Colombia: A Critical Step to Improve Mental Health Delivery Systems

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Mental health services during the last decades witnessed the historic change of having large number of patients with severe mental illness moving out of long term institutionalized treatment into outpatient treatment.  This epoch shift brought new challenges: while many patients are able to function well and achieve an independent life, a significant number are readmitted and do not adapt easily to life outside an institution.  Mental health providers struggle with this group of patients for whom treatment as usual is insufficient, and patients and families ask for solutions.

Patients find transitioning into community challenging. From: "Voces del Estigma" 2006

Patients find transitioning into community challenging. From: “Voces del Estigma” 2006

Current evidence supports programs such as Assertive Community Treatment (ACT) and intensive case management (ICM) as a way to improve the care of those patients with severe mental illness who have been discharged from the hospital. ACT has been found to reduce the frequency and length of hospitalizations, ensure continuity of care, improve clinical outcomes and quality of life and achieve independent living for patients.  Common features of these programs are a multidisciplinary team, low client/staff caseloads with more intensive contact, and community based services with 24 hour coverage provided directly by the team.  CAT is more costly to implement, but the reduced utilization of hospital and emergency services among its beneficiaries proves to be cost-effective over time.

In Colombia, there are no programs to deliver transition care for patients with severe mental illness, and many of them end living in precarious conditions or being readmitted to psychiatric hospitals.  In addition to the human suffering, the economic costs of the increased utilization of services are also considerable.  Some day-hospitals exist, but they are not able to provide care in a community setting for these patients.

Other countries in the region with similar characteristics share the need for more comprehensive community care. The implementation of ACT in Colombia could be done in a pilot program, allowing for training of teams.  Once the benefits are documented and diffused, scaling up of the program could be considered.

Helping patients build a bridge from hospital to outpatient care. From "Voces del Estigma" 2006

Helping patients build a bridge from hospital to outpatient care. From “Voces del Estigma” 2006

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5 Responses to “Colombia: A Critical Step to Improve Mental Health Delivery Systems”

  1. alfredmartin3 Says:

    Implementation of ACT with a pilot program to prove it will work in Columbia sounds like a great idea.

    In the United States, the view of society toward those with severe (and even mild) mental health problems has dramatically improved for the better over the past 20 years. The ACT program is costly over the short term, but is cost-effective over the long term. Will Columbians agree that those with severe mental health issues deserve access to the level of services that these patients need to maximize their quality of life, or are there Columbian social norms and prejudices against mental illness that will cause the ACT pilot program to fail? How will those implementing the ACT pilot program deal with this problem, if it does exists?

  2. bhuangjhsph Says:

    Thank you for this interesting post. The need for personalized medicine and services seems to be a common theme in healthcare around the world. As we increase our understanding of diseases and conditions, we learn that certain patient populations require more specialized treatment that does not align with the current services. I think it is essential to periodically reassess our healthcare and implement new services in order to better meet the needs of patients.

    This case kind of parallels with the experience of patients at a cancer survivorship clinic where I used to work. Cancer survivors often find themselves in a strange state during their transition back to regular primary care after they complete treatment. While they are no longer cancer patients, they still require special medical attention because of the new risks and side effects that arise from their treatment. This is where survivorship clinics come in, as they provide a place for survivors to receive risk assessments and care plans tailored to their specific needs and cancer history. These clinics provide support for individuals that are in a transitional period of their medical health, just like how the ACT provides assistance to the mental health patients moving from institutions to outpatient clinics.

  3. Being Discharged From Mental Health Services - Parenting And Mental Health Says:

    […] Colombia: A Critical Step to Improve Mental Health Delivery Systems […]

  4. psantacruzortega Says:

    Great post! This is such a key subject in our societies! We have seen how all over Latin america the patient with mental health problems is isolated, discriminated against and made invisible. I was wondering who in Colombia would assume most of the costs? Does the MOH provide funding for initiatives like this?

  5. josemuribe Says:

    Thanks for all the replies. As mentioned in the comments to the post, financing is a challenge, but hopefully integrated care programs can prove to be cost effective, and insurers will understand the need to implement it. The other problem is integrating services, building a network so patients do not receive fragmented care. The MOH does not directly fund programs, but it has a crucial role in directing and setting priorities to the health system, as similar challenges apply to the management of other chronic illness.

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