Living Six Hours Away from Mental Health Specialists: Enabling Access to Psychosocial Mental Health Services Through the Implementation of Problem Management Plus Delivered by Community Health Workers in Rural Chiapas, Mexico

Abstract

Living with a mental health condition in rural Chiapas, the southernmost state of Mexico, where adversity, poverty and health in accessibility prevail, make it challenging to reach for mental health services since they are mostly centralised in urban settings, understaffed and underfunded. The Mexican sister organisation of the international non-profit, Partners In Health, has served in marginalised communities in collaboration with the Mexican Ministry of Health and has provided mental health services since 2014. In 2019, community mental health workers began delivering individual Problem Management Plus (PM+) sessions to people with mental health conditions through home visits. This field report aims to share implementation practice findings through the voice of four implementers, two of whom currently deliver PM+, and through two brief case reports. Results show PM+ has had a positive impact on patients’ symptoms and community health workers’ attitudes toward mental health and themselves. However, incompletion of sessions, appropriateness and acceptability of the intervention are issues that implementers still need to tailor to the context. Despite having made adaptations, complex problems such as intimate partner violence, stress due to structural adversity and grief related to the emerging COVID-19 pandemic represent challenges that the intervention needs to address to meet the needs of underserved areas.