PIH Mexico: Compañeros En Salud (CES)

Mental Health Program

Program Overview

CES works in 10 clinics staffed by pasantes (young generalist physicians doing a service year for the government) who are trained on pharmacologic and non-pharmacologic treatments for mental health disorders. They receive ongoing monthly trainings on best clinical practices, mental health diagnosis, treatment. The pasantes deliver mental health care in the primary care setting supervised by a general physician and clinical psychologist. The general physician and psychologist receives ongoing clinical supervision in psychopharmacology, cognitive behavioral therapy, and best practices for various mental health conditions. Community mental health workers deliver a psychotherapeutic intervention, Problem Management Plus (PM+) , and are overseen by a psychologist who supports them in the diagnosis, treatment and follow up of patients; moreover, they help lead psychoeducation groups in the community. People are identified through active case finding and screening for depression using The Patient Health Questionnaire (PHQ-9) and acompañantes (community health workers) provide basic psychoeducation, monitor treatment adherence and refer people to care. CES always considers a patient-centered approach to care and has started to incorporate persons living with mental health conditions and family’s feedback through surveys to improve their quality of care.

Innovation

In collaboration with the Compañeros en Salud Community Health team, the Mental Health team have recruited a cadre of community mental health workers (CMHWs). The CMHWs were recently trained in PM+ to treat depression and anxiety in their communities. The training and supervision support was provided by a team from Socios en Salud (Partners In Health, Peru) who had implemented the PM+ in Lima.

PM+

Dr. Fátima Rodríguez, Program Coordinator for the Compañeros En Salud Mental Health Program, during a Mental Health training for Community Health Workers in the community of Capitán Luis A. Vidal.

Prior to 2016, the Patient Health Questionnaire (PHQ-9) was not validated in rural, Spanish-speaking communities in Mexico. Through a study conducted by a team from Companeros en Salud, the PHQ-9 was validated in the setting and the PHQ-2 was found to have good psychometric properties for community-based screening of depression. The PHQ-9 and PHQ-2 are used by psychologists, general physicians, and community health workers for routine screening/care for depression in Chiapas.

pasantes

(Casa Materna)

pasantes

Impact

In a cohort of 106 people with depression analyzed, 50% of patients attended at least one group psychoeducation session. Of this same cohort, 41% are in remission a year after starting treatment.
61% of people with depression receive home visits by an acompañante who helps with treatment adherence, medication adverse effects, and appointments to the clinic and provides psychoeducation.
In 2018, CES treated over 500 people living with mental health conditions.

Resources

Research

Tools

Please reach out to xsitementalhealth@pih.org if you are interested in any of the below materials:

CES has a curriculum for its psychoeducation groups work
CES has a mental health curriculum for training medical doctors in primary care
Mental Health Clinical algorithms are available for sharing
Training manuals for CHWs are available in Spanish

Multimedia

Working in Global Health: Dr. Mercedes Aguerrebere

Starting a career in global health can be intimidating. It's a diverse field that evolves quickly and demands collaboration across disciplines, from finance to supply chain and logistics, to computer programming. That's why we ask seasoned colleagues to share advice for those interested in forging a career in global health.

https://www.pih.org

PIH Mexico at Two Years: A Doctor Reflects

Compañeros En Salud, our sister organization in Mexico, marks its second anniversary this month. To mark the occasion, country director Dr. Hugo Flores Navarro reflects on progress and challenges of working in rural Chiapas. The story of the founding of Partners In Health in Mexico begins for me while I was doing my social service year in Monterrey, Mexico.

https://www.pih.org

PIH Mexico Expands to Two New Sites in Chiapas

CES partners with Mexico's Ministry of Health to recruit and train young doctors, who manage public clinics throughout Chiapas during their social service year. The first-year doctors, or pasantes, have conducted more than 45,000 patient visits in eight communities throughout the southeastern state since CES began providing services there in 2012.

https://www.pih.org

Fighting Mental Health Stigma in Chiapas

This blog is about a photo project which gives a voice to patients living with depression and anxiety. It has been cross-posted with kind permission from Partners in Health. Stigma prevents people who suffer of mental illnesses from looking for the support and care they urgently need.

https://www.mhinnovation.net

Into the Light: Treating Schizophrenia in Chiapas

Dr. Enrique Valdespino had no idea a man lived locked inside a shack three blocks from the clinic in rural Reforma, Chiapas, where he practiced medicine. Nor that the man, 52-year-old Rosemberg Lopez, had been living there for years. The news floored him.

https://www.pih.org

We Build Health Systems: Caring for People in Chiapas

Ubaldo Roblero, 34, lived locked inside a shack behind his family home in rural Chiapas, Mexico, a prisoner to his diagnosis of schizophrenia. A square hole in the door served as his portal to the world for nearly a decade. Beyond giving him his medication, his parents didn't know how else to respond to his violent spells.

https://www.pih.org

Battling Mental Illness, One Home Visit at a Time

Community health workers are the bridge connecting their neighbors, friends, and family to local clinics across the 10 communities in which Partners In Health works in rural Chiapas, Mexico. In July, Compañeros En Salud -as PIH is known in Mexico-launched a new initiative that trained five workers in the provision of mental health care, with the hopes of soon growing their number to 10.

https://www.pih.org