Building primary health care capacity to address addiction and mental health inequities: lessons from Latin America and the Caribbean

Abstract

PurposeSince 2002, the Centre for Addiction and Mental Health in Ontario, Canada, has been working closely with partners in Latin America and the Caribbean (LAC) to implement mental health capacity‐building focused on primary health care. From an equity perspective, this article seeks to critically analyze the process and key results of this capacity‐building effort and to identify various implications for the future.Design/methodology/approachThis analysis of capacity‐building approaches is based on a critical review of existing documents such as needs assessments and evaluation reports, as well as reflective discussion. Previous health equity literature is used as a framework for analysis.FindingsMore than 1,000 professionals have been engaged in various kinds of training in Chile, Peru, Brazil, Nicaragua, Mexico, and Trinidad and Tobago. These capacity‐building initiatives have had an impact on primary health care from both an equity and systems perspective because participants were engaged at all stages of the process and implementation lessons incorporated into the final efforts. Stigma was also reduced through the collaborations.Originality/valueUsing concrete examples of capacity‐building in mental primary healthcare in LAC, as well as evidence gathered from the literature, this article demonstrates how primary healthcare can play a strong role in addressing health equity and human rights protection for people with mental health and/or substance abuse problems.

Global mental health: transformative capacity building in Nicaragua

“…Some of the identified needs are similar to those addressed in other capacity-building initiatives (12, 34) and are aligned with the WHO Mental Health Gap Action Programme (mhGAP) (35). However, the high interest of participants in areas such as mental health promotion and research, as well as addiction treatment modalities, was somehow surprising.…”

“…In the Nicaraguan context, the collaborative process between UNAN-León, CAMH, and MINSA has successfully begun to develop sustainable capacity building among health and social service professionals working in primary healthcare. The capacity-building framework employed by CAMH and Nicaraguan partners fosters a strong sense of local ownership, as it is a bottom-up rather than top-down strategy (12, 37, 38). Based on the objectives set out in the PAHO Strategy and Plan of Action on Mental Health for the Americas (39), the programme will likely serve as a model for other countries in Central America.…”

“…Some aspects of the initiative were based on previous successful partnerships between CAMH and other Latin American countries (12, 15). Over 1,000 professionals have been engaged in various trainings and collaborative projects throughout Latin America and the Caribbean, leading to improved mental health and addiction services in PHC settings, reduced stigma, and an on-going commitment to further national and international mental health capacity building (12, 15).…”

“…Over 1,000 professionals have been engaged in various trainings and collaborative projects throughout Latin America and the Caribbean, leading to improved mental health and addiction services in PHC settings, reduced stigma, and an on-going commitment to further national and international mental health capacity building (12, 15). For example, the CAMH-Chile collaboration, which started in 2003, has contributed to the improvement of the Chilean mental health system, and has supported local efforts to have Chile at the forefront of primary mental healthcare in South America.…”

Trauma Education and Stigma Reduction in Global Settings: An Evaluation of the Impact of a One-Day Trauma Psychoeducation Workshop with Community Stakeholders in the Caribbean Nation of Saint Lucia

“…As a way to meet this growing divide between Caribbean survivors of trauma and provision of evidence-based care for these individuals, it is paramount to find ways to (1) increase the number of providers trained in such effective treatments [17], and (2) to engage in the task-shifting efforts seen in other global settings to expand the range of frontline providers and stakeholders who can support trauma survivors from only mental health counselors or therapists to non-mental health specialists such as school counselors, advocates, public health educators, and medical providers in primary care [18]. Indeed, multiple efforts by research scientists in other global contexts have pointed to the utility of expanding training efforts to such a broader array of potential providers in order to significantly reduce disparities related to access and outcome following trauma exposure in lower resource or non-Western settings [19,20].…”