[#WHD2017 Blog Series] Inspiring Innovations: Compañeros En Salud
This blog is part of our series celebrating World Health Day, this year themed “Depression: Let's Talk.” Hear what our community of innovators has to say about the ideas behind their Inspiring Innovations, and how they address depression across the globe.
Here, Partners in Health discuss their innovation: Compañeros en Salud, a mental health programme based on the principles of service, training, advocacy, and research in Mexico.
Tell us about your country’s context and the circumstances that inspired your innovation.
In Chiapas there is less than one psychiatrist per ~100,000 people. There is also a lack of psychologists, and the existent ones are centralized in the biggest cities. In the communities where we work, the prevalence of depression is almost 8% and patients with schizophrenia were locked and chained for years before Partners in Health (PIH) Mexico arrived. Domestic violence, alcohol use disorders, poverty and a recent plague that affected the coffee crops have all contributed contextually to the high incidence of depression. Chiapas lacks a mental health package in primary care facilities, so almost all the mental health disorders are taken care of in specialized care facilities1.
What aspect of your project are you most excited about? How is the project innovative or unique?
One of the most interesting aspects of our project is that general practitioners in the primary care clinics and the community health workers (CHWs) are using psychoeducation and psychotherapy tools as part of the non medication-based interventions that we have. The CHWs have identified more cases of patients with depression as they have become respected in the community and have established themselves as figures that can be easily approached by people. Psychoeducation groups take place in all of the communities where we work, which provides a space for people living with depression and anxiety to talk about these topics and have time for socialization and sharing experiences. In this way, we ensure that the experiences and knowledge are preserved within the community and counterbalance the medication-based measures.
Have you noticed an impact ‘on the ground’? What is the best feedback you have received (from service users, team members, or otherwise)?
People have started to go more to the clinics (through CHWs) if they experience depression symptoms. Patients´ families have started to better understand what patients are experiencing through the psychoeducation and social mobilization that CHWs provide to their families. We had two patients with obsessive-compulsive disorder meet and connect through their experiences, and with the help of one of the CHWs, they better understood their illness and increased their medication adherence. The best feedback we have received from our users is from the CHWs. They say that the psychoeducation groups and the mental health trainings help them feel like they are part of a bigger project. These aspects have helped them overcome depression themselves, given that some of them had been previously diagnosed with depression.
We will start an anti-stigma campaign this month, where facilitators will run focus groups and workshops in the communities with patients with depression and anxiety. These patients are going to be equipped with a camera to capture elements that symbolize the way they experience their illness. These pictures and stories are going to be displayed in a family session and on a webpage to empower them. The campaign is also expected to diminish self-stigma.
With the help of a PhD student, PIH Mexico´s mental health program will be evaluated to see the determinants that ensure positive and negative outcomes. As part of a Masters student’s thesis project, domestic violence is going to be addressed by evaluating the elements that should be included in an intervention after surveys and focus groups have been held.
What is the one message about depression you want people to take away from your innovation?
Depression can be treated within the community if you focus on training local people and health providers with the proper tools, the medication supply chain is guaranteed, and the community is included are central participants of the process.
- Arrieta J, Aguerrebere M, Raviola G, 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. doi: 10.1002/jclp.22390
To read more about the Innovation, visit the case study page.
To see the other blogs in this series, visit our [#WHD2017 Blog Series].