Innovation summary

The Socios En Salud (SES) mental health program provides access to supportive, quality care for marginalized communities and has grown exponentially evolving from a strong psychosocial program for people living with tuberculosis (TB) to integrated care across life stages and co-morbidities. The team works in close partnership with the Peruvian government’s arm for mental health -MINSA, and the National Institute of Mental Health (Hideo Noguchi) by providing complementary community-based interventions and referring people to Ministry of Health (MOH) facilities for care. For example, one of SES’s first mental health projects was piloting a safe house model for abandoned young women living with severe mental health conditions, which was then scaled nationally by the MOH. Since then, SES has integrated mental health care into services for maternal and child health, tuberculosis, chronic care, and their COVID-19 response.

Impact summary

  • The SES Mental health team screened 14,573 people with mental health conditions between July 2021 and June 2022.
  • In 2021, the team launched the Migrantes project, a program which supports people having recently migrated to Peru, including people moving because of political instability and violence. The number of people newly receiving services in its Migrantes program increased from 127 to 2,544 in only 6 months.
  • The program expanded its mental health service delivery to adolescents, conducting 47 visits in 2022

“Mental health, everyone’s right not to be left behind”

A slogan for the collaboration with the MOH

 

Innovation details

SES’s work has grown drastically in recent years. Care models have expanded and elaborated to target both severe (psychotic disorders) and common mental health conditions (depression, anxiety and stress-related conditions), and mental health care has been integrated into programs dedicated to other diseases. A lot of their work has been completed in very close coordination and collaboration with the Peruvian Ministry of Health. Specific program efforts include:

  • Tuberculosis: Integrated depression into care and treatment for people with TB, including psychological interventions such as Problem Management Plus (PM+).
  • Maternal and Child Health: Adapted the psychological intervention Thinking Healthy for women with perinatal depression and developed early childhood development programming (called CASITA).
  • Severe Mental Health Conditions: Established a community-based schizophrenia program and safe houses or "protected homes" for women living with severe mental illness who had been abandoned by their families.
  • Common Mental Health Conditions: SES was one of six global sites participating in the World Health Organization’s project EQUIP: Ensuring Quality in Psychological Support, as well as an active learning participant in Common Elements Treatment Approach (CETA) in collaboration with Johns Hopkins University, and leader in Peru in training Ministry of Health psychologists in aspects of psychological treatments in the COVID-19 era. Through EQUIP, the team focused on capacity building in psychosocial support and mental health services in non-specialized mental health providers, making it possible to implement remote training and innovatively strengthen non-specialists' skills through virtual platforms.
  • Community-Based Care: A key component to SES’s mental health program is the recruitment and education of CHWs to do case finding and refer severe cases to the center of community mental health, helping to create social protection mechanisms for particularly vulnerable people living with mental disorders.

Key drivers

Collaboration: Close partnerships with allied institutions such as the Peruvian government’s arm for mental health, MINSA, the National Institute of Mental Health (Hideo Noguchi), and the Municipality of Carabayllo ensure that SES’s programs are sustainable and align with the country’s health priorities. Additionally, SES collaborates with fellow PIH teams, including Mexico’s mental health team, Companeros En Salud (CES), to collaborate and provide trainings on PM+ implementation and quality improvement.

Close partnerships with the Ministry of Health (MINSA) to scale interventions and inform policy including, successfully implementing a labor force inclusion project, Ichik Wasi; Supporting national ID card renewal and access to the CONADIS card for people living with disabilities
 

Integrated Services: The SES team integrates mental health services into already-established health programs, including initiatives for maternal and child health, tuberculosis, and chronic conditions. Integrating services supports SES’s approach for efficient and comprehensive mental health care.
 

Technology: In the wake of COVID-19, SES started delivering remote Psychological First Aid (PFA) and developed a chat bot to screen for mental health conditions for people in isolation and remote areas. The use of technology helps to reach patients remotely and refer them to additional services, ensuring that everyone can access the care they need.

Challenges

Limited infrastructure for mental health: Peru faces limitations in the national and regional health systems when it comes to providing robust mental health care. Lack of mental health professionals, supply chain issues, and limited geographic coverage make it challenging to prioritize mental healthcare treatment within the health system.
 

Stigma: There is a long history of stigma towards mental illness, which makes it difficult to promote and implement community-based care programs. Discrimination from families and communities have historically marginalized people with mental health conditions, which creates a barrier for these people to seek quality care.

Continuation

Crisis Response: When COVID-19 struck, SES developed an innovative chat-bot to identify, screen, and refer people to mental health care during the pandemic in partnership with MINSA. In 2021, SES launched PIH’s first-ever cross-site grant to be held outside of the Boston office. The project focused on expanding virtual collaborative opportunities in support of PIH’s mental health care delivery value chain at 3 other PIH sites.

Moving forward, the team plans to strengthen community-based work for treating severe mental health conditions and bolstering supervision strategies. To reduce the burden of common mental health conditions in community-based settings (with a focus on depression, trauma, and substance use, often compounded by domestic violence), SES will expand their work with the CETA.

They are also expanding MINSA collaborations with national trainings, PM+, and Thinking Healthy, through in-person and virtual platforms, such as a mobile chat-bot.

In partnership with MINSA, the team is piloting an innovative psychosocial rehabilitation program called Yo Tambien Puedo (‘I Can Do”) in community health centers.

Partners

  • Center for Global Health SES
  • Ministry of Health of Peru (Diris Lima Norte)
  • Partners In Health

Funders

Evaluation methods

Data Management and Quality Improvement: SES uses an internally developed platform called SEIS for electronic data collection. Data is updated and reviewed on a regular basis.

Cost of implementation

N/A

Impact details

Through the BienEstar Program, the SES team provide psychosocial support during the COVID-19 pandemic:
- Screening more than 70,000 people for mental health conditions through a mobile chatbot.
- Over 22,000 people received virtual psychosocial support and over 6,200 social support packages were delivered

References

  1. Vigo, D (2016). Report on disease burden of mental illness across Partners in Health sites. PIH, Boston, US.
  2. Kruk, ME, et al. (July 1, 2020). Availability of essential health services in post-conflict Liberia. Bulletin of the World Health Organization, 88(7): 527-534. WHO | Availability of essential health services in post-conflict Liberia
  3. Gwaikolo WS, Kohrt BA, Cooper JL. (July 27, 2017). Health system preparedness for integration of mental health services in rural Liberia. BMC Health Serv Res, 17: Health system preparedness for integration of mental health services in rural Liberia - PubMed (nih.gov)

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