PIH Peru: Socios En Salud (SES)

Socios en Salud (SES)'s mental health program has evolved from a robust psychosocial program for people living with tuberculosis to a mental health program integrated across life stages and morbidities. The MVC provides support for human resources including program management and psychologists who tether SES’s mental health interventions into a comprehensive mental health program. 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 MOH facilities for care. As part of this, 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 integrated mental health care into services for maternal and child health, tuberculosis, chronic care, and their COVID-19 response. CHWs do case-finding, refer severe cases to the Centro de Salud Mental Communitario (community mental health center), and help create social protection mechanisms for particularly vulnerable people living with mental health conditions. 

Through their collaboration with the Many Voices Foundation, SES strengthens the public healthcare system with community strategies aimed at accompaniment and effective rehabilitation of people with schizophrenia and psychosis. CHWs provide treatment adherence, mutual aid groups for patient caregivers, occupational therapy, and remote text message appointment reminders using the digital technology platform, Memora Health. The team is strengthening community-based work for treating severe mental health conditions and is expanding to another health center. 

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 centro de salud mental communitario, helping to create social protection mechanisms for particularly vulnerable people living with mental disorders.

SES receives complementary support from additional grants for further programming. These programs include:

• The Thinking Health Intervention for perinatal women, one of six global sites funded by the World Health Organization’s EQUIP project,  
• culturally adapted and modified version of PM+ for mothers with depression who participate in Peru’s CASITA program.  
• For co-morbid conditions, SES is piloting CETA in the Casas de la Salud program at health outposts, and offering PM+ for qualifying patients who are part of the TB Móvil project.  
• In 2021, SES received funding from Grand Challenges Canada (GCC) in partnership with the Cross-Site Mental Health team and is the first site to manage a cross-site grant outside of Boston. The GCC project focuses on expanding e-learning collaborative opportunities, as well as piloting and expanding the learning collaborative in support of care delivery across the Value Chain in Mexico, Lesotho, and Liberia. 
•  In 2021, SES focused on capacity building via a new project about basic helping skills in psychosocial support and mental health services in non-specialized mental health providers through EQUIP, making it possible to implement remote trainings and innovatively strengthen non-specialists' skills through virtual platforms. 
• When COVID-19 struck, SES received additional funding from two USAID grants to develop the BienEstar program to provide community mental health interventions and psychosocial support both within Lima and in previously non-PIH supported districts across Peru. This initiative strengthens community and psychosocial support networks for identifying and monitoring of people with mental health conditions related to COVID-19. SES developed a chat bot to screen for mental health conditions for people in remote areas or isolation, which includes a self-administered tool and referrals to additional services, and is available in both Spanish and Quechua. Once USAID funding ended, Many Voices covered the project as a scale-down approach for long term sustainability from April-June 2022. 

In 2017, SES implemented the  World Health Organization’s (WHO’s) Thinking Healthy Intervention,  which is a manual for psychological management of perinatal depression, as part of a grant focusing on maternal and child health. SES adapted the manual and piloted the intervention with 10 pregnant women.

SES is partnering with the WHO on an implementation science project to pilot a new supervision competency practice with leading global mental health researchers, through the “Ensuring Quality Psychological Support” EQUIP project. 

SES is implementing the  WHO’s Problem Management Plus Intervention  (PM+), learning from best practices at PIH-Rwanda. In 2019, in collaboration with the the Compañeros en Salud team in Mexico, the mental health team taught CHWs in Mexico the PM+ intervention.

• Since February 2016, SES has been treating people in Lima, Peru with multidrug-resistant tuberculosis (MDR-TB) with bedaquiline as part of the endTB Observational Study. Throughout treatment, endTB patients receive clinical support in coordination with the Ministry of Health, as well as social and mental health support. Since the start of the program over 200 people have received mental health care. 
• 36 pregnant women diagnosed with depression have received the Thinking Healthy intervention.
• PM+ has been integrated into a rapid TB screening project, whereby 100,000 residents of Carbayallo will receive digital chest x-rays in mobile units. Persons with a confirmed TB diagnosis are screened for depression and offered PM+ as needed. 

•  1 safe house  established for women living with chronic mental illness, such as schizophrenia, was transitioned from PIH to the local municipality of Carabayllo, where PIH is based, paving the way for the Government of Peru to expand PIH’s model to 200 homes nationwide to support the roughly 1,400 people who desperately need the care and protection these safe houses provide.
• In 2019, 200 people living with mental health conditions received mental health care with over 890 people screened for mental health disorders, and 1,000 mental health visits.

• In collaboration with the Ministry of Health, 230 people with schizophrenia were screened and 130 people were enrolled into care in 2019.
• In order to reduce depression in adults, PM+ is implemented to care givers as part of the  CASITA project  and Casas de La Salud. Preliminary results show that 50 people have completed the intervention and 78% of them have clinically significant improvements in their depressive symptoms.

• Document, disseminate, and bridge the gap in mental health care gaps for people with chronic mental health conditions 
• Strengthen continuity of care for people with chronic mental health conditions in Carabayllo and Comas  
• Provide technical assistance, national mental health service delivery strategic planning support, and training for mental health professionals at the request of the Ministry of Health  
• Conduct community based and anti-stigma campaigns 
• Implement a training program for caregivers of children with neurodevelopmental conditions  
• Conduct a national situational analysis of mental health services across Peru in partnership with the Ministry of Health 
• Scale up CETA for violence, trauma, and substance use conditions 

Implementation Tools

•  A manual for psychological management of perinatal depression  
•  PIH Peru - Program Materials  
•  Chatbot-  Spanish 

External Dissemination

•  Prevalence and risk factors for postpartum depression in Women - Lima (2004)  
•  Major depression in pregnant women - Lima, Peru 
•  Norma Técnica de Rehabilitación Psicosocial 
•  Norma Técnica de las Residencias Protegidas-MINSAL 
•  Buenas Prácticas en Gestión Público-Privado 
•  Preparing to launch the ‘Thinking Healthy Programme’ perinatal depression intervention in Urban Lima, Peru: experiences from the field. 
•  Lessons From Rural Peru in Integrating Mental Health Into Primary Care 
•  Beyond screening: a call for the routine integration of mental health care with tuberculosis treatment 
•  Peruvian mental health reform: a framework for scaling-up mental health services  
•  Sistematizacion de la Implementacion del Primer Hogar Protegido Para Mujeres con Esquizofrenia de Lima Norte  

Multimedia

•  Implementation of Thinking Healthy in Peru - PIH (Presentation)  
•  Socios En Salud l Salud Mental (Video) 
•  Hogar Protegido para pacientes de Salud Mental