In Latin America and the Caribbean (LAC), mental health disorders are a growing problem and COVID-19 has highlighted multiple systemic problems, including their impact on vulnerable populations.
According to World Health Organization (WHO), the median spending in mental health services stands globally at 2.8% of total government health spending. Low-income countries spend around 0.5% of their health budget in mental health services, and high-income countries, 5.1%. In the Latin America and the Caribbean, spending ranges from 0.2% in Bolivia to 8.6% reported by Suriname. There is a significant direct linear correlation between national income and Government spending in mental health as a proportion of the total health budget.
Mental health services were interrupted or were not prioritized as a result of the pandemic. Although now, due to the exacerbation of mental illness due to the Pandemic, there is much attention being paid to the need to increase the availability and quality of mental health services, the existing gaps in access to services, and the need to rethink public policies to incorporate mental health provisions as part of the NCD agenda in low and low-middle income countries.
As part of an initiative of the World Bank and Access Accelerated, a concrete attempt to promote the discussion of mental issues in selected low-income and low- middle income countries in Latin America and the Caribbean and Africa are taking place. A few months after launching the initiative, visible results demonstrate the vast range of arrangements for the provision of mental health as well as the diversity of the challenges the countries face, including:
- Use of technological innovations to improve access to patients (Ecuador),
- Targeted community approach (Peru)
- Multisectoral approach and monitoring mechanisms to improve performance outcomes (Uruguay)
- Ensuring quality of services and fighting stigma (Paraguay)
- Linking mental health and anti-violence strategies (El Salvador).
Mental health disorders measured by Years of Life Lost (YLL) and Years Lived with Disability (YLD) show that specific mental, neurological, substance use disorders and suicide together represent a 32% of Years Lived with Disability (YLD) , and a 42% disability-adjusted life Years of Life Lost (YLL) in the LAC region.
Anxiety disorders are the leading cause of disability and constitute 29.6% of Disability-Adjusted Life-Years (DALY). The second most important disorders are depressive disorders, with 28.5% Disability-Adjusted Life-Years (DALY). The disabilities caused by these disorders do not account for lost years of life, only the disability they create. It should also be noted that there are other disorders that are consequences of or are caused by other factors that directly affect the lives of the people involved. Examples of these disorders include self-harm which represents 16.5% of Years of Life Lost (YLL) and drug use disorders represent, 0.95% of Years of Life Lost (YLL) in the region.
As part of the Access Accelerated and World Bank initiative, countries are discussing diverse and integrative models for provision of care, including community-based and primary health services as well as financing. Sustainable mental health financing – combining both traditional and innovative mechanisms – entails not only sufficient funding, but the equitable and efficient use of funding which needs action at both the policy and programming levels.
Authored by Dr Amparo Gordillo-Tobar, Senior Health Economist, The World Bank Group
Dr. Amparo Elena Gordillo-Tobar is a Senior Health Economist at The World Bank Group serving as focal point for Maternal and Child Health for Latin America and the Caribbean and as Gender focal point for the Human Nutrition and Population Group at the World Bank.
Dr Gordillo-Tobar has prepared, managed, supervised and led innovative health financing investment Bank projects and grants in Argentina, Brazil, Peru, Bolivia, El Salvador and Nicaragua and has over 15 years of experience working on health issues in the Latin America and the Caribbean Region. Prior to her work at the World Bank, she worked as a Health Economist at the Pan American Health Organization Health and coordinated projects for UNICEF.
Amparo Gordillo-Tobar has a Doctoral Degree in Medicine from the National School of Medicine in Ecuador and a PhD and Master’s degree from Tulane University in New Orleans.