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The Pan American Health Organization’s (PAHO) governing council passed a resolution in September strongly urging its member states to formulate national plans that will focus attention on and boost resources devoted to mental health programs.
The PAHO, whose representatives are the health ministers from almost all of the countries in the Western Hemisphere, is calling on its members to focus as much on mental as on physical disorders and to develop mental health services directed at children in particular. In Latin America and the Caribbean approximately 17 million children are estimated to be suffering from a mental illness, stated Itsak Levav, the PAHO’s regional adviser for mental health.
The PAHO is a division of the World Health Organization, whose membership is made up of the nations in North, Central, and South America as well as the islands of the Caribbean. Among the member countries are the United States and Cuba, both of which supported the resolution.
The PAHO’s statement, which received unanimous backing from the representatives at the September 26 meeting in Washington, D.C., notes that in light of significant advances in treating and understanding psychiatric disorders over the last several years, it was time for its member nations to "formulate and implement national mental health programs as an integral component of" large-scale reforms of their general health systems. The members also vowed to "intensify support for efforts to reorient mental health services from an institutional to a community approach" and to move toward including mental health services "in every health insurance or payment plan and every health care services program," with particular emphasis on developing programs to treat affective disorders, psychotic disorders, and epilepsy.
This is the first time in 20 years that mental health issues made it on to the governing council’s agenda, pointed out PAHO General Director George A.O. Alleyne.
Other sections of the resolution commit the nations to create programs to enhance the psychosocial development of children, to design courses in public health schools that will train students to manage mental health programs, and to work toward passing legislation "that protects the human rights of persons with mental disabilities."
The representatives at the Washington meeting wanted to ensure that the heightened concern with mental health issues does not quickly fade away at the organizational level, so they included in the resolution a call for the PAHO director to "continue supporting the inclusion of mental health topics in all health forums and activities, and in joint activities with other agencies of the inter-American system."
The state of mental health care and the needs that must be addressed vary tremendously among PAHO members, based on observations and descriptions offered by many of the representatives. Both Guatemala and Nicaragua, for example, recognize the necessity of dealing with the emotional sequelae of years of bloody civil wars and of finding ways to channel funds from wartime budgets to the requirements of serving a civilian population.
The Jamaican representative said that nearly one-third of that country’s citizens suffer from a mental illness—with the dimensions of the problem especially acute among economically deprived individuals—but there is a serious shortage of professionals trained to assist these people.
In Uruguay the minister of health has begun the process of shutting large psychiatric hospitals and shifting patients into community-based services. Health officials there recognize that they have problems in getting medications distributed to the appropriate centers and in assuring that adequate services exist for mentally ill children. The Cuban representative said he wanted the PAHO’s help in establishing community care programs in that country.
The delegate from Barbados emphasized an obstacle to improved mental illness care common to most of the region’s countries, no matter how affluent, namely stigma. That country is working toward convincing families to integrate the mentally ill relative rather than shunning or distancing themselves from that person.
Addressing the delegates at the meeting, Alleyne, the PAHO’s director general, stressed that the region’s governments cannot accomplish all that needs to be done to reform and upgrade mental health services without engaging the assistance of the private sector as well.