Abstracts

Javier Contreras-Rojas¹ y Henriette Raventós^1,2

Authors ‘affiliations:

¹ResearchCenter in Cellular and Molecular Biology, University of Costa Rica. ²Biology School, University of Costa Rica. * dr.javiercontreras@gmail.com

Costa Rica the approach to mental health has focused on treatment and very little on prevention and promotion. This work summarizes the conclusions of the Mental Health Panel.

del Seguro Social, nongovernmental organizations.

¹ There is consensus that the healing model is inefficient, expensive, and produces less wellness than the promotion of prevention.² The traditional model of medical care (physician-centered) has proven to be inefficient; the patient assumes a passive and irresponsible attitude of his condition, which makes difficult the prevention and control of mental illness. The alternative model includes the addition of three strategies: prevention and health promotion, care and rehabilitation.

³ The State, in turn, is responsible for ensuring the rights of a job, housing, education, food, health services and a social and work environment free of violence and environmental pollutants. In childhood it is especially important to have a healthy environment, protective factors such as immunization, hygiene and adequate food, and guidance from parents and other adults in charge of the care and formal education.

⁴ Ideally, these resources should be available at the community level.

⁵ Rehabilitation includes strategies that ensure family involvement and that allow an adequate social reintegration.

Costa Rica has strengths in the field of public health, such as the existence of social security system that covers almost the entire population, mental health programs focused on children and adolescents, and an extensive network of outpatient services and brief hospitalization in general hospitals. However, according to the Report of the Evaluation of the Mental Health System in Costa Rica (WHO 2008), there are significant weaknesses in health mental issues.⁶

⁷ It recommends the following to the medical management: 1. to perform a situational diagnosis of the major mental illnesses nationwide; 2. to adjust the Institutional Plan on Mental Health to what is established by the Ministry of Health in the National Health Plan; 3. to create a strategic timetable for the implementation of this action plan; 4. to develop guidelines of the procedures for psychiatric care at all three levels, 5. to make a disclosure schedule and training plan for the three levels based on these guidelines, 6. according to the Executive Decree No. 20665 -S (October 29th, 1991 ), in which psychiatry is declared as the fifth clinical specialty, to prepare a technical study to assess the availability of human, technological and economic resources for mental health; 7. to assess the appropriateness of removing the hierarchical dependence of psychiatry from the Chief of the Medicine Department, 8. to develop a strategy to strengthen regional mental health services in order to comply with the Declaration of Caracas.⁸ 9. to update the projections defined in the document “Needs of Medical Specialists for the Costa Rican Social Security” (CENDEISSS ). 10. through the participation of the Direction in Development of Health Services, to perform a technical study of the feasibility of extending the time in each psychiatric consultation, 11. to coordinate the country.

University of Costa Rica.

Costa Rica, and strategies that would improve the quality of life of this population. Table 1 illustrates the process performed.

Table 2 summarizes the institutions and organizations represented in the activity.

Table 3 summarizes the barriers identified and the possible solutions raised by attendees. Following the recommendations of various international organizations, the findings are grouped according to the health strategy to follow.

Costa Rica (Roberto Cuellar Martinez, MD), “the mental health is the basis of ethics of freedom.” There are international treaties ratified at national level, which, in general, guarantee the protection of human rights and the right to health. However, the Defender of the People of Costa Rica (Ofelia Taitelbaum Yoselewich, MSc.) recalls “the ratification is not enough if there is not a national commitment to establish a program of local action, including policies for the prevention, promotion, treatment, social reintegration and reduction of stigmatization.” There are vulnerable populations that are exposed to greater exclusion and inequality, and that you should pay more attention, such as women, indigenous population, economically disadvantaged groups, sexually diverse populations and persons infected with HIV.

NationalPoliceAcademy denounced, “the poor training received by the security forces on mental health issues and the absence of protocols to follow when caring mental health related situations.” In the police there are myths about the approach of people with any mental disorder, and it seems that there is not a direct line of communication between officials and institutions like the IAFA and the CCSS.

Central Valley.

⁹ These can provide vital information regarding their needs and expectations of attention at the social security level. Training of primary care level in the diagnosis of mental and behavioral disorders should also be improved. More training at the primary level will allow earlier and better timed diagnosis, that will reduce the risk of complications. Increased efficiency in the management of these patients at primary and community level would decrease the burden of dating in psychiatric services, which is a practical measure to address the current lack of specialists.¹⁰These actions should follow international recommendations and algorithms for priority treatment of mental illness. An implementation plan that includes impact measurement is required. Finally, it should be analyzed in a reasonable time, the effectiveness of the proposed changes, and an effective promotion intervention to increase coverage. A possible solution is that impact studies are carried out on a pilot basis by NGOs and then that the CCSS assumes the obligation to implement them if they prove to be successful.

¹¹ Fear of being labeled as “crazy”, makes people not receive early help, the diagnosis is delayed, the disease takes a more torpid course, and there is an increase in management complications and a worse overall prognosis. In other countries, education (both patients and families, and the general population, mental health issues ) and exposure of disadvantaged groups (in this case mental patients) are the most effective measures to combat the stigma.¹² In Costa Rica an educational plan that involves mass media and that reaches most of the population is required. More empowered and better self-esteem patients have more chance to fight for their rights, ensuring a better quality of life. Psychotherapy in all its forms should accompany drug therapy. Other complementary therapies that may be incorporated in care include: zootherapy, dance therapy, yoga therapy, art therapy (these are discussed in more detail in the next section).

NationalPsychiatric Hospital presented its program for behavioral, physical and cognitive rehabilitation, which aims to achieve the highest level of performance and autonomy of the individual. This trains people in activities of daily living, coexistence, cognitive and behavioral changes, and the development of job skills. The program was able to significantly decrease the number of people held for long periods in the hospital. The need for intermediate homes, shelters, supportive families and single households to return the user to their community was raised. A job management program, which is intended to form a union, and to achieve a greater impact on the process of reintegration. The AyApresented a program of employment opportunities for people with disabilities, in which physical disabilities with little mention of mental disabilities are emphasized.

¹³ It is considered that employability will enhance with information campaigns to reduce stigma and educate employers on the necessary adjustments to people with disabilities or mental illness. Education in general should seek to eradicate myths about people with mental illness, to change the view of the family, the community the media and the same health personnel. It is important to develop training programs to improve the skills of this group and to achieve greater competitiveness in the labor market. In terms of housing, the feasibility of having families, supportive homes or intermediate shelters should be explored.

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