Abstract
Mental illnesses account for 14% of the Global Burden of Disease and represent a quarter of the disability-adjusted life years (DALYs) evidencing the urgency of treating people living with them. However, the resource allocation and integration of mental health services at a community level have been scarce; furthermore its prevalence rises among poor and geographically marginalized populations, and there is a worldwide shortage of specialists to face this problem. To fill this gap, community-level interventions have been proposed, and relying on community health workers (CHWs) has shown promising results. Despite the skepticism, there is ample evidence that CHWs are able to deliver psychosocial interventions and support to patients with common and severe mental disorders by task-sharing. Platforms in which adequate training, supervision, and mentorship exist are required in order to support CHW frameworks. This chapter will describe some of the challenges and facilitators encountered with community health workforce, with a specific focus on the experience of the Compañeros En Salud (CES) team; we illustrate so with two cases of women “accompanying” mentally ill patients in rural Mexico. Likewise, we aim to demonstrate that efforts can be implemented to reduce the gap in access to mental health services. While the global health community works to make the vision of universal health coverage a reality, we submit this chapter as an orientation to how community-led and community-based mental health programs can be a part of that ambitious vision.
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Notes
- 1.
Accompagnateur is the French word for she/he who accompanies and the term used by Partners In Health for its first community health workers in Haiti.
References
Acharya B, Ekstrand M, Rimal P, et al. Collaborative care for mental health in low and middle-income countries: a WHO health systems framework assessment of three programs. Glob Ment Health Reform. 2017; https://doi.org/10.1176/appi.ps.201700232.
Araya R. Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial. Lancet. 2003;361:995–1000.
Archer J, Bower P, Gilbody S, et al. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev. 2012; https://doi.org/10.1002/14651858.CD006525.pub2.
Arrieta J. Understanding depression in rural Chiapas: contextualizing quantitative measures and – patients’ experiences. MMSc [thesis]. Boston: Harvard University; 2015.
Barnett ML, Gonzalez A, Miranda J, Chavira DA, Lau AS. Mobilizing community health workers to address mental health disparities for underserved populations: A systematic review. Administration and Policy in Mental Health and Mental Health Services Research. 2018;45(2):195–211.
Basilico M, Wigel J, Motgo A, et al. Health for all? Competing theories and geopolitics. In: Farmer P, Kim JY, Kleinman A, et al., editors. Reimagining global health. An introduction. Oakland: University California Press; 2013. p. 74–110.
Becker AE, Kleinman A. Mental health and the global agenda. N Engl J Med. 2013;369:66–73.
Bruckner TA, Scheffler RM, Shen G, et al. The mental health workforce gap in low- and middle-income countries: a needs based approach. Bull World Health Organ. 2011;89:184–94.
Chowdhary N, Jotheeswaran AT, Nadkarni A, Hollon SD, King M, Jordans MJD, et al. The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review. Psychol Med. 2013;44(6):1131–46.
Closing the gap: applying global lessons toward sustainable community health models in the United States. Report from the United Nations Special Envoy Office for Health in Agenda 2030 and for Malaria; 2016.
Compañeros En Salud. White paper. México; 2017. p. 2–5.
Farmer P. Partners in help: assisting the poor over the long term. Foreign Aff. 2011;
Freire P. Pedagogía del oprimido. Montevideo: Siglo XXI Argentina editores; 1972.
Frenk Mora J. Acuerdo por el que la secretaría de salud da a conocer las reglas de operación específicas e indicadores de gestión y evaluación del programa de ampliación de cobertura. Secretaria de Salud: artículos 39 de la Ley Orgánica de la Administracion Publica Federal. 2001. http://www.salud.gob.mx/unidades/cdi/nom/compi/acsropac.html. Accessed 25 Apr 2019.
Griffin MP, Block JW. In the company of the poor: with Dr. Paul Farmer and Fr. Gustavo Gutierrez. Orbis editions, 2013, p. 221.
Heinze G, Chapa GDC, Carmona-Huerta J. Los especialistas en psiquiatría en México: Año 2016. Salud Ment. 2016;39:69–76.
Hermann K, Damme WV, Pariyo GW, Schouten E, Assefa Y, Cirera A, et al. Community health workers for ART in sub-Saharan Africa: learning from experience – capitalizing on new opportunities. Hum Resour Health. 2009;7(1):2.
Hernández-Castillo RA. Postrevolutionary project and nationalization of the Mam people. In: Histories and stories from Chiapas: border identities in southern Mexico. Austin: University of Texas Press; 2001. p. 18–48.
Hill Z, Dumbaugh M, Benton L, Kallander K, Strachan D, ten Asbroek A, Tibenderana J, Kirkwood B, Meek S. Supervising community health workers in low-income countries- a review of impact and implementation issues. Glob Health Action. 2014;7 https://doi.org/10.3402/gha.v7.24085.
Institute for Health Metrics and Evaluation. GBD results tool. 2017. http://ghdx.healthdata.org/gbd-results-tool. Accessed Mar 2019.
Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, et al. Task shifting for non-communicable disease management in low and middle income countries – a systematic review. PLoS One. 2014;9(8):7.
Kakuma R, Minas H, Ginneken NV, Poz MRD, Desiraju K, Morris JE, et al. Human resources for mental health care: current situation and strategies for action. Lancet. 2011;378(9803):1654–63.
Kane S, Kok M, Ormel H, et al. Limits and opportunities to community health worker empowerment: a multi-country comparative study. Soc Sci Med. 2016;164:27–34.
Kleinman A, Das V, Lock M. Social suffering. Berkeley: University of California Press; 1997.
Kohrt BA, Jordans MJD, Rai S, Shrestha P, Luitel NP, Ramaiya M, Singla D, Patel V. Therapist competence in global mental health: development of the enhancing assessment of common therapeutic factors (ENACT) rating scale. Behav Res Ther. 2015;69:11–21. https://doi.org/10.1016/j.brat.2015.03.009.
Kolb D. Experiential learning: experiences as the source of learning and development. Englewood Cliffs: Prentice-Hall; 1984.
Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, Wyk BEV, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010;
Lund C, Breen A, Flisher AJ, et al. Poverty and common mental disorders in low and middle income countries: a systematic review. Soc Sci Med. 2010;71:517–28.
Maes K, Vorel E, Tesfaye Y. Using community health workers: discipline and hierarchy in Ethiopia’s women’s development army. Ann Anthropol Pract. 2015;39:42–57.
Medina-Mora E, Borges G, Lara C, Benjet C, Blanco J, Fleiz C, Villatoro J, Rojas E, Zambrano J, Casanova L, Aguilar S. Prevalencia de trastornos mentales y uso de servicios: resultados de la encuesta nacional de epidemiología psiquiátrica en México. Salud Ment. 2003;26(4):1–16.
Mendenhall E, Silva MJD, Hanlon C, Petersen I, Shidhaye R, Jordans M, et al. Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda. Soc Sci Med. 2014;118:33–42.
Mental Health Atlas 2017. Geneva: World Health Organization. 2018. www.who.int/mental_health
Mukherjee J. The roots of global health inequity. In: An introduction to global health delivery. New York: Oxford University Press; 2018a. p. 1–33.
Mukherjee J. Community health workers. In: An introduction to global health delivery. New York: Oxford University Press; 2018b. p. 165–81.
Mukherjee J. Giving care, delivering value. In: An introduction to global health delivery. New York: Oxford University Press; 2018c. p. 130–44.
Neuner F, Onyut PL, Ertl V, Odenwald M, Schauer E, Elbert T. Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial. J Consult Clin Psychol. 2008;76(4):686–94.
Newman PM, Franke MF, Arrieta J, et al. Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study. BMJ Glob Health. 2018;3 https://doi.org/10.1136/bmjgh-2017-000566. Epub ahead of print 2018.
Ormel H, Kok M, Kane S, et al. Salaried and voluntary community health workers: exploring how incentives and expectation gaps influence motivation. Hum Resour Health. 2019;17(59) https://doi.org/10.1186/s12960-019-0387-z.
Padmanathan P, De Silva MJ. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Soc Sci Med. 2013;97:82–6. https://doi.org/10.1016/j.socscimed.2013.08.004.
Palazuelos D, et al. 5-SPICE: the application of an original framework for community health worker program design, quality improvement and research agenda setting. Glob Health Action. 2011;6(19658):168–9. https://doi.org/10.3402/gha.v6i0.19658.
Palazuelos D, Farmer P, Mukherjee J. Community health and equity of outcomes: the Partners In Health experience. Lancet. 2018;6:49.
Partners In Health. Program management guide: unit 7, improving outcomes with community health workers. 2011. https://www.pih.org/sites/default/files/2017-07/PMG_U7_090811.pdf. Accessed 24 Mar 2019.
Partners In Health. We stay. 2015. https://www.pih.org/article/we-stay, Accessed 2 Jan 2020.
Partners In Health. The many lives of Gerogina Díaz. In Articles. 2016a. https://www.pih.org/article/the-many-lives-of-georgina-diaz. Accessed 10 Jan 2020.
Partners In Health. A typical, and inspiring, day with Eudeli Velasquez. In Articles. 2016b. https://www.pih.org/article/a-typical-and-inspiring-day-with-eudeli-velasquez. Accessed 2 Mar 2019.
Partners In Health. Brand handbook. We are Partners In Health. 2019. https://www.pih.org/sites/default/files/2019-11/Brand%20Handbook.pdf. Accessed 5 Jan 2020.
Patel V. The future of psychiatry in low- and middle-income countries. Psychol Med. 2009;39:1759–62.
Patel V, Kleinman A. Poverty and common mental disorders in developing countries. Bull World Health Organ. 2003;81:609–15.
Patel V, Chisholm D, Parikh R, et al. Addressing the burden of mental, neurological, and substance use disorders: key messages from disease control priorities, 3rd edition. Lancet. 2016;387:1672–85.
Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35:399–421.
Porter ME. What is the value in healthcare. N Engl J Med. 2010;363:2477–81.
Sidel VW. The barefoot doctors of the People’s Republic of China. N Engl J Med. 1972;286(24):1292–300.
Singla DR, Kohrt BA, Murray LK, Anand A, Chorpita BF, Patel V. Psychological treatments for the world: lessons from low- and middle-income countries. Annu Rev Clin Psychol. 2017;13(1):149–81.
Solomon BB. Black empowerment: social work in oppressed communities. New York: Columbia University Press; 1976.
Stahler-Sholk R. The Zapatista social movement: innovation and sustainability. Altern Glob Local Polit. 2010;35:269–90. Lynne Rienner Publishers Press.
The Lancet Psychiatry. Task sharing: stopgap or end goal? Lancet Psychiatry. 2019;6(2):81.
Thornicroft G, Deb T, Henderson C. Community mental health care worldwide: current status and further developments. World Psychiatry. 2016;15:276–86.
Treating depression where there are no mental health professionals. Bull World Health Organ. 2017;95(3):172–173.
Tulenko K, Møgedal S, Afzal MM, Frymus D, Oshin A, Pate M, et al. Community health workers for universal health-care coverage: from fragmentation to synergy. Bull World Health Organ. 2013;91(11):847–52. Available from: https://www.who.int/bulletin/volumes/91/11/13-118745/en/
Üstün T, Chisholm D. Global burden of disease-study for psychiatric disorders. Psychiatr Prax J. 2001;28:7–11. https://doi.org/10.1055/s-2001-15381.
Van Ginneken N, Tharyan P, Lewin S, Rao GN, Meera SM, Pian J, Chandrashekar S, Patel V. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low-and middle-income countries. Cochrane Database Syst Rev. 2013;11:12–33. https://doi.org/10.1002/14651858.CD009149.pub2.
Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry. 2016;3:171–8.
Walsh J, Warren K. Selective primary health care: an interim strategy for disease control in developing countries. Soc Sci Med. 1980;14c(2):145–63.
Werner D. The village health worker: lackey or liberator? Hesperian Foundation. 1981;2(1):46–8.
World Health Organization. Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. Geneva: WHO-PEPFAR-UNAIDS; 2008. http://www.who.int/healthsystems/TTR-TaskShifting.pdf?ua=1
World Health Organization. Mental Health Action Plan 2013–2020. Geneva: WHO; 2013. http://apps.who.int/iris/bitstream/handle/10665/89966/9789241506021_eng.pdf?sequence=1. Accessed 10 Feb 2019.
World Health Organization. Problem Management Plus (PM+): individual psychological help for adults impaired by distress in communities exposed to adversity. (Generic field-trial version 1.0). Geneva: WHO; 2016.
World Health Organization. Declaration of Astana. Global conference on primary health care. Astana; 2019. https://apps.who.int/iris/bitstream/handle/10665/328123/WHO-HIS-SDS-2018.61-eng.pdf?sequence=1&isAllowed=y
World Health Organization/Panamerican Health Organization. Informe sobre sistema de salud mental en México. Informe de la evaluación del sistema de salud mental en México utilizando el Instrumento de Evaluación para Sistemas de Salud Mental de la Organización Mundial de la Salud (IESM-OMS). Mexico: OPS/OMS; 2011. https://www.who.int/mental_health/who_aims_country_reports/who_aims_report_mexico_es.pdf
World Health Organization. Evaluation in health promotion: Principles and perspectives. WHO regional publications: european series. Denmark; 2001, p.521.
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Rodríguez-Cuevas, F.G., Hartman, S.J., Aguerrebere, M., Palazuelos, D. (2020). Accompanying People with Mental Illnesses: The Role of CHWs in Mental Health-Care Services in Chiapas, Mexico. In: Okpaku, S. (eds) Innovations in Global Mental Health. Springer, Cham. https://doi.org/10.1007/978-3-319-70134-9_101-1
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