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

Document Type : Original Article


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 Ministerio de Salud, Lima, Peru

6 School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru


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.
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.
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.
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.


Main Subjects

  1. World Health Organization (WHO). Investing in Mental Health: Evidence for Action. Geneva: WHO; 2013.
  2. World Health Organization (WHO). Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group. Geneva: WHO; 2010.
  3. World Health Organization (WHO). Mental Health Action Plan 2013-2020. Geneva: WHO; 2013.
  4. World Health Organization (WHO). mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings. Geneva: WHO; 2011.
  5. World Health Organization (WHO). The global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. Geneva: WHO, 65th World Health Assembly; 2012.
  6. Grand Challenges Canada. Grand Challenges in Global Mental Health. Accessed June 24, 2015. Published 2012.
  7. Collins PY, Insel TR, Chockalingam A, Daar A, Maddox YT. Grand challenges in global mental health: integration in research, policy, and practice. PLoS Med. 2013;10(4):e1001434. doi:10.1371/journal.pmed.1001434
  8. Collins PY, Patel V, Joestl SS, et al. Grand challenges in global mental health. Nature. 2011;475(7354):27-30. doi:10.1038/475027a
  9. Patel V, Belkin GS, Chockalingam A, Cooper J, Saxena S, Unutzer J. Grand challenges: integrating mental health services into priority health care platforms. PLoS Med 2013;10(5):e1001448. Doi:10.1371/journal.pmed.1001448
  10. Castillo H. Situación de la atención de salud mental en el Perú: Resultados preliminares del Estudio Epidemiológico de Salud Mental en Lima Replicación 2012.  Ciclo de Conferencias de la Academia Nacional de Medicina y el Instituto Nacional de Salud; 2012; Lima, Peru.
  11. Instituto Nacional de Salud Mental. Estudio Epidemiológico de Salud Mental en la Selva Peruana. Anales de Salud Mental. 2005;21(1-2):1-214.
  12. Instituto Nacional de Salud Mental. Estudio Epidemiológico de Salud Mental en Fronteras 2005. Anales de Salud Mental. 2006;22(1-2):1-227.
  13. Instituto Nacional de Salud Mental. Estudio Epidemiológico de Salud Mental en Lima Rural 2007. Anales de Salud Mental 2007;24(1-2):1-247.
  14. Instituto Nacional de Salud Mental. Estudio Epidemiológico de Salud Mental en Lima Metropolitana y Callao. Replicación 2012. Anales de Salud Mental. 2013;29(1):1-392.
  15. Instituto Nacional de Salud Mental. Estudio Epidemiológico de Salud Mental en Ayacucho 2003. Anales de Salud Mental. 2004;20(1-2):1-199.
  16. Velasquez A. The burden of disease and injuries in Peru and the priorities of the universal assurance essential plan. Rev Peru Med Exp Salud Publica. 2009;26(2):222-231.
  17. Ministerio de Salud. Carga de enfermedad en el Perú: Estimaciones de los años de vida saludables perdidos 2012. Lima: Dirección General de Epidemiología, Ministerio de Salud; 2014.
  18. Sorkin DH, Ngo-Metzger Q, Billimek J, August KJ, Greenfield S, Kaplan SH. Underdiagnosed and undertreated depression among racially/ethnically diverse patients with type 2 diabetes. Diabetes Care. 2011;34(3):598-600. Doi:10.2337/dc10-1825
  19. Wu DY, Munoz M, Espiritu B, et al. Burden of depression among impoverished HIV-positive women in Peru. J Acquir Immune Defic Syndr. 2008;48(4):500-504.
  20. Rayner L, Price A, Evans A, Valsraj K, Higginson IJ, Hotopf M. Antidepressants for depression in physically ill people. Cochrane Database Syst Rev 2010;(3):CD007503. Doi:10.1002/14651858.CD007503.pub2.
  21. Marcus SM. Depression during pregnancy: rates, risks and consequences--Motherisk Update 2008. Can J Clin Pharmacol 2009;16(1):e15-e22.
  22. Cripe SM, Sanchez S, Lam N, et al. Depressive symptoms and migraine comorbidity among pregnant Peruvian women. J Affect Disord 2010;122(1-2):149-153.
  23. Luna Matos ML, Salinas Pielago J, Luna Figueroa A. Major depression in pregnant women served by the National Materno-Perinatal Institute in Lima, Peru (Spanish). Rev Panam Salud Publica 2009;26(4):310-314.
  24. Vega P, Sweetland A, Acha J, et al. Psychiatric issues in the management of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2004;8(6:749-759.
  25. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24(6):1069-1078.
  26. Instituto Nacional de Salud Mental. Estudio Epidemiológico Metropolitano en Salud Mental 2002. Anales de Salud Mental. 2002;18(1-2):1-199.
  27. Instituto Nacional de Salud Mental. Estudio Epidemiológico de Salud Mental en la Sierra Peruana 2003. Anales de Salud Mental 2003;19(1-2):1-216.
  28. Instituto Nacional de Salud Mental. Estudio Epidemiológico de Salud Mental en la Costa Peruana 2006. Anales de Salud Mental 2007;23(1-2):1-226.
  29. Green LV, Savin S, Lu Y. Primary care physician shortages could be eliminated through use of teams, nonphysicians, and electronic communication. Health Aff (Millwood). 2013;32(1):11-19. Doi:10.1377/hlthaff.2012.1086
  30. World Health Organization (WHO). Mental Health Atlas 2011. Country Profile: Peru. Geneva: WHO; 2011.
  31. World Health Organization (WHO). Mental Health Atlas 2011. Geneva: WHO; 2011.
  32. Instituto Nacional de Salud Mental. Alrededor del 84% de las personas con problemas de salud mental no lo aceptan y reconocen. 2014. Accessed June 26, 2015. Published 2014.
  33. Ministerio de Salud. Informe sobre los servicios de salud mental del subsector Ministerio de Salud del Perú 2008. Lima: Ministerio de Salud; 2008.
  34. Ministerio de Salud. Lineamientos para la acción en salud mental. Lima: Ministerio de Salud; 2004.
  35. Ministerio de Salud. Plan Nacional de Salud Mental. Lima: Ministerio de Salud; 2006.
  36. El Peruano. Ley que modifica el artículo 11 de la ley 26842, ley general de salud, y garantiza los derechos de las personas con problemas de salud mental. 2012 24 June; Sect. 468951-2.
  37. Ministerio de Economía y Finanzas. Programa Presupuestario 131. Control y prevención en salud mental. 2015. Accessed June 26, 2015.
  38. Ministerio de Economía y Finanzas. Consulta Amigable - Consulta de Ejecución del Gasto. Accessed July 3, 2015.
  39. Ministerio de Salud. Lineamientos y medidas de reforma del sector Salud. Accessed June 26, 2015. Published 2013.
  40. World Health Organization (WHO). The World Health Report 2001 - Mental Health: New Understanding, New Hope. Geneva: WHO; 2001.
  41. Razzouk D, Gregorio G, Antunes R, Mari JD. Lessons learned in developing community mental health care in Latin American and Caribbean countries. World Psychiatry. 2012;11(3):191-195.
  42. Minoletti A, Galea S, Susser E. Community mental health services in Latin America for people with severe mental disorders. Public Health Rev. 2012;34(2):529-551.
  43. El Peruano. Decreto Supremo N° 033-2015-SA. October 6, 2015.
  44. Ministerio de Salud. Plan de Beneficios del PEAS. Lima: Ministerio de Salud; 2009.
  45. Seguro Integral de Salud. Resolución Jefatural N°056-2011/SIS. Lima: Seguro Integral de Salud, Ministerio de Salud; 2011.
  46. Seguro Integral de Salud. Guía Técnica de Orientación para la Operativización de los Procesos Prestacionales de los Convenios Cápita entre el Seguro Integral de Salud y los Gobiernos Regionales y DISAS. Lima: Seguro Integral de Salud, Ministerio de Salud; 2014.
  47. El Peruano. Decreto Supremo N° 071-2015-EF. March 29, 2015.
  48. Ministerio de Salud. Programa presupuestal de prevención control en salud mental (131). Lima: Ministerio de Salud; 2015.
  • Receive Date: 28 June 2016
  • Revise Date: 20 December 2016
  • Accept Date: 14 January 2017
  • First Publish Date: 01 September 2017