Innovation details
Compañeros En Salud (CES) began in Mexico in 2011 and now operates 10 rural public clinics in the Sierra Madre mountains of Chiapas—one of the most marginalized regions in the country. The team provides primary and specialized medical care in rural hospitals to improve quality and access to care. CES works with a range of staff, including Mexican physicians and nurses entering a required year of social service (pasantes), and community health workers (acompañantes) who visit patients with chronic illnesses. To meet communities' needs for specialized mental health care, CES trains physicians, nurses, and community health workers using a task-sharing model to properly diagnose and treat the most common mental health conditions, including depression, anxiety, trauma, and psychosis. Staff are overseen by professional mental health specialists to provide treatment consultations, through a mental health training and supervision curriculum.
The program is based on four principles:
Service
CES clinics are staffed by pasantes, young Ministry of Health (MOH) generalist physicians completing a year of service, who provide pharmacologic and non-pharmacologic treatments and are equipped with antidepressant and antipsychotic medications. Within the community, acompañantes (community health workers) provide basic psychoeducation and monitor treatment adherence, and refer patients to care. CES, in collaboration with Instituto Tecnologico de Estudios Superiores de Monterrey (ITESM) medical students, conducts active-case finding for patients with chronic diseases, including depression.
Training
In partnership with the ITESM, CES pasantes receive a diploma in Social Medicine and Global Health in Mexico. This involves monthly trainings on best clinical practices, how to diagnose and treat mental health problems, and social subjects. CES acompañantes complete a psychoeducation course focusing on working with patients with depression and that features expert patients describing what it is like to live with depression, so that acompañantes can give the most empathetic care possible.
Advocacy
As a private organization partnering with the government, CES is committed to advocating for mental health care throughout Mexico. The staff work to improve the reliability of the supply chain and encourage the MOH to increase the amount of mental health medication purchased. Aggregate patient data can also be used to demonstrate the burden of disease related to mental health to government officials.
Research
Like all Partners in Health (PIH) sister organizations, CES is committed to research informed by service delivery needs. A recent project assessed the validity of the PHQ-21 and the PHQ-92 for screening and diagnosis of depression in rural Chiapas. A second project determined the prevalence of depression in rural communities and primary care clinics in Chiapas.
Ongoing projects include: Chronic Psychosis Case Series – Treatment of Psychosis in Rural Primary Care Clinics3-6.
Psychotherapy
CES has expanded community-level services to treat common and severe mental health conditions using Problem Management Plus (PM+), the Common Elements Treatment Approach (CETA), gender equity-focused psychoeducation groups, and women’s reflective circles. CES trains and supervises non-specialists in mental health care delivery, including training and supervising pasantes to diagnose and treat patients with pharmacologic treatment and brief psychological interventions. Moreover, the community mental health workers provide trauma-informed care sessions when providing PM+, especially to women that have lived or live with domestic violence.
Mental Health Integration
CES integrates mental health services into its existing effective, culturally-sound programs by collaborating with other clinical teams. Along with CES's Community Health team, the Mental Health team has recruited a cadre of community mental health workers (CMHWs) or cuidadoras who have been trained in PM+ to treat depression and anxiety in their communities.
Health equity
The rural communities of the Sierra Madre of Chiapas have limited mental health services that are culturally appropriate and that enable community cohesion from the sharing of knowledge. In this area there is a high prevalence of violence against women, which is related to a higher number of women with depression and anxiety than men. Women are rarely considered in community decisions, and although there are many women living in similar situations of inequity and violence, there are not enough spaces for them to connect and share knowledge in the absence of patriarchal structures. CES created Women’s Circles programs to promote mental health with a gender-based perspective. Furthermore, for the first time in the history of CES, a Cuidador has been facilitating reflective circles with adolescent men and men with substance use problems, focused on tackling substance use and mental health from a gender perspective.
From July 2021- June 2022: CES conducted 26 psychoeducation group sessions and 29 women's circle sessions. The team also co-designed the women's circles project along with cuidadoras via an advisory group and participatory feedback. The cuidadoras project grew from one community to nine.