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Providing Mental Health Care in Primary Care Centers in LMICs

Addressing Complex Health-Care Gaps in Chiapas, Mexico

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Innovations in Global Mental Health

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Abstract

The setting for this chapter is Chiapas, Mexico’s poorest state. Chiapas has a complex history of which chronic oppression and recurrent dispossession of indigenous people, as well as social movements, play an important role. This history, along with subsequent social, political, and economic structures, has facilitated the current impoverishment of 77% of the population, as well as the lack of access to mental health care. In this chapter, we illustrate the way that this “structural violence” drives the cases of three individuals living with mental illness in the Sierra and Frailesca regions of Chiapas, through a social medicine lens. In addition, we describe an innovative community-based care-delivery platform that has been successful in providing mental health care to these three individuals and a thousand others in rural and highly marginalized communities. Leveraging existent infrastructure and human resources, and with social medicine at its core, Compañeros En Salud has forged an academic and professional support network for community health workers and young, inexperienced, general practitioners to provide mental health care at the first level, while strengthening the links between first, secondary, and tertiary levels of care.

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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. Psychiatr Serv. 2017;68(9):870–2.

    PubMed  PubMed Central  Google Scholar 

  • Aguerrebere M. Compañeros En Salud: Mental Health Services and Gender Equality. Rev Harvard Rev Lat Am Stud [Internet]. 2018a;(Winter). https://revista.drclas.harvard.edu/book/compañeros-en-salud-mental-health-services-and-gender-equality

  • Aguerrebere M. Understanding intimate partner violence, sexual abuse, and mental health in non-indigenous rural Chiapas. Implications for Global Mental Health Practice. Unpublished Master’s thesis, Harvard University; 2018b.

    Google Scholar 

  • Alegria M, Alvarez K, DiMarzio K. Immigration and mental health. Curr Epidemiol Rep. 2017;4(2):145–55.

    PubMed  PubMed Central  Google Scholar 

  • Araya R. Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial. Lancet [Internet]. 2003;361:995–1000.

    PubMed  Google Scholar 

  • Arrieta J. Understanding depression in rural Chiapas: contextualizing quantitative measures and – patients’ experiences. Master’s thesis, Harvard University, Boston; 2015.

    Google Scholar 

  • Arrieta J, Aguerrebere M, Raviola G, Flores H, Elliott P, Espinosa A, et al. Validity and utility of the patient health questionnaire (PHQ)-2 and PHQ-9 for screening and diagnosis of depression in rural Chiapas, Mexico: a cross-sectional study. J Clin Psychol. 2017;73(9): 1076–90.

    PubMed  PubMed Central  Google Scholar 

  • Barta A. El México Bárbaro: Plantaciones y Monterías del Sureste Durante el Porfiriato. Mexico City: El Atajo Ediciones; 1996. 516 p.

    Google Scholar 

  • Bourgois P, Holmes SM, Sue K, et al. Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care. Acad Med 2017;92:299–307.

    Google Scholar 

  • Bourque F, Van der Ven E, Malla A. A meta-analysis of the risk for psychotic disorders among first- and second- generation immigrants. Psychol Med. 2011;41: 897–910.

    CAS  PubMed  Google Scholar 

  • Brunt D. Mastering the struggle: gender, actors and agrarian change in a Mexican Ejido. Amsterdam: CEDLA Centro de estudios y documentación Latinoamericanos; 1992. 226 p.

    Google Scholar 

  • CENETEC. Diagnosis and treatment of bipolar disorder. Mexico City: Secretaria de Salud; 2009a. p. 1–55. http://www.cenetec.salud.gob.mx. Accessed Nov 2018.

    Google Scholar 

  • CENETEC. Diagnosis and treatment of schizophrenia in the first and second levels of care. Mexico City: Secretaria de Salud; 2009b. http://www.cenetec.salud.gob.mx. Accessed Nov 2018.

    Google Scholar 

  • CENETEC. Diagnóstico y Tratamiento de la Depresión en el Adulto Mayor en el Primer Nivel de Atención. Guía de Práctica Clínica GPC. Mexico City: Secretaria de Salud; 2011. p. 1–67. http://www.cenetec.salud.gob.mx. Accessed Nov 2018.

    Google Scholar 

  • Crenshaw K. Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford Law Rev. 1991;43(6):1241–99.

    Google Scholar 

  • Cuijpers P, Dekker J, Hollon S, et al. Adding psychotherapy to pharmacotherapy in the tratment of depressive disorders in adults: A meta-analysis. J Clin Psychol. 2009a;70(9):1219–29.

    Google Scholar 

  • Cuijpers P, Van Straten A, Warmerdam L, et al. Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis. Depress Anxiety. 2009b;26(3):279–88.

    PubMed  Google Scholar 

  • Delisi M, Alcala J, Kusow A, Hochstetler A, Heirigs MH, Caudill JW, et al. Adverse childhood experiences, commitment offense, and race/ethnicity: are the effects crime-, race-, and ethnicity-specific? Int J Environ Res Public Health. 2017;14(3)

    Google Scholar 

  • Dieleman M, Biemba G, Mphuka S, Sichinga-Sichali K, Sissolak D, van der Kwaak A, et al. We are also dying like any other people, we are also people’: perceptions of the impact of HIV/AIDS on health workers in two districts in Zambia. Health Policy Plan. 2007;22(3): 139–48.

    PubMed  Google Scholar 

  • Dube SR, Anda RF, Felitti VJ, Edwards VJ, Croft JB. Adverse childhood experiences and personal alcohol abuse as an adult. Addict Behav. 2002;27(5): 713–25.

    PubMed  Google Scholar 

  • Eaton J, De Sivla M, Rojas G, Patel V. Scaling up services for mental health. In: Patel V, Minas H, Cohen A, Prince MJ, editors. Global mental health: principles and practice. London: Oxford University Press; 2014. p. 297–334.

    Google Scholar 

  • Elliott M, Aguerrebere M, Elliott P. Depression in rural communities and primary care clinics in Chiapas, Mexico. J Epidemiol Glob Health 2019;9(2):103–106.

    Google Scholar 

  • Farmer P. On suffering and structural violence. In: Saussy H, editor. Partner to the poor. Berkeley/Los Angeles: University of California Press; 2010. p. 328–249.

    Google Scholar 

  • Farmer PE, Nizeye B, Stulac S, Keshavjee S. Structural violence and clinical medicine. PLoS Med. 2006;3(10):1686–91.

    Google Scholar 

  • Fonseka RW, Minnis AM, Gomez AM. Impact of adverse childhood experiences on intimate partner violence perpetration among Sri Lankan men. PLoS One. 2015;10(8):e0136321.

    PubMed  PubMed Central  Google Scholar 

  • Frenk J. The global health system: strengthening national health systems as the next step for global progress. PLoS Med. 2010;7(1):2008–10.

    Google Scholar 

  • Galtung J. Violence, peace, and peace research. J Peace Res. 1969;6(3):167–91.

    Google Scholar 

  • García-Morales IV, Gutiérrez-Martínez MT, Rodríguez Álvarez C, Cifuentes TA. Panorama del trabajo de la salud mental en Chiapas. Salud en Chiapas. 2017;17(188):96–9.

    Google Scholar 

  • Golding J. Intimate partner violence as a risk factor for mental disorders: a meta-analysis. J Fam Violence. 1999;14:99–132.

    Google Scholar 

  • Hanlon C. Next steps for meeting the needs of people with severe mental illness in low- and middle-income countries. Epidemiol Psychiatt Sci. 2017;26(4):348–54.

    CAS  Google Scholar 

  • Hanna B, Kleinman A. Unpacking Global Health. Theory and critique. In: Farmer P, Kleinman A, Kim JY, Basilico M, editors. Reimagining global health an introduction. Berkeley: University of California Press; 2013. p. 15–32.

    Google Scholar 

  • Heinze G, Chapa GDC, Carmona-Huerta J. Los especialistas en psiquiatría en México: Año 2016. Salud Ment. 2016;39(2):69–76.

    Google Scholar 

  • Herman J. Trauma and recovery. 2015th ed. New York: Basic Books; 1992. 325 p.

    Google Scholar 

  • Hernández-Castillo RA. Organic growers. In: Histories and stories from Chiapas. Austin: University of Texas Press; 2001a. p. 161–86.

    Google Scholar 

  • 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; 2001b. p. 18–48.

    Google Scholar 

  • Hernández-Castillo RA. Sur profundo: Identidades indígenas en la frontera Chiapas-Guatemala. Mexico City: Publicaciones de la Casa Chata, CIESAS, CDI; 2012.

    Google Scholar 

  • Horyniak D, Melo JS, Farrell RM, Ojeda VD, Strathdee SA. Epidemiology of substance use among forced migrants: a global systematic review. PLoS One. 2016;11(7):1–34.

    Google Scholar 

  • Howard LM, Trevillion K, Agnew-Davies R. Domestic violence and mental health. Int Rev Psychiatry. 2010;22(5):525–34.

    PubMed  Google Scholar 

  • Howard L, Feder G, Agnew-Davis R. Domestic violence and mental health. London: Royal College of Psychiatry; 2013. 113 p.

    Google Scholar 

  • IHME. Mexico. What health problems cause the most disability? 2017. http://www.healthdata.org/mexico. Accessed Nov 2018.

  • INEGI. Chiapas. Servicios de Salud. Encuesta Intercensal. 2015a. http://www.beta.inegi.org.mx/proyectos/enchogares/especiales/intercensal/. Accessed Oct 2018.

  • INEGI. Cuéntame. Información por entidad. Chiapas: INEGI. 2015b. http://www.cuentame.org.mx/monografias/informacion/chis/poblacion/educacion.aspx?tema=me&e=07. Accessed Oct 2018.

  • INEGI. CONEVAL. Medición de la Pobreza las Entidades Federativas [Internet]. 2016. https://www.coneval.org.mx/Medicion/PublishingImages/Pobreza_2008-2016/medicion-pobreza-entidades-federativas-2016.JPG

  • Instituto Mexicano del Seguro Social. Diagnosis and treatment of depressive disorder in the adult. CENETEC: Mexico City; 2015. p. 64.

    Google Scholar 

  • Instituto Nacional de Salud Pública. Encuesta Nacional de Salud y Nutrición 2012. Resultados por Entidad Federativa. Chiapas/Cuernavaca: Instituto Nacional de Salud Pública; 2013. p. 1–112.

    Google Scholar 

  • Jewkes R. Intimate partner violence: causes and prevention. Lancet. 2002;359(9315):1423–9.

    PubMed  Google Scholar 

  • Katon W, Lin E, Von Korff M, et al. Collaborative care of patients with depression and chronic illnesses. N Engl J Med. 2010;326:2611.

    Google Scholar 

  • Kleinman A, Das V, Lock M. Social suffering. Berkeley: University of California Press; 1997.

    Google Scholar 

  • Klostermann KC, Fals-Stewart W. Intimate partner violence and alcohol use: exploring the role of drinking in partner violence and its implications for intervention. Aggress Violent Behav. 2006;11(6):587–97.

    Google Scholar 

  • Kohrt BA, Jordans MJ, Rai S, Shrestha P, Luitel NP, Ramaiya MK, et al. Therapist competence in global mental health: development of the enhancing assessment of common therapeutic factor (ENACT) rating scale. Behav Res Ther. 2015;69:11–21.

    PubMed  PubMed Central  Google Scholar 

  • Lara MA, Navarro C, Navarrete L, Mondragón L, Rubí NA. Seguimiento a dos años de una intervención psicoeducativa para mujeres con síntomas de depresión, en servicios de salud para población abierta. Salud Ment. 2003;26(3):27–36.

    Google Scholar 

  • Loeb DF, Bayliss EA, Binswanger IA, Candrian C, DeGruy FV. Primary care physician perceptions on caring for complex patients with medical and mental illness. J Gen Intern Med. 2012;27(8):945–52.

    PubMed  PubMed Central  Google Scholar 

  • Lozano R, Gómez-Dantés H, Garrido-Latorre F, Jiménez-Corona A, Campuzano-Rincón JC, Franco-Marina F, et al. La carga de enfermedad, lesiones, factores de riesgo y desafíos para el sistema de salud en México. Salud Publica Mex. 2013;55(6):580.

    PubMed  Google Scholar 

  • Mahajani AA, Prabhughate AS, Tiwari P, Sohoni S, Phatak AG, Morgaonkar VA, et al. “Self-development matters” – perception of Sakhis (CHWs) assessing self-development outcomes of their participation in the HBNC program. BMC Womens Health. 2018;18(1):1–7.

    Google Scholar 

  • Medina-Mora ME, Borges G, Muñoz CL, Benjet C, Jaimes JB, Bautista CF, et al. Prevalencia de Trastornos Mentales y Uso de Servicios. Resultados de la Encuesta Nacional de Epidemiología Psiquiátrica. 2003;26(4): 1–16.

    Google Scholar 

  • Mendenhall E, Kohrt B, Norris S, Ndetei D, Prabhakaran D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet. 2017;387(10073): 951–63.

    Google Scholar 

  • Mendez Mendez JS. Gasto público en salud mental. 2017. https://ciep.mx/gasto-en-salud-mental/. Accessed Nov 2018.

  • Merrick MT, Ports KA, Ford DC, Afifi TO, Gershoff ET, Grogan-Kaylor A. Unpacking the impact of adverse childhood experiences on adult mental health. Child Abus Negl. 2017;69:10–9.

    Google Scholar 

  • Montero-Mendoza E, Cruz-Sánchez M. Servicio social de medicina en el primer nivel de atención médica: de la elección a la práctica. Rev la Educ Super. 2014;XLIII(172):79–99.

    Google Scholar 

  • Morokuma I, Shimodera S, Fujita H, Hashizume H, Kamimura N, Kawamura A, et al. Psychoeducation for major depressive disorders: a randomised controlled trial. Psychiatry Res. 2013;210(1):134–9.

    PubMed  Google Scholar 

  • Mukherjee J. An introduction to global health delivery. New York: Oxford University Press; 2018a. 351 p.

    Google Scholar 

  • Mukherjee J. Giving care, delivering value. In: An introduction to global health delivery. New York: Oxford University Press; 2018b. p. 130–44.

    Google Scholar 

  • Mukherjee J. Reversing the tide: lessons from the movement for AIDS treatment access. In: An introduction to global health delivery. New York: Oxford University Press; 2018c. p. 36–65.

    Google Scholar 

  • Mukherjee J. The roots of global health inequity. In: An introduction to global health delivery. New York: Oxford University Press; 2018d. p. 1–33.

    Google Scholar 

  • Murray C, Lopez A, Jamison D. The global burden of disease in 1900s: summary results, sensitivity analysis and future directions. Bull World Health Organ. 1994;72(3):495–509.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Nigenda G. Servicio social en medicina en Mexico. Una reforma urgente y posible. Salud Publica Mex. 2013;55(5):519–27.

    PubMed  Google Scholar 

  • OMS. Informe Sobre el Sistema de Salud Mental en México. Ciudad de Mexico: IESM-OMS; 2011.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomized controlled trial. Lancet. 2010;376(9758):2086–95.

    PubMed  PubMed Central  Google Scholar 

  • Patel V, Chowdhary N, Rahman A, Verdeli H. Improving access to psychological treatments: lessons from developing countries. Behav Res Ther. 2011;49(9):523–8.

    PubMed  PubMed Central  Google Scholar 

  • Patel V, Chisholm D, Parikh R, Charlson FJ, Degenhardt L, Dua T, et al. Addressing the burden of mental, neurological, and substance use disorders: Key messages from Disease Control Priorities, 3rd edition. Lancet. 2015;387(10028):1672–85.

    PubMed  Google Scholar 

  • Raviola G, Machoki M, Mwaikambo E, Delvecchio Good MJHIV. Disease plague, demoralization and “burnout”: resident experience of the medical profession in Nairobi, Kenya. Cult Med Psychiatry. 2002;26:55–86.

    PubMed  Google Scholar 

  • Selten J-P, CantorGgraae E, Kahn RS. Migration and schizophrenia. Curr Opin Psychiatry. 2007;20:111–5.

    PubMed  Google Scholar 

  • Stark E. Rethinking coercive control. Violence Against Women. 2009;15(12):1509–25.

    PubMed  Google Scholar 

  • Tursi MFDS, Baes CVW, Camacho FRDB, Tofoli SMDC, Juruena MF. Effectiveness of psychoeducation for depression: a systematic review. Aust N Z J Psychiatry. 2013;47(11):1019–31.

    PubMed  Google Scholar 

  • Van Wieren A, Palazuelos L, Elliott PF, Arrieta J, Flores H, Palazuelos D. Service, training, mentorship: first report of an innovative education-support program to revitalize primary care social service in Chiapas, Mexico. Glob Health Action. 2014;7(1):25139.

    PubMed  Google Scholar 

  • Waitzkin H, Iriart C, Estrada A, Lamadrid S. Social medicine then and now: lessons from Latin America. Am J Public Health. 2001;91(10):1592–601.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Wang P, Angermeyer M, Borges G, Bruffaerts R, Chiu W, Girolamo G, et al. Delay and failure in treatment seeking after first onset of mental health disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry. 2007;6:177–85.

    PubMed  PubMed Central  Google Scholar 

  • West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388(10057):2272–81.

    PubMed  Google Scholar 

  • World Health Organization. mhGAP Programa de Acción para Superar las Brechas en Salud Mental. Geneva: WHO; 2008. http://www.who.int/mental_health/evidence/mhgap_spanish.pdf?ua=1. Accessed Sep 2018.

    Google Scholar 

  • World Health Organization and Calouste Gulbenkian Foundation. Social determinants of mental health. Geneva: WHO; 2014.

    Google Scholar 

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Authors and Affiliations

  1. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico

    Mercedes Aguerrebere

  2. Compañeros En Salud México A.C., Ángel Albino Corzo, Chiapas, Mexico

    Mercedes Aguerrebere

  3. London School of Hygiene and Tropical Medicine, London, UK

    Fátima G. Rodríguez-Cuevas

  4. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Hugo Flores

  5. Partners in Health, Harvard Medical School, Institute for Health Improvement, Boston, MA, USA

    Jafet Arrieta

  6. Heal Initiative, Oakland, CA, USA

    Fátima G. Rodríguez-Cuevas & Giuseppe Raviola

  7. Compañeros En Salud México A.C, Ángel Albino Corzo, Chiapas, Mexico

    Fátima G. Rodríguez-Cuevas

Authors
  1. Mercedes Aguerrebere
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  2. Fátima G. Rodríguez-Cuevas
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  3. Hugo Flores
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  4. Jafet Arrieta
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  5. Giuseppe Raviola
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Editors and Affiliations

  1. Center for Health, Culture, and Society, Nashville, TN, USA

    Samuel O. Okpaku

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Aguerrebere, M., Rodríguez-Cuevas, F.G., Flores, H., Arrieta, J., Raviola, G. (2021). Providing Mental Health Care in Primary Care Centers in LMICs. In: Okpaku, S.O. (eds) Innovations in Global Mental Health. Springer, Cham. https://doi.org/10.1007/978-3-030-57296-9_95

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  • DOI: https://doi.org/10.1007/978-3-030-57296-9_95

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