International Journal of Health Policy and Management

International Journal of Health Policy and Management

Peruvian Mental Health Reform: A Framework for Scaling-up Mental Health Services

Document Type : Original Article

Authors
Mauricio Toyama 1
Humberto Castillo 2
Jerome T. Galea 3, 4
Lena R. Brandt 1
María Mendoza 5
Vanessa Herrera 2
Martha Mitrani 2
Yuri Cutipé 6
Victoria Cavero 1
Francisco Diez-Canseco 1
J. Jaime Miranda 1, 7
1 CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
2 Instituto Nacional de Salud Mental “Honorio Delgado - Hideyo Noguchi,” Lima, Peru
3 Socios en Salud, Lima, Peru
4 Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
5 Instituto Nacional de Salud Mental “Honorio Delgado - Hideyo Noguchi,” Lima, Peru
6 Ministerio de Salud, Lima, Peru
7 School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
10.15171/ijhpm.2017.07
Abstract
Background
Mental, neurological, and substance (MNS) use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face.
 
Methods
Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up.
 
Results
Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru.
 
Conclusion
Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru has achieved a number of legal, policy and fiscal milestones, thereby presenting a unique and fertile environment for the expansion of mental health services.
Keywords
Policy Analysis
Mental Health Services
Low- and Middle-Income
Health Systems
Healthcare Reform
Subjects
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International Journal of Health Policy and Management
Volume 6, Issue 9
2017
Pages 501-508

  • Received Date 28 June 2016
  • Revised Date 20 December 2016
  • Accepted Date 14 January 2017
  • First Published Date 01 September 2017
  • Published Date 01 September 2017