Citation

Cubillos L, Muñoz J, Caballero J, Mendoza M, Pulido A, Carpio K, Udutha AK, Botero C, Borrero E, Rodríguez D, Cutipé Y, Emeny R, Schifferdecker K, Torrey WC. Psychiatr. Serv. 2020; ePub(ePub): ePub.

Affiliation

Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).

Copyright

(Copyright © 2020, American Psychiatric Association)

DOI

10.1176/appi.ps.201900306

PMID

31896339

Abstract

Many Latin American countries face the challenge of caring for a growing number of people with severe mental illnesses while promoting deinstitutionalization and community-based care. This article presents an overview of current policies that aim to reform the mental health care system and advance the employment of people with disabilities in Colombia, Costa Rica, and Peru. The authors conducted a thematic analysis by using public records and semistructured interviews with stakeholders. The authors found evidence of supported employment programs for vulnerable populations, including people with disabilities, but found that the programs did not include people with severe mental illnesses. Five relevant themes were found to hamper progress in psychiatric vocational rehabilitation services: rigid labor markets, insufficient advocacy, public subsidies that create conflicting incentives, lack of deinstitutionalized models, and lack of reimbursement for evidence-based psychiatric rehabilitation interventions. Policy reforms in these countries have promoted the use of medical interventions to treat people with severe mental illnesses but not the use of evidence-based rehabilitation programs to facilitate community integration and functional recovery. Because these countries have other supported employment programs for people with nonpsychiatric disabilities, they are well positioned to pilot individual placement and support to accelerate full community integration among individuals with severe mental illnesses.

Language: en

Keywords

Individual placement and support; community mental health; mental health systems; psychiatric rehabilitation; severe mental illness