Schizophrenia Treatment Coverage Provided by the Public and Private Health Systems of Chile.

Since health care delivery in Chile was comprehensively reformed in 2005, treating schizophrenia for its populace has been guaranteed, regardless of individuals' type of health insurance coverage. The implementation of this national schizophrenia treatment program has facilitated timely access to care for Chileans with a first episode of schizophrenia, particularly for publicly insured individuals. Although this reform has benefited 98% of the population, significant challenges remain.

Burden experienced by caregivers of schizophrenia patients and its related factors.

Deinstitutionalization of patients with schizophrenia shifted the primary locus of care from psychiatric hospitals to family and informal caregivers. Family members often play a vital role as caregivers in the lives of individuals with schizophrenia and other serious mental illnesses. This study aimed to assess the burden experienced by the caregivers of patients with schizophrenia and to evaluate its correlation with some demographic characteristics of patients, their caregivers, and the level of expressed emotion in the family.

Integrated mapping of local mental health systems in Central Chile.

Objective: To describe the availability of local mental health (MH) services in small MH catchment areas in Central Chile, using a bottom-up approach.

Methods: MH services of 19 small MH catchment areas in five health districts of Central Chile that provide health care to more than 4 million inhabitants were assessed using DESDE-LTC (Description and Evaluation of Services and Directories in Europe for Long-Term Care), a tool for standardized description and classification of LTC health services, in a study conducted in 2012 ("DESDE-Chile") designed to complement other studies conducted in 2004 and 2012 at the national and regional level using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS). Key informants from national, regional, and local health authorities were contacted to compile a comprehensive list of MH services or facilities (health, social services, education, employment, and housing).

[Mental health response capacity in primary care in Chile: a contribution to Alma-AtaCapacidade de resposta da atenção primária em saúde mental no Chile: uma contribuição de Alma-Ata].

This article identifies strategies that have contributed to the development of mental health response capacity in primary care in Chile and analyzes some lessons learned from this process. It highlights the formulation of national mental health plans, the gradual development of an information system, the investment of additional resources, the creation of programs and guidelines, human resources development, the positioning of mental health in integrated health service delivery networks, support for biopsychosocial child development, the family and community care model, and the strengthening of leadership and partnerships between health and human services.Its indicators of response capacity are the increase in resources for mental health in primary care, both financial and staffing (that is, the number of professionals and the training provided to them), and the expansion of mental health treatment in primary care settings, notably the rate of people in treatment for mental illness and the support provided for child development.

[Analysis of Governance in the Implementation of the Chilean Community Mental Health ModelAnálise da governança na implementação do modelo comunitário de saúde mental no Chile].

This article describes and analyzes the role of governance in the development of the Chilean community mental health model. It describes and analyzes five dimensions of governance: 1) the implementation of a series of strategies to encourage the participation of users of mental health services has yielded limited results; 2) the implementation of three national mental health plans with the same strategic vision over the course of three decades has helped increase access to community care for people with mental illness and diminish the role of psychiatric hospitals; 3) the lack of a mental health law remains a challenge, although a series of laws and decrees has partially compensated for this; 4) financial resource allocation regulations, human resources education, and technical guidelines have helped improve access and the quality of care; and 5) the gradual development of a mental health information system has provided knowledge, primarily on access rates, treatment gaps, and geographical inequities. The Chilean experience confirms the importance of implementing a set of governance strategies and mechanisms to promote the development and operation of mental health services.

[A survey about quality of care and user’s' rights in Chilean psychiatric services].

Background: Quality of care and respect for the rights of users are critical to achieve positive health outcomes and respond appropriately to the expectations of people, particularly if they have mental illnesses.

Aim: To carry out a baseline diagnosis of quality of care and respect for rights in public outpatient psychiatric services.

Material And Methods: Quality of care and respect for patients'’ rights was assessed by a mental health professional and a trained psychiatric service user in 15 ambulatory psychiatric services.

[Pathway to care of people with first episode of schizophrenia, in Chile].

Background: It has been considered that the duration of first episode of psychosis is a critical period influencing the clini-cal and psychosocial evolution in people with diagnosis of schizophrenia. However, there is little knowledge about this issue in Low and Middle Income Countries.

Objective: To describe the clinical characteristics and contacts with health services of people with first episode of schizophrenia, prior to their diagnoses and initiation of treatment.

[Response of primary care teams to manage mental health problems after the 2010 earthquake].

Background: Thirty to 50% of people exposed to a natural disaster suffer psychological problems in the ensuing months.

Aim: To characterize the activities in mental health developed by Primary Health Care centers after the earthquake that affected Chile on february 27th, 2010.

Material And Methods: A cross-sectional study analyzing 16 urban centers of Maule Region, was carried out.

Psychiatric hospital beds and prison populations in South America since 1990: does the Penrose hypothesis apply?

Importance: In 1939, English mathematician, geneticist, and psychiatrist Lionel Sharples Penrose hypothesized that the numbers of psychiatric hospital beds and the sizes of prison populations were inversely related; 75 years later, the question arises as to whether the hypothesis applies to recent developments in South America.

Objective: To explore the possible association of changes in the numbers of psychiatric hospital beds with changes in the sizes of prison populations in South America since 1990.

Design, Setting, And Participants: We searched primary sources for the numbers of psychiatric hospital beds in South American countries since 1990 (the year that the Latin American countries signed the Caracas Declaration) and compared these changes against the sizes of prison populations.

[Intellectual development disorders in Latin America: a framework for setting policy priorities for research and care].

Intellectual development disorders (IDDs) are a set of development disorders characterized by significantly limited cognitive functioning, learning disorders, and disorders related to adaptive skills and behavior. Previously grouped under the term "intellectual disability," this problem has not been widely studied or quantified in Latin America. Those affected are absent from public policy and do not benefit from government social development and poverty reduction strategies.

Community Mental Health Services in Latin America for People with Severe Mental Disorders.

Mental disorders are highly prevalent in Latin American countries and exact a serious emotional toll, yet investment in public mental health remains insufficient. Most countries of the region have developed national and local initiatives to improve delivery of mental health services over the last 22 years, following the technical leadership of the Pan American Health Organization/World Health Organization (PAHO/WHO). It is especially notable that PAHO/WHO facilitated the development of national policies and plans, as well as local programs, to deliver specialized community care for persons with severe mental disorders.

Adherence to guidelines and treatment compliance in the Chilean national program for first-episode schizophrenia.

Objective: Adherence to clinical guidelines for mental disorders among clinicians in industrialized countries is low. Research on guideline adherence among clinicians in lower- and middle-income countries is scarce. The purpose of this study was to evaluate the implementation of clinical guidelines for first-episode schizophrenia in the pilot phase of the Explicit Guarantees in Health (GES) program in Chile.

Depression in primary care: Chile's Programme for Screening, Diagnosis and Comprehensive Treatment of Depression.

In 2001, an initiative to provide effective treatment for people with depressive disorders in primary care clinics was introduced in Chile, the Programme for Screening, Diagnosis and Comprehensive Treatment of Depression (PSDCTD) (Ministerio de Salud, 2001). It was extended to all primary care clinics in the country 4 years later.

[The National Mental Health Plan in Chile: 10 years of experience].

Dealing with mental health problems is undoubtedly an increasingly important public health responsibility around the world. In Chile, because of the changes in the epidemiological profile of the population, the lifetime prevalence of mental and behavioral disorders has reached 36%. In response, the Ministry of Health of Chile, through its Mental Health Unit, prepared the National Plan for Mental Health and Psychiatry.

Advocacy for mental health: roles for consumer and family organizations and governments.

The World Health Organization urges countries to become more active in advocacy efforts to put mental health on governments' agendas. Health policy makers, planners and managers, advocacy groups, consumer and family organizations, through their different roles and actions, can move the mental health agenda forward. This paper outlines the importance of the advocacy movement, describes some of the roles and functions of the different groups and identifies some specific actions that can be adopted by Ministries of Health.

The mental health country profile: background, design and use of a systematic method of appraisal.

This article describes the construction and use of a systematic structured method of mental health country situation appraisal, in order to help meet the need for conceptual tools to assist planners and policy makers develop and audit policy and implementation strategies. The tool encompasses the key domains of context, needs, resources, provisions and outcomes, and provides a framework for synthesizing key qualitative and quantitative information, flagging up gaps in knowledge, and for reviewing existing policies. It serves as an enabling tool to alert and inform policy makers, professionals and other key stakeholders about important issues which need to be considered in mental health policy development.

The appropriateness and use of focus group methodology across international mental health communities.

The ability to interpret collected data across international mental health communities often proves to be difficult. The following paper reports on the use and appropriateness of focus group methodology in helping to clarify issues that could help substantiate data collection and comparison across different cultures and regions. Field tests of the focus group methodology were undertaken in different regions and this paper describes an overview of the final field test in Sofia, Bulgaria.