Innovation summary

In many Latin American countries, people with severe mental disorders are often faced with discrimination leading to social isolation1. This has a particularly damaging effect on economically disadvantaged populations that already lack social protection2. The rise of ‘Residential’ care came about to address this issue by providing homes and treatment for people requiring long term psychiatric care3. Recent evidence suggests that this initiative promotes both community integration and quality of life in people with severe mental illness4.

The Carabayllo Protected Home initative is a community-based approach that contributes to improving the quality of life for people with chronic mental illnesses in the event of familial and social abandonment. It also works around areas of residential protection, health and safety within the framework of citizens' rights and social inclusion. It was installed in Lima-Peru in 2015 and houses 6 women (residents) with chronic mental health disorders. These women are clinically stabilized but have no family or social support. Community health workers, also known as ‘care-givers’ provide support and supervise resident activities.

Impact summary

•   6 female residents with chronic mental illnesses have been successfully housed under the Protected Home program.

•   10 community agents have been trained in the care and protection of the residents, of which 6 are actively conducting facilitative care in the Protected Home.

•   All of the residents are actively participating in the community; 3 have enrolled to complete their state education and 4 of the residents have engaged in economic activities.

•   The Protected Home initiative contributed to the reduction of the hospitalized population in the Honorio Delgado-Hideyo Noguchi National Institute of Mental Health, promoting inter-institutional agreements for the benefit of the community.

"No one makes fun of those who are visibly physically injured, but people with mental illnesses are frequently stigmatized and suffer discrimination because they have an illness that is not visible"

- Jerome Galea, Deputy Director of Partners in Health-Peru

Innovation details

In 2015, Partners In Health (PIH) Peru, in coordination with the Ministry of Health and the Municipality of Carabayllo implemented the first Protected Home in Metropolitan Lima to house women with chronic mental illness who, while medically stable lack social support and the skills to live independently.

This initiative marks a critical milestone in efforts to promote Peru’s move to a community-based care for mental health services.

The implementation of introducing the residents to the Protected Home was carried out alongside a comprehensive evaluation an expert committee consisting of professionals from the National Institute of Mental Health-Honorio Delgado-Hideyo Noguchi. The program has the capacity to house 8 women with chronic mental disorders but currently cares for 6 residents. Policy makers aim to expand the current model to provide 200 homes for approximately 1400 people in need of the protection of residential mental health care.

PIH trained community health agents, called "Cuidadoras (caretakers)" to care for the residents. The training included modules on recognizing mental health disorders, behavior management, delivering better treatment and building social skills. Caretakers are responsible for conducting self-care workshops, individual and group therapies for the residents of the Protected Home.

Currently, there are 6 caretakers responsible of supporting residents through the following activities:

  • Building self-care skills
  • Developing domestic autonomy
  • Social skills and community integration
  • Daily routine structure
  • Health and psycho-education
  • Occupational reintegration

Key drivers

Legal Infrastructure

  • Regulation of the Health Law N ° 29889 (which modifies Article 11 of Law N ° 26842) guarantees the rights of people with mental health problems5. This document provided the rationale behind the formation of community networks like Protected Homes through the proliferation of community mental health centers and free treatment for mental health.

Successful Partnerships

  • Collaborative partnerships with policy makers like the Municipality of Carabayllo and the Honorio Delgado-Hideyo Noguchi National Mental Health Institute provided a sustainable approach for the Carabayllo Protected Home.

Challenges

Logistical Challenges

  • Difficulties making the transfer of the Protected Home initiative to the State in order to honor the political commitment between partners.

Quality Assurance

  • Constant supervision required by the caregivers managing resident behaviors given the diversity of mental health problems in the Protected Home.

Recruitment

  • Difficulty finding appropriate community health workers for the recruitment of caregivers. 
  • Caregivers needed to possess strong interpersonal qualities that are not commonly found in this cadre of health workers but which are needed for the adequate management of any problems that may arise in the Protected Home  

Continuation

The Ministry and Municipality also aim to expand PIH’s model to achieve the following:

  • Introduce 200 homes nationwide to support approximately 1,400 people who require the care and safety these homes provide.
  • Use the learnings from the women’s Protected Home to implement a similar service for men with chronic mental illness.

Partners

Evaluation methods

The program carried out an evaluation to assess how the different areas of resident development in the Protected Home were functioning. The evaluation aimed to measure the following outcomes:

  1. Health outcomes
  2. Educational outcomes
  3. Recreational activities
  4. Functional roles of caregivers
  5. Psychological and psychiatric assessment
  6. Social assessment

Monitoring and evaluation activities included planned monthly visits to the Protected Home for direct observation, incident, visit and case records, income reports, economic expenses and inventory tracking. The National Institute of Mental Health Honorio Delgado Hideyo Noguchi were responsible for the psychological, psychiatric and social assessment of residents.

Cost of implementation

The Protected Home program substantially reduced operating costs from $70 per patient per day to approximately $30 per person per day. It is potentially replicable, sustainable and extensible at the national level (MINSA).

Impact details

  • Reduction in levels of social exclusion, disability, clinical dysfunction and costs for people living in a sheltered home compared to a similar institutionalized population. A more detailed analysis of findings will be available post-pilot completion 
  • Increased participation in educational (50%) and economic activities (80%) of the women living in the Protected Home.
  • The first established Protected Home implemented in the northern zone of Metropolitan Lima, with the support of the Municipality of Carabayllo and the Ministry of Health.

References

  1. Mascayano TF, Lips C, Mena PC, Manchego SC (2015) Stigma towards mental disorders: characteristics and interventions. Mental health, 38(1):53-58.
  2. Mathias K, Kermode M, San S, Koschorke, M, Goicolea I (2015) Under the banyan tree-exclusion and inclusion of people with mental disorders in rural North India. BMC public health, 15(1): 446.
  3. Padgett DK, Gulcur L, Tsemberis S (2006) Housing first services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on social work practice, 16(1): 74-83.
  4. Stergiopoulos V et al. (2015). Effectiveness of housing first with intensive case management in an ethnically diverse sample of homeless adults with mental illness: A randomized controlled trial. PLoS One, 10(7).
  5. LEY N° 29889 - Norma Legal Diario Oficial El Peruano (Legal document, General Health Law).

Research

Multimedia

Reports
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Country

Peru

Affiliated organizations

Partners In Health

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