Regional Overview and Mexico
The majority of Latin American countries allocate less than 2% of their annual budgets for health care expenditures. Scholars believes this low expenditure rate "[compounds] a dismal picture already affected by everyday stresses" such as massive migration flows and domestic violence. The budget of Latin American countries is affected by cultural components. There is shame and guilt associated with mental illness in the region. Many people afflicted with mental health illnesses use unorthodox help-seeking practices. Also, those making the budget prioritize long term health projects to improve primary care in the region. These factors stunt the growth of Western mental health systems, and lead to wide unavailability of appropriate mental health services.The general disregard for mental health care affects the living conditions of those with mental illness: there are problems in the region of human rights violations against patients and their families, negligent care in mental health facilities, and poor housing conditions of the mentally ill.65
As of 2005, 75% of Latin American countries now have mental health legislation. One of the major regional goals is to incorporate this into primary health care. 90% of countries claim that they have done this, but scholars consider mental health to be insufficiently integrated in most Latin American countries.66
The regional estimates suggest that 18-25% of Latin Americans have mental disorders. However, only 1 in 5 patients in need of mental health care receive it. Regionally, there are 1.6 psychiatrists, 2.7 psychiatric nurses, 2.8 psychologists, and 1.9 social workers per every 100,000 people. There are 3.3 psychiatric beds per 10,000 individuals. 48% of those come in psychiatric hospitals, 17% in general hospitals, and 36% in other community settings.
Mental health professionals are among the lowest paid medical professionals in most Latin American countries. Training for mental health professionals occurs in facilities with limited staff and equipment, and little monitoring from government agencies. There has recently been a slight increase in trainees, but also consistent emigration of professionals.
The concentration of professionals is in metropolitan areas, leaving the 45% of the region that lives in rural regions less attended. The process of visitation for those with mental health concerns goes as follows: they are first seen by non-professionals, the non-psychiatric professionals, then mental health professionals. This lengthy and likely expensive process is forgone by many, particularly since insurance coverage for mental illness is minimal in the region.67
Mexico has the strongest social security sector in Latin America, but this has not defrayed the high cost of mental health care that deters many patients, especially youth. Social security is available to 70.4% of Mexicans.68
In a study of access to care for Mexico City youth, though, less than 1 in 7 youth with any psychiatric disorder had received cared in the last year. This was a lower percentage than adults, partially because so few personnel specialize in adolescent mental health care. The percent of these adolescents receiving minimally adequate care ranged from 27-58%, based on the operational definition of "minimally adequate." This was based on a combination of low resources, stigmatization, and patients rejecting some prescriptions. Also, for anyone paying out of pocket, the prices would be very high. Young females were treated at a higher rate; one hypothesis is that the culture stresses a tradition of protecting young women more so than young men. Also, 40% of the population that did use the services available to urban youth had no disorder, a misuse of the already scare resources.69
New efforts to promote mental health have been made. NGOs recently have introduced educational activities to build understanding of mental illnesses. Mexico also has the benefit of additional research to support awareness efforts, with the only functioning institute of mental health research in Latin America.
65 Alarcon, Renato, "Mental Health and Mental Health Care in Latin America," World Psychiatry 2.1 (2003): 54-56. Print. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525063/
66 de Almeida, Jose Miguel Caldas, and Marcela Horvitz-Lennon, "Mental Health Care Reforms in Latin America: An Overview of Mental Health Care Reforms in Latin America and the Caribbean," Psychiatric Services 61.3 (2010). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525063/
69 Borges, G, C Benjet, ME Medina-Mora, R Orozco, and PS Wang, "Treatment of Mental Disorders for Adolescents in Mexico City," World Health Organization 86.(10) (2008): 757-764. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525063/
Honduras has an interest in addressing mental health, but not the resources to do so. Only 1.75% of the annual health budget goes to mental health, well below the WHO's recommendation of a minimum 5% mental health allotment, and not nearly enough to implement the broad policy changes that have been devised.70
Honduras' policy decisions over the last two decades have demonstrated a steady interest in improving mental health care. The country began a postgraduate psychiatry training program in 1994, demonstrating an investment in increasing human resources. Honduras later created a policy working document to develop "National Mental Health Policy 2004-2021," with primary goals of promoting community health, decentralizing mental care, and incorporating mental health into the general health system. This whole program has been cultivated by the Health Secretariat's mental health program, instituted in 1975, which has been a consistent promoter of the mental health system.71 Perhaps most importantly, prominent government institutions have demonstrated the political will to continue to introduce and implement new strategies.72
Unfortunately, insufficient funding has made it difficult, despite strong policy, for the mental health system to address the needs of its citizens. There is both a lack of resources and a poor distribution of the resources available. Human and financial resources are heavily skewed towards mental hospitals, with 88% of the mental health budget going towards them.73 This creates a great disadvantage for primary care and community mental health facilities.
The juxtaposition of policy and practice is most clearly seen in access to psychotropic drugs: 100% of the country's population is supposed to have free access to mental health drugs while in mental hospitals, but the supply of drugs is very limited. It is also very difficult for primary care physicians to get any access to psychotropic drugs.74 Social security systems are intended to cover costs of mental health medicine, but the system has lacked the resources recently, forcing users to pay entirely out of pocket. This is extremely pricey, with antipsychotics costing 26% of the daily minimum wage and antidepressants costing 19% of the daily minimum wage.
Mental health is a relatively well-taught health sub-sector, with 5% of all training for medical doctors devoted to mental health, and 7% of all nurse training. These professionals rarely get refresher courses after their degrees, with only 4% of primary care doctors and 2% of nurses have received continued training. Refresher training is difficult to access because it is only offered in one region of the country.75
The number of human resources in the mental health system is a reasonably strong 6.12 per 100,000. This includes 0.81 psychiatrists, 0.67 other medical doctors, and 2.58 nurses. Psychiatrists are reasonably well divided between facilities, with 21 psychiatrists in outpatient facilities and 27 in mental hospitals. 76
While Honduras has hopes of decentralizing mental health care, it has not happened yet. Mental health professionals are still concentrated in the capital city, despite 45% of the population living in rural regions.77 35 of 43 psychiatrists and 156 of 186 mental health nurses practicing in Honduras were located in cities.78 Rural users are often most in need of services, but least able to access them. The rural populations in extreme poverty often do not seek mental health care until their symptoms are so severe that they require hospitalization.
Honduras lacks a human rights review body. There is also no internal review at mental health hospitals, and mental health workers do not receive any training of human rights protection. There is also no record of involuntary admission or restraining of patients, and no practice of recording human rights conditions of patients.79
Inequity of care is a major issue in the country. The most disadvantaged linguistic and ethnic minorities struggle to get equal access to care. This problem is particularly worrisome because of the country's high multiculturalism, with eighteen distinct ethnic groups. There are also no legislative provisions for those with mental illness, which can contribute to housing and labor discrimination.80
The role of advocacy is primarily taken by NGOs, who focus particularly on promotion and rehabilitation for women and children.81
70 World Health Organization, “Mental Health System in Honduras,” WHO-AIMS Report (2008): 7.
71 WHO 5.
72 WHO 6.
73 WHO 7.
74 World Health Organization, “Mental Health Atlas,” (2005): 228.
75 WHO 14.
76 WHO 15.
77 WHO 6.
78 WHO 16.
79 WHO 10.
80 WHO 19.
81 WHO Atlas 228.