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“Welcome to my house!” said World Bank Group President Jim Yong Kim during his opening remarks to the Peruvian President, First Lady, Minister of Health and Mayor of the district of Carabayllo. Dr. Kim felt like he was at home because he had been a regular visitor to Carabayllo since 1994, when he led an initiative to implement the first community-based approach to control multidrug-resistant tuberculosis (MDR-TB) in a resource-poor setting.
This time, Carabayllo was making history again. The President had recently signed a law that protected the rights of people with mental health problems. The regulation includes a set of community mental health services integrated at the primary health care level, which require the direct involvement of the community and the family of the patients. It is a first step to decentralize mental health services through the implementation of the new model of community care for mental health, including general and specialized care services for mental health.
Across six regions in Peru, there are 21 community centers for mental health. The coordinated effort—of the Ministry of Health, the National Institute of Mental Health, local government of Carabayllo, and several international and national organizations—is promoting social participation and is strengthening the network of mental health community-based approaches to implement psychosocial interventions in families with problems and mental disorders. In the past, mental health patients were hospitalized; now, in this new model of health care delivery, patients are ambulatory. The community health workers conduct home visits to beneficiaries and provide psycho-education, support adherence to treatment, and encourage the participation of family members in the recovery of the patient with mental health problems.
Anxiety and depression are common problems in Peru. In Carabayllo, as in other districts with high levels of poverty, social problems like domestic violence, sale and consumption of drugs, gangs, prostitution, assaults, and robberies are common. Community organizations in Carabayllo are trying to implement a comprehensive approach to deal with these complex challenges.
Efforts in Carabayllo include opening the first home for people with severe mental disorders in socially neglected situations. Six therapeutic caregivers, who are community health workers with ad-hoc training, are taking care of eight women, ranging from 21 to 63 years old. They are responsible for overseeing the treatment of the residents, for providing new skills training, and for enabling the socialization and reintegration of patients into the community. The National Institute of Mental Health is providing technical advice, training, monitoring and therapeutic support to caregivers.
As we left the district of Carabayllo, I thought about the great challenges the community is still facing to become a healthy society. Undoubtedly, the lessons from the past allow for an active community participation, creating a platform for true collaboration among government bodies and community-based organizations. With this new mental health initiative, Carabyllo once again—despite its persistent challenges—could become a model for innovation and learning, just as it was for MDR-TB.
The experience of Carabayllo convinced me that if we are going to fully embrace and support the progressive realization of universal health coverage, we must work to help bring mental health “out of the shadows” and into the mainstream of what is considered to be essential health care. To this end, we at the World Bank Group, in partnership with the World Health Organization, and with the support of an international, multi-institutional working group, are starting to work to build momentum and will co-host a major event on global mental health in spring 2016. Building on country experiences such as in Peru, the time has come to place mental health at the center of the global health and development agenda.
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