Accompanying People with Mental Illnesses: The Role of CHWs in Mental Health-Care Services in Chiapas, Mexico

Mental illnesses account for 14% of the Global Burden of Disease and represent a quarter of the disability-adjusted life years (DALYs) evidencing the urgency of treating people living with them. However, the resource allocation and integration of mental health services at a community level have been scarce; furthermore its prevalence rises among poor and geographically marginalized populations, and there is a worldwide shortage of specialists to face this problem. To fill this gap, community-level interventions have been proposed, and relying on community health workers (CHWs) has shown promising results. Despite the skepticism, there is ample evidence that CHWs are able to deliver psychosocial interventions and support to patients with common and severe mental disorders by task-sharing. Platforms in which adequate training, supervision, and mentorship exist are required in order to support CHW frameworks. 

This chapter will describe some of the challenges and facilitators encountered with community health workforce, with a specific focus on the experience of the Compañeros En Salud (CES) team; we illustrate so with two cases of women “accompanying” mentally ill patients in rural Mexico. Likewise, we aim to demonstrate that efforts can be implemented to reduce the gap in access to mental health services. While the global health community works to make the vision of universal health coverage a reality, we submit this chapter as an orientation to how community-led and community-based mental health programs can be a part of that ambitious vision.