Mental Health Services Reform: Successful experiences from South American communities

Exchanging experiences between Chile, Peru and Paraguay: Strengthening mental health systems and services

Despite the enormous challenge of the mental health response, Chile, Paraguay and Peru have initiated and implemented community-based mental health reforms to bridge the gap in the treatment and care needed for the affected populations. Importantly, the three countries have drawn on each other’s experiences to strengthen their respective mental health systems and services.  

Community-based services are essential to ensure that people suffering from mental, neurological and substance use disorders receive appropriate treatment and care within their communities. The outdated psychiatric hospital-centred model is gradually being replaced by mental health multidisciplinary networks that are accessible and that respect the rights of population.  

The mental health community-based reform project contributed to Sustainable Development Goals 3 (SDG 3); targets 3.4 (By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being) and target 3.5 (Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol).  

Extensive collaboration was primarily carried out between Chile and Peru. The Chilean experience of establishing mental health networks at the community level greatly influenced the Peruvian mental health reform. Specific projects of intercountry cooperation between Chile and Peru were implemented and often funded by the Pan American Health Organization/World Health Organization (PAHO/WHO). 

The cooperation between countries took the following forms, including: 

In Paraguay, a renewed interest in reforming mental health services was manifested by the current Minister of Health. The current model, based on specialized mental health services – mainly in the notorious psychiatric hospital in the capital city, Asuncion – must be replaced by decentralized mental health services. In 2019, a delegation of health authorities and professionals from Paraguay travelled to Lima to meet with representatives of the Peruvian Mental Health Department of the Ministry of Health, and to become familiar with the mental health model, and exchange on best practices and lessons learned in the development and implementation of the mental health strategy. 

In addition, Paraguay has been selected to participate in the global World Health Organization (WHO) Special Initiative on Mental Health, which seeks to ensure universal health coverage involving access to quality and affordable care for mental health conditions in 12 countries to 100 million more people. The initiative, which will advance policies, advocacy and human rights, and scale up quality interventions and services for people with mental conditions, is already being implemented in Paraguay and the situation analysis is being carried out   

However, one of the outcomes of the project determined that a common challenge that the three countries have encountered is tackling mental health within indigenous communities. Among indigenous communities, mental disorders are highly prevalent and suicide rates higher than in the general population. More joint efforts are needed to address the special need of these populations, and thus the project ‘Good practices in community-based mental health: Chile, Paraguay and Peru’ was submitted to the PAHO/WHO funding mechanism for Cooperation among Countries for Health Development (CCHD).  

Since mental health remains a challenge for many countries, the best practices and lessons learned from this project are a primary resource in the development and implementation of mental health policies and service delivery. Through this initiative, countries have worked together to identify common barriers and consolidated the political commitment to address mental health problems, with a specific focus on populations living in conditions of vulnerability.