1. Mental Health in Latin America and Caribbean
Joana Godinho
Health Sector Manager
March 2014

2. 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 gap
Caldas de Almeida JM 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 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):

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

4. 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
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 Mental health services development in Latin America and the Caribbean: achievements, barriers and facilitating factors. International Health 5:15-18.

5. 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 PHC
Caldas de Almeida JM 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 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):

6. 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

7. Burden of Mental & Substance Abuse Disorders in LAC
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
Institute for Health Metrics and Evaluation, Human Development Network, The World Bank The Global Burden of Disease: Generating Evidence, Guiding Policy – Latin America and Caribbean Regional Edition. Seattle, WA: IHME.

8. Prevalence of mental health disorders in LAC
Alcohol abuse
5.7
Depression
4.9
Anxiety
3.4
Dysthymia
1.7
OCD
1.4
Non-affective psychoses 1
Panic disorder
Bipolar
0.8
Kohn R, Levav I, Caldas de Almeida JM, Vicente B, Andrade L, Caraveo-Anduaga JJ, Saxena S, Saraceno B Mental disorders in Latin America and the Caribbean: a public health priority. Rev Panam Salud Publica 18(4/5):

9. Global Burden of 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
Whiteford HA et al Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study The Lancet, 382, 9904, , 9 November 2013.

10. Shifts in ranking of DALYs in LAC 1990-2010
Institute for Health Metrics and Evaluation, Human Development Network, The World Bank The Global Burden of Disease: Generating Evidence, Guiding Policy – Latin America and Caribbean Regional Edition. Seattle, WA: IHME.

11. Mental Health Treatment Gap in LAC
Disorder
Prevalence
Treatment Gap
Alcohol 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
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 Mental disorders in Latin America and the Caribbean: a public health priority. Rev Panam Salud Publica 18(4/5):

12. Mental Health Treatment Gap in LAC
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
Lynskey MT, Strang J The global burden of drug use and mental disorders The Lancet, 382, 9904, , 9 November 2013.
WHO World Mental Health (WMH) Surveys.

13. 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 Mental health services development in Latin America and the Caribbean: achievements, barriers and facilitating factors. International Health 5:15-18.
PAHO WHO-AIMS: Report on Mental Health Systems In Latin America And The Caribbean. WDC: PAHO.

14. 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 Barriers to improvement of mental health services in low-income and middle-income countries. The Lancet, 370, 9593, , 29 September.

15. 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