Latin American and Spanish-speaking perspectives on the challenges of global psychiatry

Utility of a multidimensional recovery framework in understanding lived experiences of Chilean and Brazilian mental health service users

La comprensión y aplicación del concepto de recuperación, a pesar de sus posibles beneficios para los servicios de salud mental, aún se encuentra en incipiente desarrollo en América Latina. Si bien la reforma psiquiátrica en la región ha tenido algunos avances, el marco de la recuperación no ha sido suficientemente explorado. Whitley y Drake (2010) sugirieron un marco conceptual integral para la recuperación que incluye cinco dimensiones: clínica, existencial, funcional, física y social. El presente estudio tuvo como objetivo explorar las perspectivas de los usuarios chilenos y brasileños sobre la recuperación identificando su adscripción y aplicabilidad de estas cinco dimensiones. Se entrevistó a treinta participantes de la Intervención en Momento Crítico-Delegación de Funciones (CTI-TS) realizada en Santiago (Chile) y en Río de Janeiro (Brasil) sobre sus experiencias de recuperación. Se exploró la aplicabilidad del marco de Whitley y Drake al contexto de Chile y de Brasil. Los resultados mostraron que: 1. El marco era aplicable a esta población; 2. Las dimensiones presentaban un tipo particular de entrelazamiento y estaban influenciadas por una serie de procesos tales como la continuidad en el proceso de atención/cuidado/autocuidado, y sobresalía la funcionalidad y la esfera social; 3. Los valores culturales, el estigma y los determinantes sociales emergieron como factores cruciales que afectan el tratamiento y la recuperación. Se propuso una reinterpretación del esquema referencial. Los hallazgos representan un aporte a la literatura internacional sobre recuperación al aumentar la validez de este marco referencial multidimensional y su aplicabilidad a diversas poblaciones.

Implementation of a pilot community-based psychosocial intervention for patients with psychoses in Chile and Brazil: a comparative analysis of users' perspectives

BACKGROUND

Few studies provide clear rationale for and the reception of adaptations of evidence-based interventions. To address this gap, we describe the context-dependent adaptations in critical time intervention-task shifting (CTI-TS), a manualized recovery program for individuals with psychosis in Rio de Janeiro, Brazil and Santiago, Chile. Implications of the adaptations - incorporating a task-shifting approach and modifying the mode of community-based service delivery - are examined from users' perspectives.

METHODS

A secondary analysis of in-depth interviews with CTI-TS users (n = 9 in Brazil; n = 15 in Chile) was conducted. Using the framework method, we thematically compared how participants from each site perceived the main adapted components of CTI-TS.

RESULTS

Users of both sites appreciated the task-shifting worker pair to provide personalized, flexible, and relatable support. They wanted CTI-TS to be longer and experienced difficulty maintaining intervention benefits in the long-term. In Chile, stigma and a perceived professional hierarchy toward the task-shifting providers were more profound than in Brazil. Engagement with community-based services delivery in homes and neighborhoods (Chile), and at community mental health centers (Brazil) were influenced by various personal, familial, financial, and social factors. Uniquely, community violence was a significant barrier to engagement in Brazil.

CONCLUSION

CTI-TS' major adaptations were informed by the distinct mental health systems and social context of Santiago and Rio. Evaluation of user experiences with these adaptations provides insights into implementing and scaling-up task-shifting and community-oriented interventions in the region through the creation of specialized roles for the worker pair, targeting sustained intervention effects, and addressing socio-cultural barriers.

Peruvian psychiatry in America and the world: its journey in search of an identity

Throughout history, Latin American psychiatry has followed a variety of routes as its mythic-religious origins experienced the various influences of European and North American ideas of the last three centuries. In its modern trajectory, a post-colonial subordination was followed by a more selective import of ideas and a critical approach to their application in the New Continent. At one point, the identity of Latin American psychiatry was essentially considered mestiza, social and critical, reflecting a search for autonomy and originality. In this journey, Peruvian psychiatry has been considered one of the most representative versions of the history and position of the discipline. This article attempts to detail the identity-seeking process of Peruvian and Latin American Psychiatry through the life and work of three notable Peruvian figures: Honorio Delgado, Carlos Alberto Seguín and Humberto Rotondo. Delgado fostered the need for scientific evidence in support of any piece of knowledge, as well as humanism as essential component of best service and optimal patient care. Seguín led studies on folkloric and ethnic psychiatry, stimulated integrated approaches to care, and advocated in favour of a regional identity for psychiatry.