WASHINGTON, United States (CMC)— The Pan American Health Organization (PAHO) has outlined new strategies regarding the deinstitutionalisation of psychiatric care to transform mental health care in Latin America and the Caribbean (LAC), by promoting the treatment of people with mental health conditions within their own communities, instead of in institutional settings.

PAHO said the new publication document was released following the 30th anniversary of the Caracas Declaration- a set of landmark principles that signalled a regional shift from institutional to community-based care.

 “Community-based care is not only the most effective form of care, it also respects the human rights and dignity of people with mental health conditions,” said PAHO Director Dr Carissa Etienne.

“We have come a long way toward realising our goal of more humane, deinstitutionalised treatment, but there is still much more work to be done. Far too many people are still trapped in institutions that do not allow them to fulfil their full potential as human beings,” the Dominica-born PAHO director said.

PAHO said about only two per cent of health budgets is spent on mental health care in the region, with around 60 per cent of this amount used to fund psychiatric hospitals.

It said while countries in the region have advanced legislation that promotes the transition to community-based mental health services, only a few nations actually provide community residences for people with severe mental health disorders.

In recent years, PAHO said the region has had some successful experiences with the development of national deinstitutionalisation plans, regulations and community -based mental health services, stating that these can be used as examples to expand community-based care.

The deinstitutionalisation publication compiles the results and lessons learned from a review of the existing literature, a series of seminars organised with country health authorities and a survey of persons in leadership positions within regional health care systems.

Barriers to deinstitutionalisation include low spending on mental health care, too few mental health workers, inconsistent advocacy and a critical lack of political support.

The document promotes strategies for developing sustained political support for deinstitutionalisation, including mental health policies, laws, programmes and services with a community-based approach; increasing financial investment to restructure mental health systems to allow for deinstitutionalisation; and strengthening mental health services within communities and providing housing support before or while deinstitutionalisation takes place.

The new publication also recommends integrating mental health into general health care, particularly primary health care; advocating for the protection of human rights of people with mental health disorders; and increasing public awareness about mental health disorders in the communities.

“Despite the commitment of the Caracas Declaration, we have not advanced nearly as much as we had hoped,” said Dr Renato Oliveira e Souza, PAHO’s Unit Chief of Mental Health and Substance Use.

“We know how to achieve deinstitutionalisation based on evidence-based strategies, but we must work harder to develop the will and financial resources to implement them.”

In November 1990, PAHO and the World Health Organization (WHO), with co-sponsorship from international, regional, and national mental health and related institutions, organised the Regional Conference for the Restructuring of Psychiatric Care in Latin America, held in Caracas, Venezuela.