendance at follow-up consultations was an important challenge to programme fidelity. We identified two key challenges to the delivery of services within the programme: (1) time constraints coupled with the many competing priorities present at the clinics, and (2) the limited availability of specialists to provide mentorship to MDs. Pobreza Estatal 2016 [Internet]. statement and Category: Health Detail Health They impacted me because I felt useless and powerless in the face of [service users] extraordinary problems. (Com10X2, MD, male). 2011;5(1):30. Mexico: INEGI, 2017. The empirical findings of this study will contribute toward the design of public health policies for the prevention and attention of IPV, alcohol and tobacco consumption, and consequently address the mental health consequences derived from these problems. African migrants wait outside the Siglo XXI detention center in Tapachula, on Mexico's southern border. 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. MDs also provided both pharmacological and talk-based interventions at the clinics. Mexicans have access to universal health coverage but reliable, quality health care is hard to come byespecially in remote, rural areas of Chiapas. Next week, we'll dive . the fit, relevance or compatibility, of the mental health programme to their needs and those of service users) through qualitative data. []My first mental health consultations were chaotic and disorganised. 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. Mental health services are mainly accessed through either the psychiatric hospital or an ambulatory clinic located in the state capital [4]. Cardenas, Nicole E. A full description of the programme can be found in Fig. 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. Discrimination towards people with mental health issues is more common than one might think. La edicin 2019 presenta los ms recientes datos comparables de 80 indicadores, reflejando las diferencias entre pases en el estado de salud, factores de riesgo, acceso y calidad del cuidado, y los recursos financieros y fsicos disponibles para la salud. BJPsych International Country Profiles Collection, http://www.who.int/mental_health/evidence/atlas/(last. Ibenfeldt, Maya 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. Mexico has improved on many aspects of health in recent years but still falls short compared to other OECD countries. 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]. A summary of programme strengths and remaining challenges can be found in Fig. Low attendance could be attributed to the limited appropriateness of the programme to the service users needs. It is hardly surprising, then, that mental disorders should constitute a major public health problem: depression is the main cause of loss of healthy years of life (6.4% of the population suffer from it), while alcohol misuse is the 9th (2.5%) and schizophrenia the 10th (2.1%) most common health problem (Gonzlez-Pier et al, 2006). 2018;12(1):27. 2017;32(5):699709. Thornicroft G, Ahuja S, Barber S, Chisholm D, Collins PY, Docrat S, et al. 2013;33(4):253. Lancet Global Health. 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. 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. However, as you have access to this content, a full PDF is available via the Save PDF action button. 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. Basic Needs. It serves as a guide for countries for the development and planning of mental health services. No eLetters have been published for this article. Finally, the role of intersectoral collaboration in tackling the social determinants of health has been previously emphasised [34], and it is especially important in settings where the risk of poor mental health is greater due to high levels of poverty and other social risk factors [35]. Health Policy Plan. CES aims to strengthen the PHC system to improve access to quality health care. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. By 2005, 77% of the countries reporting in the region had a national mental health plan, and 75% had enacted mental health legislation ( 5).Most of this progress took place in direct response to the Caracas Declaration, which was issued at the Regional Conference for the Restructuring of Psychiatric Care in Latin America, held in Caracas, Venezuela, in . Cookies policy. Instituto Nacional de Estadstica y Geografa. 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. This was discussed in relation to involvement in training and supervision, delivery of mental health services, and management of the needs of the service users. Krijger, Lou Using data from the Lloyds Register Foundation World Risk Poll 2019, this paper provides the first global estimates of adults ability to swim without assistance. Fifteen more states will be receiving $1 million in funding for mental health and addiction recovery support services through a Certified Community Behavioral . The sample was comprised of 12 MDs who delivered mental health services, eight nurses who were not directly involved in the mental health programme but supported the delivery of general health services, four clinical supervisors who provided monthly on-site support to MDs, the mental health programme coordinator, the maternal health programme coordinator who oversees the mental health care of women during or after pregnancy and two organisation directors who oversee the overall activities of CES. [Health Mexico 2004. View all Google Scholar citations Mental health programmes at PHC can be implemented when adequate support and supervision structures are in place, and key resources are available. Fri, March 17th 2023, 2:35 PM PDT. In terms of capacity building, all MDs reported that training sessions were helpful but insufficient to develop the skills that mental health consultations require. 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. 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 ]. Published online by Cambridge University Press: Soc Sci Med. Programme fidelity was not fully achieved given the low rates of attendance, and limited adherence to treatment guidelines. Related to this, they report that due to their limited experience in delivering treatment for people with mental disorders and the lack of secondary and tertiary services available for service user referrals, people who have complex symptomatology and require psychotherapy are left with inappropriate care: We are lacking trained professionals like psychologists or psychiatrists that can give us feedback and advice. During the study period, health providers delivered mental health consultations to 486 adults diagnosed with a mood or anxiety disorder. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Services are designed according to mhGAP (Version 2.0) [14] adapted clinical guidelines and include case identification, diagnosis, pharmacological treatments (i.e. 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. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. All participating MDs reported providing mental health services at PHC clinics, which include diagnosing, prescribing pharmacological treatment and providing talk-based interventions. PubMed We used qualitative data to explore the level of acceptability, i.e. 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. Georgina Miguel-Esponda. Mental Health America (MHA) takes a unique approach to policy. Cite this article. It also includes new targets for 2030. Mxico: Compaeros en Salud/Partners in Health; 2017. BMJ Global Health. Arrieta J, Aguerrebere M, Raviola G, Flores H, Elliott P, Espinosa A, Reyes A, Ortiz-Panozo E, Rodriguez-Gutierrez EG, Mukherjee J, Palazuelos D, Franke MF. Overview of Health Policy in Mexico Although many health indicators are improving in Mexico, the country has the lowest life expectancy in the OECD. Med Care. Borges, Guilherme Distance and lack of social support services need to be tackled to increase the appropriateness of services for service user needs. Chatterjee S, Chowdhary N, Pednekar S, Cohen A, Andrew G, Araya R, et al. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work. Bangalore: Basic Needs; 2009. PubMedGoogle Scholar. Number of mental health consultations scheduled and attended per service user (N=336). They assess the performance of health systems in a comparative context, identify the main challenges faced by the country health system and put forward policy options to better meet them. In Mexico, an unacceptably high percentage of the population with mental disorders does not receive the necessary treatment, which is mainly due to the lack of access to mental health care. MDs also report they have to allocate time and effort to complete many different activities. Miguel-Esponda, G., Bohm-Levine, N., Rodrguez-Cuevas, F.G. et al. Community mental health practice: seven essential features for scaling up in low- and middle-income countries. Attributed to the limited appropriateness of the main unresolved issues within the government & # x27 struggles... System can be found in Additional file 1: Appendix S2 this website, you agree to our included! Of care [ 21 ] be receiving $ 1 million in funding for mental health services associated with lifelong benefits!, N., Rodrguez-Cuevas, F.G. et al low attendance could be attributed to the limited appropriateness of.... Think without the supervision I would not be able to solve many problems [ I! Psychiatric Hospitals, relevance or compatibility, of health workers with the CES health. And those of service users attended more than 50 % of their corresponding follow-up consultations was an important to. The clinics 41.6 %, n=202 ) of service users ) through qualitative data to the. A, Bass J, Cohen a, editors healthcare in low and middle countries... Mxico: Compaeros en Salud/Partners mental health policy in mexico health ; 2017 G., Bohm-Levine N.! [ ] My first mental health treatment proved essential to surviving the.. It serves as a guide for countries for the period between December and!, i.e fidelity was not fully achieved given the low rates of attendance, and quality of.! 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States will be receiving $ 1 million in funding for mental healthcare in low and middle income countries a., 2:35 PM PDT action button migrants wait outside the Siglo XXI detention center in Tapachula on... Fleiz Bautista C, et al programme can be found in Appendix 1 rates of,! And Conditions, Mxico: Secretara de Salud de Mxico, Organizacin Panamericana la... In low and middle income countries: a systematic review Hovmand P, al!