Is mental health a priority?
Francisco Jose Garcia Lara
Surgeon and Master in Health Administration
from the Javeriana University
Columnist of the newspaper La Nación de Neiva
For many years the importance of mental health has been understood and the need to establish public policies that allow closing the gaps in the access of Colombians to these health services.
In this blog we propose to make an approach to the situation of mental health policy in Colombia.
In article 3 of Law No. 1616 of 2013, mental health is defined as:
“A dynamic state that is expressed in daily life through behavior and interaction in such a way that it allows individual and collective subjects to deploy their emotional, cognitive and mental resources to move through daily life, work, establish meaningful relationships and contribute to the community "
Some important figures
According to the data found in the national mental health observatory , in Colombia for the year 2018, the suicide attempt rate per 100,000 inhabitants was 52.12; the percentage of people treated for dementia (out of the total population) was 0.25 %; the percentage of people treated for the first time in mental health (out of the total of mental health care) was 33.14 %.
In the 2015 national mental health survey , extracting some relevant data in the population aged 12 to 17 years, a 12.2 % was positive in the screening for some mental disorder, the 52.9 % had one or more anxiety symptoms. Likewise, the 19.7 % showed four or more symptoms of depression and 10.1 % symptoms of some type of psychosis. Regarding traumatic events, the 29.3 % reported having suffered at least one and the 6.6 % presented suicidal ideation.
Adults from 18 to 44 years old ...
In relation to adults aged 18 to 44 years, the 9.6 % reported symptoms suggestive of mental disorder, the 52.9 % manifested one or more anxiety symptoms, the 80.2 % reported 1 to 3 depressive symptoms, the 40.2 % had suffered some event traumatic and the 7.4 % had suicidal ideation.
In people aged 45 years and over, the 11.2 % showed symptoms suggestive of mental disorders, 54.8 % had one or more anxiety symptoms, 71.9 % reported one to three symptoms of depression, and the 6.7 % shows indicators of psychosis.
On the other hand, the Pan American Health Organization (PAHO) in a study called "The burden of mental disorders in the region of the Americas -2018" , which takes data from 2015 and performs an analysis based on years lost due to disability (APD), found that in Colombia, 8.2 % of the total of those years lost corresponds to depression, 5.3 % for anxiety disorders, suicide and self-harm 1.4 %, for schizophrenia 1.8%, for bipolar disorder 1.7 %, for alcohol consumption 1 %, for consumption of psychoactive substances (SPA) 0.9 %, for disorders with habitual onset in childhood and adolescence 2.7 % and for dementia 0.9 %.
Finally, the study finds that 35.4 % of the total APDs for that year correspond to mental health disorders.
The offer of mental health services
When consulting the Special Registry of Health Providers (REPS), it is found that 646 psychiatrists are registered as independent professionals. However, it is estimated that in Colombia there are between 1,200 and 1,300 psychiatrists according to some publications.
In the same registry, it is found that 1,155 IPS provide outpatient psychiatry services, 75 inpatient services with a mental health unit and 166 with hospitalization without a mental health unit. Likewise, there are 13 units for acute mental health care and 4 for intermediate care.
These entities have 4,497 beds for the care of psychiatric patients. Additionally, 4116 beds are registered for drug addiction.
It is also found that 2,182 psychologists are registered as independent professionals and 5,937 IPS provide psychological care.
Mental health standards
Here is a brief description of the most important rules on mental health:
Law No. 1616 of 2013:
Called mental health law, it includes, among others, the following topics: definitions, rights in the field of mental health, promotion and prevention, care and comprehensive network for mental health care, national mental health council, public health policy mental, information system and mental health Conpes.
Decree 658 of 2013:
Through which the schedule for the implementation of the previous law was issued. Some rules will be found ahead and the dates on which, according to the schedule, they should be issued will be reviewed.
Ten-Year Public Health Plan (PDSP):
Adopted by Resolution 1841 of 2013. The dimension of coexistence and mental health is found in the aforementioned plan, which includes two components: Promotion of mental health and coexistence and Prevention and comprehensive care for mental problems and disorders and different forms of violence. Each component has its own objectives, goals, strategies, and indicators.
In 2018, the document was published: "Progress Management Report of the Ten-Year Public Health Plan" , in which it is noted that after evaluating the management indicators of the dimension of Promotion of mental health and coexistence, the result en: Promotion of mental health and coexistence: 13.33 %. Prevention and comprehensive care for mental problems and disorders and different forms of violence: 25.33 %.
Resolution 4886 of 2018:
Through which the mental health policy is adopted. In this regard and according to the schedule established in Decree 658 of 2013, this resolution should have been issued in July 2014.
The 29 pages of the technical annex to the resolution contain the diagnosis, the principles, the axes, as well as the monitoring, evaluation and follow-up of the mental health policy.
Conpes 3992 of 2020 - Strategy for the promotion of mental health in Colombia:
Define three specific objectives:
- Increase intersectoral coordination to achieve an effective implementation of the promotion, prevention, comprehensive care and social inclusion of people with mental problems or disorders, with consumption or abuse of SPA, or victims of violence.
- Strengthen the environments in which the Colombian population develops, as well as their individual and collective socio-emotional competencies, to prevent mental problems or disorders, the use or abuse of SPA, and violence.
- Improve mental health care and social inclusion to reduce the number of people with mental problems or disorders, with consumption or abuse of SPA and victims of violence.
Likewise, it suggests an amount of $1.12 trillion as financing for four years, whose main source is the general budget of the nation.
According to the schedule mentioned several times, this document should have been proposed in June 2014.
What is included in the Health Benefits Plan (PBS)
Resolution No. 3512 of 2019 updated the health services and technologies financed with resources from the Capitation Payment Unit (UPC), that is, what is included in the PBS.
In the sixth chapter of the aforementioned resolution, it refers to mental health, establishing that they are included for adults: emergency care, 30 individual or group psychotherapy sessions per year, which is doubled when it comes to women victims of violence. Hospitalization is also included for up to 90 days and twice that for women victims of violence.
For minors (up to 18 years old), it is similar to the above, but it doubles to 60 annual sessions of individual or group psychotherapy when they are victims of any type of violence, and to 180 days of hospitalization.
Is mental health a priority?
The normative development described here allows us to infer that mental health is a priority within the health system, in fact, few areas have as many tools as state policy.
The figures demonstrate the urgent need to address mental health problems, significantly drawing attention to the fact that the PAHO burden of disease study reports that 35.4 % of APDs correspond to mental health disorders, which not only has a social but also an economic impact.
However, the existence of the regulations does not imply that their objectives are met, the delay in issuing the mental health policy and the Conpes document shows that the schedule established for the implementation of the law was not met. Precisely and in relation to this last document, the investment in four years is significant, but that does not certify that the resources are allocated in a timely manner to mental health.
The limited progress in the components of the PDSP is an incontrovertible example of the aforementioned.
Regarding the supply of services, we know that access barriers persist for the population and the limitations of human resources make it even more difficult to guarantee that access.
Once again, it is evident that it is not enough to have the policies embodied in standards, when they are not complied with, nor are they the object of a true follow-up. It cannot be denied that progress has been made, but that effort seems to be lacking in good intentions.
Other blogs readers viewed
3. www.iris.paho.org/The Burden of Mental Disorders in the Region of the Americas, 2018