Abstract
Background: The global burden of mental health conditions has led to the implementation of new models of care for persons with mental illness. Recent mental health reforms in Peru include the implementation of a community mental health model (CMHM) that, among its core objectives, aims to provide care in the community through specialized facilities, the community mental health centers (CMHCs). Community involvement is a key component of this model. This study aims to describe perceptions of community engagement activities in the current model of care in three CMHCs and identify barriers and potential solutions to implementation.Methods: A qualitative research study using in-depth semi-structured interviews with clinicians from three CMHCs and with policy-makers involved in the implementation of the mental health reforms was conducted in two regions of Peru. The interviews, conducted in Spanish, were digitally recorded with consent, transcribed and analyzed using principles of grounded theory applying a framework approach. Community engagement activities are described at different stages of patient care.Results: Twenty-five full-time employees (17 women, 8 men) were interviewed, of which 21 were clinicians (diverse health professions) from CMHCs, and 4 were policy-makers. Interviews elucidated community engagement activities currently being utilized including: (1) employing community mental health workers (CMHWs); (2) home visits; (3) psychosocial clubs; (4) mental health workshops and campaigns; and (5) peer support groups. Inadequate infrastructure and financial resources, lack of knowledge about the CMHM, poorly defined catchment areas, stigma, and inadequate productivity approach were identified as barriers to program implementation. Solutions suggested by participants included increasing knowledge and awareness about mental health and the new model, implementation of peer-training, and improving productivity evaluation and research initiatives.Conclusion: Community engagement activities are being conducted in Peru as part of a new model of care. However, their structure, frequency, and content are perceived by clinicians and policy-makers as highly variable due to a lack of consistent training and resources across CMHCs. Barriers to implementation should be quickly addressed and potential solutions executed, so that scale-up best optimizes the utilization of resources in the implementation process.
Highlights
Identification and documentation of community engagement activities conducted in the community mental health centers (CMHCs) will allow policy-makers to allocate resources more efficiently to activities with higher impact in order to optimize the implementation process
Data showing barriers to implementation as well as potential solutions to improve community engagement activities will provide other low- and middle-income countries (LMICs) with important information about the implementation process, and valuable experiences and lessons learned to guide them through their own mental health reform process
Our findings show that among community engagement activities, employing community mental health workers (CMHWs) and psychosocial clubs have been more consistently utilized across CMHCs
Summary
Neurologic, and substance use disorders account for nine of the top twenty leading causes of years lived with disability and 10% of the global burden of disease.[1,2,3] Mental health disorders are disproportionally represented among the poor, either as a result of a drift by those with mental health problems toward more socially disadvantaged circumstances or because of less access to healthcare compared to the general population.[3,4] Patients with mental health disorders are six times more likely to use emergency departments compared with patients without psychiatric conditions.[5,6,7,8]In recent years, several countries have implemented models of care to promote, prevent, and treat patients with mental health conditions in the community, moving away from the tertiary healthcare facility-based model.[9,10,11,12] In this context, the World Health Organization is actively supporting the community mental health model (CMHM) as an effective approach to provide mental healthcare.[13,14] Community mental healthcare is defined as comprising the principles and practices needed to promote health for a local population by addressing their needs in an accessible and acceptable way; building on the goals and strengths of people with mental conditions; promoting a wide network of supports, services and resources of adequate capacity; and emphasizing services that are both evidence‐based and recovery‐oriented. 15,16.
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