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Recommendations for Mental Health Interventions in Latin America » Women's Courage

Recommendations for Mental Health Interventions in Latin America

February 28th, 2013 by megm3 Leave a reply »

Issues in mental health are more pervasive among women than men (1). In Latin America, poverty and violence exacerbate many of the triggers to mental health illness thus many women end up experiencing it(4). Depression and Schizophrenia are particularly common mental disorders among Latin American women (2).

A meta-analysis of mental disorder perceptions in Latin America, Community perception of mental disorders: A systematic review of Latin American and Caribbean studies (3), sought to identify mental illness stigma notions in Latin America. They found that the majority of the studies were in Mexico and concentrated in the 1980’s. The majority of the studies were in urban areas, signaling the need for studies about mental illness perceptions in rural areas, largely populated by indigenous and/or destitute communities. They found that educated and/or wealthy people were more likely to have a positive perception of those with mental illnesses (still considered them functional in society). They also found that schizophrenia was more likely to be recognized as an illness than depression and that depression wasn’t considered very serious.

According to the findings in the meta-analysis, there is need for outreach efforts to inform communities about the severity and types of mental disorders. Most of these efforts are needed in poor, uneducated communities where perceptions of mental illness are still negative. It is also important to note that perceptions of mental illness can be drastically different by country or region, thus interventions should be tailored to them.

As mentioned in one of my previous blog posts, there must be a negotiation between cultural medicine and Western medicine among Latin American patients and the Western medical system. A psychiatry elective, Jordan Sloshower, reflected in the Journal of Global Health about cross-cultural issues in Peruvian mental health. Jordan Sloshower observed the practices of  Comisión de Salud Mental de Ayacucho (COSMA) in Ayacucho, Peru and Instituto Nacional de Salud Mental Honorio Delgado—Hideyo Noguchi (commonly called “Noguchi”). In Noguchi he spoke to a schizophrenic female patient: “ she enthusiastically described to me how she had ended up in the hospital and recounted recent supernatural experiences. She told me about energies she felt from television screens and fears she had, as well as some messages she had intuitively received from a variety of sources”. He goes on to reflect, “ Perhaps, if we had been in Ayacucho or a cultural context where speaking of spirits and witchcraft was more commonplace, such remarks would not have evoked suspicion of psychosis”. As illustrated by this experience, healthcare providers must also be sensitive about local cultural beliefs and ensure their diagnoses aren’t ethnocentric. Also, this patient did not feel comfortable taking medication for her mental disorder, thus treatment should be within the patients’ comfort zone.

While Jordan Sloshower observed the practices of  Comisión de Salud Mental de Ayacucho (COSMA) in Ayacucho, Peru he was impressed at the outreach efforts by psychiatrists.  These psychiatrists would do home visits for rural patients and were free of cost. From a clinical standpoint, home visits were more beneficial for the patient-doctor relationship and for the doctor’s judgement of the patient’s health. By visiting patients at their home, the doctors had insight of their home-life, poverty, accessibility, etc and thus had a holistic view of the patient. The home visits also initiated constructive dialogue about mental illness in families and the larger community, breaking down stigma and promoting support. This support is essential for Latin-American women with mental disorders because familial relations are extremely important in their culture. Although this intervention is wonderful, it would be difficult to replicate out of pure altruism in other Latin-American countries.

 

 

  1. http://www.nimh.nih.gov/health/publications/women-and-depression-discovering-hope/complete-index.shtml
  2. http://www.ghjournal.org/jgh-print/fall-2012-issue/on-the-path-to-mental-health-in-the-andes-reflections-from-a-psychiatry-elective-in-urban-and-rural-peru/
  3. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=1c9d6333-24e9-46e3-ba38-cd65f8122968%40sessionmgr13&vid=2&hid=11
  4. http://www.ghjournal.org/jgh-print/fall-2012-issue/on-the-path-to-mental-health-in-the-andes-reflections-from-a-psychiatry-elective-in-urban-and-rural-peru/
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2 comments

  1. Casey says:

    I think doctors visiting patients homes is one solution but isn’t necessarily going to make mental health assessments more available. I think you gain a holistic perspective on the patients mental status but it isn’t an efficient way to go about it for large populations of patients. Really interesting blog post, thanks!

  2. robsan24 says:

    Being a hopeful future doctor I really liked hearing about the altruism of these psychiatrists. Often getting the whole story and picture of a patients living situation and lifestyle can greatly improve a doctors ability to treat. And while I agree the home visit intervention would be hard to replicate as it is in Latin America, maybe similar interventions can be put in place through a non-profit that makes it more financial feasible. Overall really interesting.

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