Mental health in Latin America

January 05, 2021

Juan Carlos Brea Minier, student at Technological Institute of Santo Domingo
Carla Lee Kim, student at Technological Institute of Santo Domingo
Priscila Hernandez, student at Technological Institute of Santo Domingo

This post is a series of mental health pieces from the AMSA WSL Committee

Is mental health really important for Latin American society? The answer is yes, and not only for Latin America, but for the entire globe. Latin America is considered the geographic space from Mexico to Central America, South America and the Caribbean Islands. Most countries speak Spanish and Portuguese, but we can’t ignore English, French, Dutch, Creole and other native american language speaking lands. Although the population is certainly heterogeneous in many other aspects, cultural features and values are very common among latinos. During the last few decades, there have been strong efforts to increase mental health awareness and understand the influence of mental health in Latin American society. But despite the recent research and advances on mental health in Latin America, there is still much to do.

Latin American Mental Health Epidemiology
Based on a study by the PAHO conducted in 2013, the yearly prevalence in the Americas for mental, neurological, and substance use (MNS) disorders range from 18.7% to 24.2%. Depressive disorders and alcohol abuse show the highest lifetime prevalence in Latin América and the Caribbean (LAC): 14.5% and 12.4% respectively. Chronic presentations of these two disorders have been identified present in more than 90% of suicidal victims in LAC. Dementia is another concern, since LAC has once again the highest 12-month prevalence among people aged 60 and over (8.5%).  

The Role of Latin American Culture in Mental Health
In Latin America, family plays a role in the behavior, limitations and duties. When the term family is mentioned, it does not only encompass the nuclear family but also grand-parents, aunts, uncles, cousins, god-parents and even certain parts of the community. Pride, respect and dignity define tradition.Therefore, especially in conditions where it may bring disgrace to the family, such as mental health issues, family influences health seeking behaviors. Research was conducted with relatives of psychiatric patients. The relatives’ limited knowledge towards mental illness prior to the diagnosis was eye opening, as the presentation of frustration and denial from the families. 

Religion is a reflection of the Iberian heritage shared by most Latin American countries. These beliefs help in coping with illness, death, and other adversities. Not obstant, patients with chronic medical conditions and/or their families tend to accept the medical conditions either with resignation as a punishment for misbehavior or to wait for a miraculous cure. Through all this, these patients do not seek proper treatment. Most of Latin American societies exhibit a concept called machismo. Influenced by the legacy of colonialism and religious beliefs, men have been determined as the sole provider and protector of the family. On the other hand, women shall be devoted to household chores and maintain a passive role in society. Therefore, when neither men nor women are no longer able to fulfill their respective duties, stigmatization becomes evident. Men may even try to hide their symptoms, deny symptoms, and avoid seeking treatment in order to keep their status in society. 

The Impact of a Declaration in Mental Health
The Caracas Declaration was an agreement signed in 1990 by Latin American countries with the main objective of promoting respect for the human and civil rights of the mentally ill. The impact of the Declaration of Caracas on the policy and legislation of psychiatric care and mental health was a great evolution, through the call of all segments of Latin American society in support of restructuring psychiatric care. This was one of the pillars that generated the greatest impact and awareness for Latin American mental health.

A study was conducted by Larrobla and Botega in 2000 on psychiatric care with the deinstitutionalization among South America countries, such as Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uruguay and Venezuela. This study determined that  most  Latin American countries have integrated mental health programs within their primary health care facilities, and  public coverage of mental health services is offered.

Mental Health Policies in Different Latin American Countries
In reference to civil society participation, it is interesting to note that most of the constitutions promulgated in Latin America countries since the second half of the 1980s (Argentina, Brazil, Colombia, Ecuador and Paraguay) provide for the protection of collective rights and interests. These constitutions specify public health and consumers’ rights, as well as others related to the quality of life.

The Caracas Declaration prompted several countries in Latin America to review their legislation regarding psychiatric care, with a hope to adapt its principles to this Declaration and, at the same time, adapt it to promote a public health structure. Advances reported since 1990 include: changes to mental health services where treatment and rehabilitation are guaranteed for all people with mental disorders, the implementation of mental health care in integral psychiatric units whose objective is to standardize the operational criteria, actions and attitudes of human resources in mental health units, and a comprehensive approach to the management of mental disorders.

Gaps in Accessing Mental Health Facilities in Latin América
Although mental health has been widely acknowledged by the medical community, and much more after the Declaration of Caracas, it is regrettable to mention the critical treatment gaps among adult and pediatric patients (73.5% and 82.2% respectively). According to the PAHO, services are fragmented and coordination among health care levels is poor. Mental health staff and resources are scarce. In 2019, the total health budget for psychiatric hospitals in Mexico, Central América and the Caribbean was only 0.9% and 2.1% for South América. This only proves that mental health is not given the importance it deserves. 
Mental health is currently a growing public health crisis as evidenced by the alarming increase in mortality, morbidity and disability rates, as well as the overwhelming loss of potential years of life and psychosocial effects. Although there has been recent implementation of different policies and increased funding for mental health resources, uncontrollable facts, such as its own culture, puts Latin America in a difficult position. One’s own belief cannot be changed, but adaptation is a possibility. As the next generation, we aspire to create a more open-minded community, one that is able to accept each other to the fullest extent.