COVID-19 and global mental health

In The Lancet Psychiatry, Lola Kola and colleagues¹ suggested three dimensions that could change the way global mental health is framed to achieve equitable mental health coverage worldwide: context, stakeholders, and sectors. Here we share one of our interventions as an example of how these dimensions should be addressed. Our organisation, Partners in Health Mexico (Compañeros En Salud), has been working for 10 years in the rural Sierra and Fraylesca regions of Chiapas, Mexico. Chiapas has severe socioeconomic adversity, with 77% of the population living in poverty. The regions supported by Compañeros En Salud are also afflicted by a high burden of mental illness, with an estimated prevalence of depression of 7·9% which is exacerbated by a shortage of health-care professionals, with less than one psychiatrist per 100 000 inhabitants.

Given the scarcity of mental health personnel in Chiapas, in 2014, Compañeros En Salud decided to introduce a mental health programme. In June, 2019, the programme piloted a version of the Problem Management Plus intervention, which has been scaled up during the COVID-19 pandemic. This low-intensity psychological intervention was designed by WHO as a therapy to be provided by non-specialists, targeting adults impaired by distress and common mental disorders in communities exposed to adversity. We hereby describe how this intervention addresses the three dimensions suggested by Kola and colleagues.

With regard to context, the communities served by Compañeros En Salud experience funding shortages for health-care professionals and infrastructure. However, these communities have deep ties to the land and to each other that have been strengthened over several decades. The organisation identified this as a resource for improving community access to mental health care.

In terms of stakeholders, we implemented the Problem Management Plus intervention through a local workforce of female community mental health workers. 80% of the workforce had experienced mental health issues at some point in their lives. Therefore, by providing mental health care through community mental health workers, we help empower women in the community, ensure that the care provided is socioculturally appropriate, and promote that patients benefit from providers“ lived experiences.

As for sectors, we offer integrated mental health care to our patients. Through collaboration with the Compañeros En Salud referrals programme, we provide accompaniment, food, and transportation to patients who require access to specialised mental health services in the state. We also cooperate with other programmes and Ministry of Health services so that patients have access to other health services and those with greater socioeconomic vulnerability have access to social support packages.

During the COVID-19 pandemic, this project has helped provide mental health care to remote rural areas during regular lockdowns that prevented people from accessing care outside their communities. Community mental health workers have acquired a major role in ensuring community wellbeing during these hard times, combining their tasks as mental health providers with the distribution of occupational psychosocial toolkits among community households during physical distancing. This model provides an example of how local leadership-based interventions appear as a compelling approach to relieve underserved communities from the burden of mental illness which has been exacerbated by the pandemic.