Peruvian psychiatrists have traditionally had a psychosocial approach to mental health and illness. Social psychiatry studies, under the leadership of Rotondo and Mariategui in the 1950s and early ’60s, were fundamental in the conceptualization of mental health as a cultural construct. Another interesting development is that of psychosomatic medicine, under the leadership of Seguin, which originated in the establishment of a psychiatric ward in a general hospital, long before the Declaration of Caracas so suggested, and which also is the precursor of the current interest in women’s mental health and in the consequences of violence in the country.
Another breakthrough came into play when, In 2018, the Ministry of Health of Peru approved the sectoral policy guidelines on mental health which updated those published 14 years ago.
The five guidelines highlight the transitional framework of public mental health, from tertiary care (psychiatric hospitals) to secondary and primary care. They also call for the inclusion of mental health management in non-specialised centres and for the implementation of new community mental health centres across the country.
The Ministry of Health took into account social determinants of health, human rights, and intercultural, intersectional, and territorial approaches for the development of these guidelines. In addition to the above mentioned instances, The pilot project “Salud Mental para el Desarollo de la Región Apurímac,” or “Mental Health for Development in Apurímac,” provides a rich case for extracting lessons in implementing community mental health care in remote areas of low- and middle-income countries. The project, implemented from 2010 to 2014, sought to strengthen capacity for mental health services in primary health centers and regional hospitals in Apurímac—a remote, mountainous region of southern Peru.
The region withstood ongoing violence during the Shining Path conflict between 1980 and 2000. Over a third of the population in the region lost a close family member to the violence, and over a third of those individuals have a mental disorder. An epidemiologic study conducted in 2010 in the region also found that 60% of women experience domestic abuse, another significant risk factor for mental disorders. Piloting a community mental health program in Apurímac was a bold commitment to learning how to implement community mental health care in one of the most high-needs and low-resourced regions in the country. The program was initiated and funded by Peru’s National Institute of Mental Health and aimed to strengthen the capacities of health teams in primary care clinics and general hospitals in the Apurímac region to carry out promotion, prevention, treatment, and rehabilitation in mental health to benefit the region’s population of approximately 440,000.
The experience in Apurímac suggests that even in the most challenging environments, significant inroads to implementing mental health reform can be made. Human resources are the most valuable assets for mental health service development, and health reforms should refine ways to develop and support health workers.
A concerted effort to build broad and sustained partnerships across sectors in the local region can help to make mental health system reforms enduring and self-regenerating. Not surprisingly, resource constraints can still hinder mental health service reform efforts in extremely low-income settings, and external partnerships can help to bridge funding gaps, as long as foreign funding priorities are not imposed and domestic plans remain central.
However, there is always room for improvement, especially on the bridge between understanding mental health concerns and the society. Mental health has been considered a taboo-topic, which greatly and negatively affects the youth, as well as every individual living in Peru. A lot of work has been put in by numerous organizations and individuals to end the stigma that Mental Illness is caused by the supernatural and that it is a hoax in reality.
In conclusion, we still need to educate, empower and advocate for a better future with respect to accepting mental health as an important factor, with the support of the Peruvian Governmental policies, as well as the help of organizations and their campaigns to end the stigma which has been engraved in the society for ages.
Article Credit: Ridhima P.