Mental health disorders are increasingly recognized as a major cause of the global burden of disease, accounting for an estimated 7.4% of the disease burden worldwide and significantly contributing to disability and death. This challenge is particularly evident in low and middle-income countries (LMICs) where more than half of the world's populations live. Latin America is one region of the world composed of LMICs where the burden of mental health problems is high and services for mental health are low (and account for <2% of the health budget in the region). In the Latin American country of Colombia, 8 out of 20 individuals have a lifetime prevalence of one or more mental health disorders. Depression and substance use, often coupled with other mental health problems resulting from endemic violence in Colombia, are particularly striking concerns in the region. Only 11% of persons with a mental health disorder in Colombia receive mental health care. This application brings together a broad array of stakeholders, including leading researchers in both the US and Latin America; governmental organizations (Ministry of Health in Columbia; Ministry of Communication and Information Technology in Colombia; National Institute of Mental Health in Peru); patient advocacy organizations; insurance company payers in Latin America; and non-governmental and/or multilateral organizations (PAHO/WHO; The World Bank; industry partners; and primary care systems in Latin America). We will (Aim 1) support a core organizational structure and management approach to maximally benefit from a broad array of stakeholders and ensure efficient and successful coordination and integration of the activities across project Cores (Administrative Core);
(Aim 2) conduct systematic, multi-site mental health implementation research in both rural and urban primary care settings (Scale-Up Study Core), and (Aim 3) use science-based methods and information to build sustainable capacity for conducting mental health implementation research and informing mental health policies and programs in Latin America (Capacity Building Core). In this new mental health service delivery model, we will (1) harness science-based mobile behavioral health technology for mental health (with a primary focus on depression), (2) launch new workforce training and service delivery models, (3) launch and evolve an integrated data management system for systematic data tracking and outcomes assessment, and (4) launch and grow a learning collaborative of organizations integrating mental health into primary care. We will conduct this project in multiple primary care sites in various parts of Colombia, with planned capacity-building activities in several other Latin American countries, including Chile and Peru. Overall, this project brings together an outstanding expert team to test and refine an entirely new model for delivering widespread, science-based, mental health care in Latin America. This project may also serve as an important demonstration project to LMICs globally as they tackle the significant burden of mental health disorders and scale-up access to evidence-based mental health care.

Public Health Relevance

Through the integration of Core activities, this project will create new knowledge to inform unprecedented, science-based approaches to scaling-up mental health implementation research and building sustainable research capacity and science-based policies and programs in Latin America. If successful, this approach can be expanded over time to embrace other areas of mental health (e.g., severe mental illness), chronic disease management, as well as health promotion prevention interventions based on community needs and priorities in Latin America.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Program--Cooperative Agreements (U19)
Project #
1U19MH109988-01
Application #
9110583
Study Section
Special Emphasis Panel (ZMH1-ERB-K (03))
Program Officer
Amarreh, Ishmael G
Project Start
2016-06-01
Project End
2021-05-31
Budget Start
2016-06-01
Budget End
2017-05-31
Support Year
1
Fiscal Year
2016
Total Cost
$724,222
Indirect Cost
$217,251
Name
Dartmouth College
Department
Psychiatry
Type
Schools of Medicine
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755
Uribe-Restrepo, J M; Escobar, M L; Cubillos, L (2017) Psychiatric rehabilitation in Latin America: challenges and opportunities. Epidemiol Psychiatr Sci 26:211-215
Naslund, John A; Aschbrenner, Kelly A; Araya, Ricardo et al. (2017) Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. Lancet Psychiatry 4:486-500