I think without the supervision I would not be able to solve many problems []. PubMedGoogle Scholar. Ive seen it with some patients, its a cycle of maybe two, three months and [then] they come back because [the cycle starts] again. (Com1X, MD, female). If I do not listen to them, no one else will. Ingram, Maia Surjaningrum ER, Minas H, Jorm AF, Kakuma R. The feasibility of a role for community health workers in integrated mental health care for perinatal depression: a qualitative study from Surabaya, Indonesia. The programme provides mental health services based on the mhGAP guidelines through multiple implementation strategies, including programme financing, infrastructure strengthening, high-intensity training, and supervision. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: mental health Gap Action Programme (mhGAP)version 2.0: World Health Organization; 2016. Risk and protective factors for mental health problems 22 2. Hows Life in Latin America? Attendance at follow-up consultations was an important challenge to programme fidelity. Many Latin American countries have experienced improvements in income over recent decades, with several of them now classified as high-income or upper middle-income in terms of conventional metrics. Integration of mental health care services in PHC in Mexico will require improved financing and resource management of PHC and specialist services, ongoing capacity building, the development of effective referral systems, further development of community-based services, and to link PHC with locally-relevant social interventions. Overview of Health Policy in Mexico Although many health indicators are improving in Mexico, the country has the lowest life expectancy in the OECD. For people like Columbus resident Lievano Ramirez, mental health treatment proved essential to surviving the pandemic. Shidhaye R, Shrivastava S, Murhar V, Samudre S, Ahuja S, Ramaswamy R, et al. The Hidden Mental Health Crisis at Mexico's Border. Summary of findings according to implementation outcomes. The mental health care system in Mexico is underdeveloped and underfunded, and for the approximately 40% of the population with no insurance, access to and quality of care are particularly poor . Of the 1770 mental health follow-up consultations delivered, MDs used a scale to assess symptoms in 76% of consultations, and further explored key symptoms and relevant life events in 52% and 41% of consultations respectively. The incidence of overweight and obesity among the Mexican population has reached alarming levels. In a recent report, Human Rights Watch documented how Mexico has done little to prevent discrimination, stigma, and abuses against people with disabilities, including those with mental health. Materials offered helpful reminders and made MDs feel more comfortable providing these treatments. A full description of the programme can be found in Fig. No eLetters have been published for this article. GME was the lead researcher and was responsible for the study design, data collection, data analysis, and the writing of the manuscript. We used quantitative and qualitative data to explore the extent of penetration of the CES mental health programme, defined as the extent to which the programme activities have been integrated into the organisation and the PHC clinics. Collaborative care models have been promoted as a solution to make more efficient use of resources and redistribute workloads [30]. Mexico. The Institute for Health Metrics and Evaluation. Those in-depth studies of the health system of member countries focus on economic issues. Mental health policy and legislation. Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Mental health services are mainly accessed through either the psychiatric hospital or an ambulatory clinic located in the state capital [4]. 1. the extent to which the programme was delivered as intended. with higher frequency and improved adherence). According to the World Health Organization (WHO), victims suffering from schizophrenia, anxiety . expenditure on health in Mexico is still the highest in the OECD Despite decreasing from 55% in 2005, 45% of all health spending in Mexico was paid directly by patients in 2013, compared with the OECD average of 19%. Of the approximately 5 million inhabitants of Chiapas, 50% per cent live in rural areas [8] and 77% in poverty [9]. MDs mainly expressed concerns regarding the delivery of talk-based interventions, since these require skills for which they have not been trained. However, the limited knowledge and experience of clinical supervisors in treating mental health conditions was considered a barrier. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work. Individuals in high-income countries are considerably more likely to report being able to swim without assistance than individuals in low-income countries. Informe de la evaluacin del sistema de salud mental en Mxico utilizando el Instrumento de Evaluacin para Sistemas de Salud Mental de la Organizacin Mundial de la Salud (IESM-OMS) Mexico: Organizacin Panamericana de la Salud/Organizacin Mundial de la Salud, 2011. Despite feasibility challenges, the essential support and resources provided by CES, including mentoring, guidelines, printed materials, and medications made the programme implementation possible. 2008;46(3):26674. Xavier M. Mexico: the Hidalgo experience. This is due to unhealthy lifestyles with higher risk factors to health leading to chronic diseases and mortality, but also to persisting barriers of access to high-quality health care services. Prevalencia de trastornos mentales y uso de servicios: resultados de la Encuesta Nacional de Epidemiologa Psiquitrica en Mxico. The majority of MDs and clinical supervisors report finding the materials available for the delivery of mental health services, such as the guidelines and other aids to provide talk-based interventions, as useful. Jordans M, Luitel N, Pokhrel P, Patel V. Development and pilot testing of a mental healthcare plan in Nepal. Designing and Conducting Mixed Methods Research. The health budget in 2017 was $2.586 million pesos or just over $1.00 per capita, while in high-income countries it was, on average, $58.73.22 When the Popular Insurance Scheme was established, public expenditure on mental health increased from 0.3% to 0.7%, then declined continually to a level of 0.3% by 2017. The New Mexico Human Services Department (HSD)/Behavioral Health Services Division (BHSD) has created this Provider Toolkit for those interested in becoming an agency providing behavioral health services in New Mexico. It also has a significant impact on our country's economic performance. Our findings indicate that the presence of strategies that strengthen the service delivery platform (i.e. 2016;208:s1320. Only 42% of service users attended more than 50% of scheduled mental health follow-up consultations, which also hindered fidelity. The 7 measures that make up the Adult Ranking include: Adults with Any Mental Illness (AMI) Adults with Substance Use Disorder in the Past Year Adults with Serious Thoughts of Suicide Adults with AMI who Did Not Receive Treatment Adults with AMI Reporting Unmet Need Adults with AMI who are Uninsured Less than half (41.6%, n=202) of service users attended more than 50% of their corresponding follow-up consultations. adequate financing, the inclusion of ongoing capacity building mechanisms, information systems to monitor progress and ensuring medication supply) are essential to implement mental health programmes in PHC [22, 23]. Mental Health Reports for New Mexico 2015 - A series of five reports that describe county-level rates of mental disorders and suicidal behaviors for each public health region of New Mexico. All audio recordings were transcribed verbatim by bilingual researchers. Or you can have the best medications available but if you are not trained to know how to use it, then it is useless. (Com10X, MD, female). The current study aimed to contribute to the scarce evidence base on implementation of mental health programmes integrated in PHC platforms in low resource settings, which is needed given the difficulties in translating policy into practice. Aceves, Benjamn The majority did not have a community health worker allocated (82.9%) and had been receiving services for more than 6 months (>70%). Between December 2016 and December 2017, MDs delivered at least one mental health consultation to 486 adults diagnosed with a mood or anxiety disorder (Table2). Georgina Miguel-Esponda. 2023 BioMed Central Ltd unless otherwise stated. Number of mental health consultations scheduled and attended per service user (N=336). Spanning material conditions, quality of life, resources for future well-being, and inequalities, the report presents available evidence on well-being both before and since the onset of the pandemic, based on the OECD Well-being Framework. Resource constraints are important barriers to the improvement of mental health care in Mexico, where only 2% of the health budget is allocated to mental health [3], there are 0.67 psychiatrists per 100,000 people [6], and the few services are hampered by staff and medication shortages [4]. Better understanding of the challenges surrounding translation of policy into practice is crucial to the improvement of mental health care. The authors declare that they have no competing interests. New Mexico School Nurses are granted Public Health authority by the NM Secretary of Health for collecting and submitting immunization information School & Daycare Immunization Schedule Letter 2022-2023 Immunization - Policies, Protocols & Procedures February 23, 2022 New Mexico Childcare/Pre-School/School Entry Immunization Requirements. We used pre-established definitions of implementation outcomes [19] to develop the analytical framework. Two experienced Spanish-speaking qualitative researchers conducted two focus groups (with two directors, two programme coordinators, and six MDs), and 24 semi-structured interviews (with 12 MDs, eight nurses, and four clinical supervisors). ReThe purpose for the Behavioral Health Policy & Billing Manual (BH Manual) is to provide a reference for the policies and processes related to Behavioral Health for administration of Medicaid behavioral health services, as defined in New Mexico Administrative Code (NMAC), Section 8.321.2. - Medicin del bienestar para la formulacin de polticas pblicas, Panorama de la Salud 2019 - Indicadores de la OCDE, Health at a Glance 2019 - OECD Indicators, Health at a Glance: Latin America and the Caribbean 2020, Panorama de la Salud: Latinoamrica y el Caribe 2020, Launch of the Study: The Heavy Burden of Obesity: The Economics of Prevention, Presentacin del estudio: La Pesada Carga de la Obesidad: La Economa de la Prevencin, Second Public Procurement Review of the Mexican Institute of Social Security (IMSS) - Reshaping Strategies for Better Healthcare, Segundo Estudio de la OCDE sobre Contratacin Pblica en el Instituto Mexicano del Seguro Social (IMSS) - Rediseando las Estrategias para Mejorar el Cuidado de la Salud. Lancet Global Health. Psychiatric Serv. In this sense, there is an important role for the inclusion of links to social work interventions in the planning of PHC based programmes [37]. BJPsych International Country Profiles Collection, http://www.who.int/mental_health/evidence/atlas/(last. New Mexico licensing regulations, contract with the state for non-Medicaid services, paid through state general funds.1 Approach Mental Health (MH) and Substance Use Disorder (SUD): The New Mexico Department of Health (DOH), Division of Health Improvement (DHI) regulates all CTCs. By using this website, you agree to our This toolkit contains information about the process, documents, forms, links, 2018;3(1):e000566. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. As a result, our garden styles reflect a more flower-filled space to create a relaxing atmosphere amongst nature rather than a plain minimalist effect. The Mental Health Atlas, released every three years, is a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilization of services and data collection systems. Copyright The Royal College of Psychiatrists 2009. The programme was also largely acceptable to providers, as evidenced by providers engagement and commitment to programme activities. All analyses were conducted in RStudio (Version1.1.453). Mail: National Institute of Mental Health Office of Science Policy, Planning, and . High levels of acceptability and feasibility enabled through strong support from the organisation were key programme strengths. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. We used qualitative data to explore the level of acceptability, i.e. Miguel-Esponda, G., Bohm-Levine, N., Rodrguez-Cuevas, F.G. et al. All interviews and focus groups were audio recorded, except in two instances when consent was not provided, so detailed notes were taken. Chatterjee S, Chowdhary N, Pednekar S, Cohen A, Andrew G, Araya R, et al. 2011;5(1):30. To integrate the quantitative and qualitative data, we identified common findings across the data sets and compared them to determine how these confirmed, disconfirmed or enhanced understanding of each other [15]. Framework analysis was utilised to analyse the qualitative data. Data are however available from the authors upon reasonable request and with permission of Compaeros En Salud. Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries. Cite this article. A few providers perceived that low attendance is an indicator that some service users are not benefitting thoroughly from the mental health services: Im not very convinced that [the treatment impact] will be a long-term thing. Low attendance is partially attributed to limited programme appropriateness, given that interventions to address social risk factors are not available. Additionally, the clinical notes could not be interpreted as a perfectly faithful representation of all events that occurred during a consultation due to variability regarding what talk-based interventions entail. A previous study in Mexico highlighted the difficulties of delivering mental health services in PHC due to an overwhelming lack of resources (i.e. Carpenter J. FRC advised on the study design and data collection, contributed to the data analysis and discussion, and provided comments earlier drafts of the manuscript. Health at a Glance: Latin America and the Caribbean 2020 presents key indicators on health and health systems in 33 Latin America and the Caribbean countries. The essential need for capacity building mechanisms that include adequate and ongoing support and supervision, has been highlighted as relevant by other programmes integrating mental health services at PHC[28]. The accuracy of these translations was assessed by a group of independent bilingual researchers, and changes were made if needed. We included all service users registered in the HIS (i.e. 2017;73(9):107690. National Institute of Psychiatry Ramon de la Fuente Muz', Mexico City, National Institute of Psychiatry Ramon de la Fuente Muz', Mexico City, email medinam@imp.edu.mx, https://doi.org/10.1192/S1749367600000783, Lineamientos para la Preservacin de los Derechos Humanos en los Hospitales Psiquitricos. Since clinical supervisors had no specialist training in psychiatry or psychology, a few MDs felt that they were no better equipped than them in providing mental health services. Lund C, Breen A, Flisher AJ, Kakuma R, Corrigall J, Joska JA, et al. MDs at CES supported PHC clinics identified service users with potential mood or anxiety disorders, and made diagnoses. for this article. Extracted data included sociodemographic indicators (sex, age, and community of residence), clinical characteristics (diagnosis, PHQ-9 and GAD-7 scores, presence of comorbid conditions, treatment allocated, medication prescriptions, and months in treatment) and clinical notes (MDs records at diagnosis and follow-up consultations). A March 22 New Mexico Legislative Finance Committee report [6] reflects that a total of $49.1 million in federal pandemic stimulus funding was allocated for substance use and mental health grants in the state. The cost of providing inpatient care is one barrier. Depressive and anxiety disorders are among the top 10 causes of disability in the state [10]. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Feature Flags: { We selected dose and fidelity as relevant process indicators based on the Medical Research Council (MRC) guidance on the evaluation of complex interventions [16] and developed indicators based on the programmes guidelines (Table1). Higher than 15 other states. A talk-based intervention was provided in 24% of mental health follow-up consultations. Kakuma R, Minas H, van Ginneken N, Dal Poz MR, Desiraju K, Morris JE, et al. Third Edition: Sage Publications; 2018. PubMed The community mental health care model was created and has been implemented to improve this situation. Has data issue: true Hostname: page-component-7dc689bd49-q9qq5 The 10 PHC clinics supported by CES are each staffed by one medical doctor (MD) and, when possible, one nurse. MDs identified service users with mental health conditions successfully and performed appropriate clinical assessments. 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