Latin America and the Caribbean

Regional or Sub-Regional Initiatives / Brazil / Chile / Mexico / Nicaragua / Trinidad & Tobago

There are 4 countries in Latin America and the Caribbean (LAC), with an estimated population in 2009 of 587 million.[1] The health situation in the region is characterized by the presence of infectious diseases and nutritional problems coexisting with chronic conditions like cardiovascular diseases, cancer, accidents, violence, as well as mental heath and addiction problems, among others.[2] 

The challenges regarding mental health and addiction are urgent in this region. Some studies demonstrate a much higher percentage than the global average, with 22.2% of all disease being attributed to mental and neurological disorders[3].  It is also the case that substance abuse represents on of the leading public health problem in Latin America and the Caribbean[4].

As well, there is an important lack of appropriate services². At the same time, there are a number of social and environmental determinants, like income inequalities, and rapid urbanization, that affect the prevalence of mental disorders and the psychosocial problems associated with them in the region. It is also very important to consider the ethnocultural diversity[5] of the population, where Indigenous and African descendants represent around one third of  it[6]. Most LAC countries have faced traumatic situations associated with natural disasters, armed conflict and political violence[7]. Just recently Haiti (2010) had a catastrophic earthquake affecting millions of people there.

There is a strong history of mental health development in LAC in recent years.  In 1990, LAC countries signed the emblematic Caracas Declaration [8], aimed –among other objectives- at promoting respect for the human and civil rights of the mentally ill, and at the restructuring of psychiatric care on the basis of primary health care in the framework of local health systems. Important changes were made during the following years. Recently (2009) a Strategy and Plan of Action on Mental Health for the Americas has been approved[9].

CAMH's Office of International Health collaborates and works close with different international organizations in the region, including the Pan-American Health Organization -PAHO- (e.g. the Mental Health Management training for Central America and Dominican Republic) and the Inter-American Drug Abuse Control Commission –CICAD (e.g.the International Research Capacity Building Program for Health-Related Professional to Study the Drug Phenomenon), among others.

Since the beginning of the CAMH’s Office of International Health, most of our work has been implemented in this part of the world, in different contexts. Please, know more of our initiatives: Regional or Sub-Regional Initiatives / Brazil / Chile / Mexico / Nicaragua / Trinidad & Tobago

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Some of our Regional and Sub-Regional initiatives

 

(1) Mental Health Management Training for Central America and Dominican Republic.  

(2) The International Research Capacity Building Program for Health-Related Professionals to Study the Drug Phenomenon in Latin America and the Caribbean. 

(3) The Caribbean Institute of Alcoholism and other Drug Problems (CARIAD). 

(4) International Metal Health and Addiction Leadership Training Program: Strengthening Health Systems from a Public Health Perspective in the Americas.

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• Mental Health Management Training for Central America and Dominican Republic. It is an online training course with a face-to-face component to address the particular contextual factors that have limited the development of mental health systems within Central America and the Dominican Republic.  This capacity building initiative fosters the skills of key professionals/decision-makers leading programs or public mental health services to effectively manage mental health systems/services with an emphasis on community and primary care. The participants design concrete projects of mental health management for their specific contexts.  As final outcomes, we expect the enhancement of management regarding mental health system effectiveness and the reduction of the gap between needs and available resources. This joint initiative is organized by the Pan-American Health Organization, the Centre for Addiction and Mental Health (Ontario, Canada), the Panama National Institute of Mental Health and the Universidad Nacional Autónoma de Nicaragua-León. The project clearly addresses two of PAHO and Health Canada’s top priorities: (1) “Policy and Health Systems”, (2) “Mental Health”. The first version of this joint program finished in January 2010. This project has been funded by the Canada Biennial Work Plan Fund (PAHO-Health Canada).

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• The International Research Capacity Building Program for Health-Related Professional to Study the Drug Phenomenon in Latin American and the Caribbean, is a joint initiative by the Inter-American Drug Abuse Control Commission –CICAD- of the Organization of American States –OAS-  and CAMH since summer of 2006, with the goal of providing health professionals with scientific knowledge and research skills to study and work on drug-related issues in Latin American and Caribbean.  The program is divided in two phases:   (1) Theory & Practice in Toronto, Canada (this phase of the program consists of in class education for two months in Toronto) and (2) Research Implementation in Country Origin (in this phase the participants spend 12 months in their country of origin to implement the multi-centric research study). Every year 10 participants graduate.

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The Caribbean Institute of Alcoholism and other Drug Problems (CARIAD).  An annual two-week addiction-training program is implemented in partnership with the University of West Indies ‘s  Caribbean Institute of Alcoholism and other Drug Problems (CARIAD).  The institute attracts health professionals from about 8 countries in the Caribbean each year.  The program also provides advanced training on specialized topics.

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International Metal Health and Addiction Leadership Training Program: Strengthening Health Systems from a Public Health Perspective in the Americas. This program contributes to the continuous development and improvement of addiction & mental health systems across the Americas through support for innovative and effective leadership processes. Its general objective is to strengthen decision making knowledge and skills among leaders for improving mental health and addiction services and practices. A one week face-to face training took place in March 2009 and a follow up component has also been implemented. 

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Initiatives by Country

BRAZIL

With 191,971,506 inhabitants, Brazil is not only the most populous country in Latin America, but also one of the most populous countries in the world: Brazil ranks fifth in population in the world. Mental health and addiction needs are very important in Brazil. A complex range of factors contribute to mental illness, including social inequities, as well as lack of services. OIH is working in the following regions in Brazil

In Curitiba (Parana), the OIH has adapted CAMH’s First Contact program for youth in partnership with the Catholic University of Parana. The OIH has also facilitated a process to build social infrastructure for the reintegration of the mentally ill into the community, with the Psychiatric hospital – Hospital Nossa Senhora da Luz.

An ongoing effort is underway to strengthen primary health care in the north and east of Brazil in Sergipe and Fortaleza. In December 2008, a CAMH team visited those states in order to (1) to identify training needs in Brazil, (2) to explore possible research collaborations, and (3) to formalize an on-going working relationship.

2009 was a busy positive year in terms of our collaboration with the Sergipe Ministry of Health and other partners in Aracaju, Brazil. Following an initial needs assessment, an intensive addiction capacity building initiative was implemented to train interprofessional teams from the psychosocial care centers (CAPS) serving different marginalized communities in Aracaju. .  In 2010, a second stage of this capacity building process is planned to be focused on mental health and addictions primary care needs. Recently, in December 2009, the second version of our program “Towards Ongoing Health Systems Improvement: Institutional Capacity Building for Evaluating Mental Health and Addiction Initiative in Latin American Countries” started in Sergipe aimed to train and strengthen the skill base of small teams of professionals to effectively evaluate designated projects or programs

Initial collaboration is being initiated among CAMH and the University of Salvador, in Salvador de Bahia.

Partners: Ministry of Health, State of Sergipe.

               Ministry of Health, State of Fortaleza.

               Catholic University of Parana

               Aliança de Redução de Danos Fátima Cavalcanti - ARD-FC,  

                             Faculdade de Medicina da Universidade Federal da Bahia.

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CHILE

Chile has a population of approximately 17  million people. It seems to have one of the highest prevalence rates of psychiatric morbidity in Primary Care (Saraceno et al., 2005). Santiago, the capital of Chile, presents one of the highest global prevalence of psychiatric disorders, the most prevalent being mood and anxiety disorders. The challenges addiction are also urgent in Chile.

Since 2003, a collaborative program for capacity-building training in primary care for professionals working in, and dealing with common mental disorders and addiction within the primary care sector, has been jointly developed by the Municipal Corporation of Puente Alto and CAMH. The P. Universidad Católica de Chile (especially through its Department of Family Medicine) also participated in the process of program development.

In December 2005, CAMH teamed up with the Chilean Ministry of Health in their national healthcare reform efforts aimed at improving health using a comprehensive approach. In 2009, CAMH supported the Chilean Ministry of Health in its efforts to develop a national alcohol policy.

The CAMH team has worked also with the National Drug Control Commission (CONACE) to evaluate its national pilot program for addiction treatment for children and youth.

An international program on evaluation of mental health and addiction initiatives started in January 2009 in Santiago with the participation of 17 institutional teams from Chile, Argentina, Peru, Ecuador, and Mexico. A new version of this program in Chile will be initiated in April 2010.

Partners:    Chilean Ministry of Health

                    National Drug Control Commission (CONACE)

                    Municipal Corporation of Puente Alto

                 Family Medicine Department, P. Universidad Católica de Chile

                 South East Metropolitan Health District (SSMSO)

                 Others

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MEXICO

Mexico’s estimated population is about 111 million inhabitants. Mexico has particular needs in terms of mental health and addiction and it is one of the first countries CAMH’s Office of International Health is collaborating with to strengthen mental health and addiction capacity.

Partnership with the Mexican Institute of Psychiatry is in its fifth year. Collaborative trainings have been implemented with a focus on Aboriginal Health, Health Promotion, Primary Health Care, and Organizational Development.  In August-September 2009 two workshops, focused on collaborative mental health care and needs based planning, took place as a new step of this collaboration.

An extensive process of collaboration exists with the state of Hidalgo. Different capacity building initiatives have been implemented involving different key actors of the health system regarding mental health and addictions, including primary care capacity building and leadership training for decision makers.

Partners:   Mexican Institute of Psychiatry

                  Ministry of Health, State of Hidalgo

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NICARAGUA

Nicaragua’s estimated population is about six million inhabitants. Less than 25% of the population has access to the mental health services (WHO, 2005). The most frequently problem among those seen in health care units are: depression, schizophrenia, psychoactive substance abuse (alcohol, drug, etc).Another major  public health problems is suicidal behaviour, especially among young people. In Nicaragua to work effectively in this primary care practice, knowledge and skills are required for the identification and management of mental disorders, as well as for working with different vulnerable population. For all those condition is urgent need to move forward in an effort to meet global and local mental health need has never been greater (Saxena S, Maulik PK et al. 2002 ; Saxena S, P et al. 2006 ).

In November of 2008, a collaboration agreement was signed with the Universidad Nacional Autonoma e Nicaragua-Leon with a special focus on primary health care. In November 2009 an international workshop about mental health and addiction in primary care was co-organized in Leon as a foundation for the development of a Diploma in 2010.

Partners: Universidad Nacional Autónoma de Nicaragua-León

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TRINIDAD & TOBAGO

An annual two-week addiction-training program is implemented in partnership with the University of West Indies ‘s  Caribbean Institute of Alcoholism and other Drug Problems (CARIAD).  The institute attracts health professionals from about 8 countries in the Caribbean each year.  The program also provides advanced training on specialized topics.

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Contacts:

 Akwatu Khenti (Director): Akwatu_Khenti@camh.net

Jaime Sapag (Special Advisor): Jaime_Sapag@camh.net

 

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