Need estimates of psychiatric beds: a systematic review and meta-analysis.

This study aimed to review and synthesize the need estimates for psychiatric beds, explore how they changed over time and compare them against the prevalence of actually existing beds. We searched PubMed, Embase classic and Embase, PsycINFO and PsycIndex, Open Grey, Google Scholar, Global Health EBSCO and Proquest Dissertations, from inception to September 13, 2022. Publications providing estimates for the required number of psychiatric inpatient beds were included. Need estimates, length of stay, and year of the estimate were extracted. Need estimates were synthesized using medians and interquartile ranges (IQRs). We also computed prevalence ratios of the need estimates and the existing bed capacities at the same time and place. Sixty-five publications with 98 estimates were identified. Estimates for bed needs were trending lower until 2000, after which they stabilized. The twenty-six most recent estimates after 2000 were submitted to data synthesis (n = 15 for beds with unspecified length of stay, n = 7 for short-stay, and n = 4 for long-stay beds). Median estimates per 100 000 population were 47 (IQR: 39 to 50) beds with unspecified length of stay, 28 (IQR: 23 to 31) beds for short-stay, and 10 (IQR: 8 to 11) for long-stay beds. The median prevalence ratio of need estimates and the actual bed prevalence was 1.8 (IQR: 1.3 to 2.3) from 2000 onwards. Historically, the need estimates for psychiatric beds have decreased until about 2000. In the past two decades, they were stable over time and consistently higher than the actual bed numbers provided.

Montreal Cognitive Assessment (MoCA) as a screening tool for cognitive impairment in early stages of psychosis.

Background: Cognitive alterations have been reported in early stages of psychosis including people with First Episode Psychosis (FEP), Clinical High-Risk Mental State (CHR), and Psychotic-Like Experience (PLE). This study aimed to compare the cognitive function in early stages of psychosis using the Montreal Cognitive Assessment (MoCA), a low-cost and brief assessment tool of cognitive functions. Methods: A total of 154 individuals, including 35 with FEP, 38 CHR, 44 PLE, and 37 healthy controls (HC), were evaluated with the MoCA in Santiago, Chile. We calculated the mean total score of the MoCA and the standard deviation of the mean. Groups were assessed for a trend to lower scores in a pre-determined sequence (HC > PLE > CHR > FEP) using the Jonckheere-Terpstra test (TJT). Results: The mean total MoCA scores were 24.8 ± 3.3 in FEP, 26.4 ± 2.4 in CHR, 26.4 ± 2.3 in PLE, and 27.2 ± 1.8 in HC. The analyses revealed a significant trend (p < 0.05) toward lower MoCA individual domain scores and MoCA total scores in the following order: HC > PLE > CHR > FEP. The mean total scores of all groups were above the cut-off for cognitive impairment (22 points). Conclusions: The MoCA describes lower scores in cognition across early stages of psychosis and may be a useful low-cost assessment instrument in early intervention centers of poorly resourced settings.

Community-Based Prevention of Substance Use in Adolescents: Outcomes Before and During the COVID-19 Pandemic in Santiago, Chile.

A primary community prevention approach in Iceland was associated with strong reductions of substance use in adolescents. Two years into the implementation of this prevention model in Chile, the aim of this study was to assess changes in the prevalence of adolescent alcohol and cannabis use and to discuss the impact of the COVID-19 pandemic on the substance use outcomes. In 2018, six municipalities in Greater Santiago, Chile, implemented the Icelandic prevention model, including structured assessments of prevalence and risk factors of substance use in tenth grade high school students every 2 years. The survey allows municipalities and schools to work on prevention with prevalence data from their own community. The survey was modified from an on-site paper format in 2018 to an on-line digital format in a shortened version in 2020. Comparisons between the cross-sectional surveys in the years 2018 and 2020 were performed with multilevel logistic regressions. Totally, 7538 participants were surveyed in 2018 and 5528 in 2020, nested in 125 schools from the six municipalities. Lifetime alcohol use decreased from 79.8% in 2018 to 70.0% in 2020 (X2 = 139.3, p < 0.01), past-month alcohol use decreased from 45.5 to 33.4% (X2 = 171.2, p < 0.01), and lifetime cannabis use decrease from 27.9 to 18.8% (X2 = 127.4, p < 0.01). Several risk factors improved between 2018 and 2020: staying out of home after 10 p.m. (X2 = 105.6, p < 0.01), alcohol use in friends (X2 = 31.8, p < 0.01), drunkenness in friends (X2 = 251.4, p < 0.01), and cannabis use in friends (X2 = 217.7, p < 0.01). However, other factors deteriorated in 2020: perceived parenting (X2 = 63.8, p < 0.01), depression and anxiety symptoms (X2 = 23.5, p < 0.01), and low parental rejection of alcohol use (X2 = 24.9, p < 0.01). The interaction between alcohol use in friends and year was significant for lifetime alcohol use (ß = 0.29, p < 0.01) and past-month alcohol use (ß = 0.24, p < 0.01), and the interaction between depression and anxiety symptoms and year was significant for lifetime alcohol use (ß = 0.34, p < 0.01), past-month alcohol use (ß = 0.33, p < 0.01), and lifetime cannabis use (ß = 0.26, p = 0.016). The decrease of substance use prevalence in adolescents was attributable at least in part to a reduction of alcohol use in friends. This could be related to social distancing policies, curfews, and homeschooling during the pandemic in Chile that implied less physical interactions between adolescents. The increase of depression and anxiety symptoms may also be related to the COVID-19 pandemic. The factors rather attributable to the prevention intervention did not show substantial changes (i.e., sports activities, parenting, and extracurricular activities).

Types of Psychiatric Beds and Mental Health Services in 16 Latin American Countries, 1990-2020.

OBJECTIVE: Latin America has undergone major changes in psychiatric services over the past three decades. The authors aimed to assess the availability of service data and changes in psychiatric services in this region during the 1990-2020 period. METHODS: The authors formed a research network to collect data on psychiatric service indicators gathered between 1990 and 2020 from national registries in Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama, Paraguay, Peru, and Uruguay. Indicators included psychiatric beds in psychiatric and general hospitals overall, for children and adolescents, and for forensic populations; residential beds for substance use treatment; treatment slots in residential facilities and day hospitals; and outpatient facilities. RESULTS: Data availability varied among countries, service indicators, and time points. The median prevalence of psychiatric beds decreased in psychiatric hospitals from 5.1 to 3.0 per 100,000 people (-42%) and in general hospitals from 1.0 to 0.8 (-24%). The median prevalence estimates of specialized psychiatric beds for children and adolescents (0.18) and for forensic populations (0.04) remained unchanged. Increases in prevalence were observed for residential beds for substance use treatment (from 0.40 to 0.57, 43% increase), available treatment slots in residential facilities (0.67 to 0.79, 17%), treatment slots in day hospitals (0.41 to 0.54, 32%), and outpatient facilities (0.39 to 0.93, 138%). CONCLUSIONS: The findings indicate that treatment capacity shifted from inpatient to outpatient and community care. Most countries had a bed shortage for acute psychiatric care, especially for children and adolescents and forensic patients. More comprehensive and standardized mental health service registries are needed.

Facilitating Factors and Barriers to the Implementation of the Icelandic Prevention Model of Adolescent Substance Use in Chile: A Focus Group Study.

The use of alcohol and other drugs is a major public health problem in adolescence. The implementation of evidence-based prevention strategies is still scarce in the global south. This study aimed to evaluate facilitators and barriers to the implementation of the Icelandic prevention model of adolescent substance use (IPM) in Chile. We conducted a qualitative study of stakeholders during the implementation process of the IPM in six municipalities of the Metropolitan Region of Santiago, Chile. We convened six focus groups with parents and professionals from schools and municipal prevention teams (38 participants). Recordings were transcribed and submitted to a six-step thematic analysis. The following facilitators emerged: Participants valued the contribution of the IPM to articulate existing programs and teams, its community focus, and the local data obtained through the survey. There were also several barriers: Those included resistance to adopting a foreign model, the tension between generating local strategies and looking for measures to ensure the fidelity of the implementation, socioeconomic differences between and within municipalities, low-risk perception and supervision of parents in Chile, and a culture that generally does not discourage adolescent substance use. Implementation of the IPM was largely accepted by the stakeholders who agreed with the community approach of the model. The main barriers to consider were related to cultural and socioeconomic factors that need to be addressed in further research and may limit the effects of the model in Chile.

Parental practices and their association with alcohol and cannabis use among adolescents in Chile.

Background: Adolescent alcohol and cannabis use are common in Chile. The present study aimed to assess the relationship between perceived parenting practices and alcohol and cannabis use among adolescents in a Latin American context. Methods: We adapted and implemented a substance use prevention strategy in Chile, which included surveys of tenth-grade students from six municipalities in the Metropolitan Region of Greater Santiago. We assessed the reliability and factorial structure of the parenting scale with 16 items, which formed part of the survey. We dichotomized parenting scores into high (above the median) and low. The association of parenting practices with alcohol and cannabis use in adolescents was assessed using multivariate multilevel regression models. Results: A total of 7,538 tenth-grade students from 118 schools were included in the study. The 16-item scale of parenting practices showed good internal consistency (Omega total = 0.84), and three factors representing Relationship between parents and adolescents, Norms and monitoring, and Parents knowing their children's friends and the parents of their children's friends. High total scores of parenting were associated with lower odds of lifetime alcohol use (OR 0.57; 95% CI: 0.49-0.65), past-month alcohol use (OR 0.63; 95% CI: 0.57-0.70), lifetime drunkenness (OR 0.64; 95% CI: 0.58-0.72), and lifetime cannabis use (OR 0.54; 95% CI: 0.47-0.61). Above median scores on each parenting subscale were associated with significantly lower odds of substance use. The strongest associations were observed for the subscale Norms and monitoring. Interactions between parenting and gender showed a significantly stronger effect of parenting practices on alcohol and cannabis use among girls. Conclusion: Different types of parenting practices were associated with a lower prevalence of adolescent alcohol and cannabis use. Improving parenting practices has the potential to prevent adolescent substance use in Chile, especially among girls.

Validación de la escala Five Facet Mindfulness Questionnaire en estudiantes de medicina y médicos en Chile / Validation of the Five Facet Mindfulness Questionnaire scale in medical students and doctors in Chile

BACKGROUND: The increasing use of Mindfulness-based interventions requires standardized construct-based measurement instruments for clinical and research purposes. The Five Facet Mindfulness Questionnaire scale with five factors was developed in the United States and validated in Spain. There are versions of 39, 24 and 15 items (FFMQ-39, FFMQ-24 and FFMQ-15). OBJECTIVE: To validate the FFMQ-24 and FFMQ-15 scale in Chile. METHODOLOGY: Six experts performed a linguistic adaptation of the Spanish version of the FFMQ-24. The adapted instrument was applied to a sample of 795 physicians. Internal validity was analyzed by calculating Cronbach's alpha (α) and confirmatory factor analysis (CFA). Finally, 15 items were retained, and the 5-factor solution was maintained. The FFMQ-15 scale was applied to a sample of 365 medical students and analyzed by calculating (α) and CFA. The external validity of FFMQ-15 was evaluated with the Mental Health Continiuum-14 (MHC-14) scale. RESULTS: Linguistic changes were made. The CFA of FFMQ-24 obtained a lower-than-expected fit for a 5-factor solution. The (α) value varied between .68 and .86 in all dimensions. The FFMQ-15 had an adequate fit for five factors for physicians (c2 = 216.17, df = 80, p < .01; CFI = .96; TLI = .94; RMSEA = .05 [.04, .06]; SRMR = .04) and students (c2 = 163.61, df = 80, p < .01; CF = .96; TLI = .94; RMSEA = .05 [.04, .07]; SRMR = .05). External validity with MHC-14 was adequate. CONCLUSION: The FFMQ-15 scale has acceptable internal consistency and adequate internal and external validity in Chile.

[Validation of the Five Facet Mindfulness Questionnaire scale in medical students and doctors in Chile]. / Validación de la escala Five Facet Mindfulness Questionnaire en estudiantes de medicina y médicos en Chile.

BACKGROUND: The increasing use of Mindfulness-based interventions requires standardized construct-based measurement instruments for clinical and research purposes. The Five Facet Mindfulness Questionnaire scale with five factors was developed in the United States and validated in Spain. There are versions of 39, 24 and 15 items (FFMQ-39, FFMQ-24 and FFMQ-15). OBJECTIVE: To validate the FFMQ-24 and FFMQ-15 scale in Chile. METHODOLOGY: Six experts performed a linguistic adaptation of the Spanish version of the FFMQ-24. The adapted instrument was applied to a sample of 795 physicians. Internal validity was analyzed by calculating Cronbach's alpha (α) and confirmatory factor analysis (CFA). Finally, 15 items were retained, and the 5-factor solution was maintained. The FFMQ-15 scale was applied to a sample of 365 medical students and analyzed by calculating (α) and CFA. The external validity of FFMQ-15 was evaluated with the Mental Health Continiuum-14 (MHC-14) scale. RESULTS: Linguistic changes were made. The CFA of FFMQ-24 obtained a lower-than-expected fit for a 5-factor solution. The (α) value varied between .68 and .86 in all dimensions. The FFMQ-15 had an adequate fit for five factors for physicians (c2 = 216.17, df = 80, p < .01; CFI = .96; TLI = .94; RMSEA = .05 [.04, .06]; SRMR = .04) and students (c2 = 163.61, df = 80, p < .01; CF = .96; TLI = .94; RMSEA = .05 [.04, .07]; SRMR = .05). External validity with MHC-14 was adequate. CONCLUSION: The FFMQ-15 scale has acceptable internal consistency and adequate internal and external validity in Chile.

Changes in rates of psychiatric beds and prison populations in sub-Saharan Africa from 1990 to 2020.

Background: Psychiatric bed numbers (general, forensic, and residential) and prison populations have been considered indicators of institutionalization. The present study aimed to assess changes of those indicators across sub-Saharan Africa (SSA) from 1990 to 2020. Methods: We retrospectively obtained data on psychiatric bed numbers and prison populations from 46 countries in SSA between 1990 and 2020. Mean and median rates, as well as percentage changes between first and last data points were calculated for all of SSA and for groups of countries based on income levels. Results: Primary data were retrieved from 17 out of 48 countries. Data from secondary sources were used for 29 countries. From two countries, data were unavailable. The median rate of psychiatric beds decreased from 3.0 to 2.2 per 100 000 population (median percentage change = -16.1%) between 1990 and 2020. Beds in forensic and residential facilities were nonexistent in most countries of SSA in 2020, and no trend for building those capacities was detected. The median prison population rate also decreased from 77.8 to 71.0 per 100 000 population (-7.8%). There were lower rates of psychiatric beds and prison populations in low-income and lower-middle income countries compared with upper-middle income countries. Conclusions: SSA countries showed, on average, a reduction of psychiatric bed rates from already very low levels, which may correspond to a crisis in acute psychiatric care. Psychiatric bed rates were, on average, about one twenty-fifth of countries in the Organization for Economic Co-operation and Development (OECD), while prison population rates were similar. The heterogeneity of trends among SSA countries over the last three decades indicates that developments in the region may not have been based on coordinated policies and reflects unique circumstances faced by the individual countries.

Corrigendum: Expert arguments for trends of psychiatric bed numbers: A systematic review of qualitative data.

[This corrects the article DOI: 10.3389/fpsyt.2021.745247.].

The alcohol prevention magnitude measure: Application of a Spanish-language version in Santiago, Chile.

BACKGROUND: The Alcohol Prevention Magnitude Measure (APMM) is an instrument to monitor and improve substance use prevention at the community level developed in Sweden. The aim of this study was to produce and apply a Spanish-language version of the APMM. METHOD: We translated and adapted the APMM using an expert panel. We retained 37 indicators in five dimensions, with total scores ranging from 0 to 100 points and 0 to 20 in each dimension. The instrument was administered to the prevention coordinators in six socioeconomically heterogeneous municipalities of Santiago de Chile, during the pilot implementation of a community-based prevention model in 2019 and 2020. We calculated median scores for the instrument and each dimension. We tested for differences between 2019 and 2020 using the Wilcoxon Test and between municipalities with the Friedman Test. RESULTS: The Spanish version of the APMM was acceptable to stakeholders. The median scores were 49.3 (range: 34.0 to 64.0) in 2019 and 67.3 (range 55.5 to 80.5) in 2020. The median scores for Staff and budget were 14.0 in 2019 and 2020, for Prevention policy 5.0 in 2019 and 16.0 in 2020, for Cooperation with key agents 12.0 in both years, for Supervision and alcohol licenses 4.3 in 2019 and 9.0 in 2020, and for Prevention activities 11.0 in 2019 and 15.0 in 2020. The scores in the dimensions Prevention policy and Supervision and alcohol licenses significantly increased in 2020. The differences between the municipalities were not significant. CONCLUSIONS: Improvements of the prevention index between 2019 and 2020 in the dimension Prevention policies may be related to the intervention. Improvements in Supervision and alcohol licenses could be related to curfew policies in the context of the COVID-19 pandemic. The Spanish version of the APMM deserves larger scale testing in Latin America.

The effects of national mental health plans on mental health services development in Chile: retrospective interrupted time series analyses of national databases between 1990 and 2017.

AIMS: To describe changes in mental health services in Chile between 1990 and 2017, and to retrospectively assess the effects of national mental health plans (NMHPs) on mental health services development during this period. METHODS: Service data (beds in psychiatric hospitals, psychiatric beds in general hospitals, forensic psychiatric beds, beds in protected housing facilities, psychiatric day hospital places, and outpatient mental health care centers) were retrieved from government sources in Chile. Data were reported as rates per 100,000 population. We conducted interrupted time series analyses, using ordinary least-square regressions with Newey-West standard errors, to assess the effects of the 1993 and 2000 NMPHs on mental health services development. RESULTS: Rates of short- and long-stay beds in psychiatric hospitals (per 100,000 population) were reduced from 4.3 to 3.2 and from 19.0 to 2.0 over the entire time span, respectively. The strongest reduction of short- and long-stay beds in psychiatric hospitals was seen between the 1993 and 2000 NMHPs (annual removal of - 0.14 and - 1.03, respectively). We observed increased rates of psychiatric beds in general hospitals from 1.8 to 4.0, beds in protected housing facilities from 0.4 to 10.2, psychiatric day hospital places from 0.4 to 5.0, outpatient mental health care centers from 0.1 to 0.8 and forensic psychiatric beds from 0.3 to 1.1 over the entire time span. The strongest annual increase of rates of psychiatric beds in general hospitals (0.09), beds in protected housing facilities (0.50), psychiatric day hospital places (0.16) and outpatient mental health care centers (0.04) were observed after the 2000 NMHP. Forensic psychiatric beds increased in the year 2007 (0.58) due to the opening of a new facility. CONCLUSIONS: The majority of acute care psychiatric beds in Chile now are based in general hospitals. The strong removal of short- and long-stay beds from psychiatric hospitals after the 1993 NMHP preceded substantial expansion of more modern mental health services in general hospitals and in the community. Only after the 2000 NMHP, the implementation of new mental health services gained momentum. Reiterative policies are needed to readjust mental health services development.

Minimum and optimal numbers of psychiatric beds: expert consensus using a Delphi process.

The required minimum number of psychiatric inpatient beds is highly debated and has substantial resource implications. The present study used the Delphi method to try to reach a global consensus on the minimum and optimal psychiatric bed numbers. An international board of scientific advisors nominated the Delphi panel members. In the first round, the expert panel provided responses exploring estimate ranges for a minimum to optimal numbers of psychiatric beds and three levels of shortage. In a second round, the panel reconsidered their responses using the input from the total group to achieve consensus. The Delphi panel comprised 65 experts (42% women, 54% based in low- and middle-income countries) from 40 countries in the six regions of the World Health Organization. Sixty psychiatric beds per 100 000 population were considered optimal and 30 the minimum, whilst 25-30 was regarded as mild, 15-25 as moderate, and less than 15 as severe shortage. This is the first expert consensus on minimum and optimal bed numbers involving experts from HICs and LMICs. Many high-income countries have psychiatric bed numbers that fall within the recommended range. In contrast, the number of beds in many LMIC is below the minimum recommended rate.

Psychiatric beds and prison populations in 17 Latin American countries between 1991 and 2017: rates, trends and an inverse relationship between the two indicators.

BACKGROUND: In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America. METHODS: We searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela. RESULTS: The number of psychiatric beds decreased in 15 out of 17 Latin American countries (median -35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship -2.70 (95% CI -4.28 to -1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates -2.37 (95% CI -3.95 to -0.8; p = 0.006). CONCLUSIONS: Important numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.

Changes in national rates of psychiatric beds and incarceration in Central Eastern Europe and Central Asia from 1990-2019: A retrospective database analysis.

BACKGROUND: Numbers of psychiatric beds (general, forensic, and residential) and prison populations have been considered to be indicators of institutionalisation of people with mental illnesses. The present study aimed to assess changes of those indicators across Central Eastern Europe and Central Asia (CEECA) over the last three decades to capture how care has developed during that historical period. METHODS: We retrospectively obtained data on numbers of psychiatric beds and prison populations from 30 countries in CEECA between 1990 and 2019. We calculated the median of the percent changes between the first and last available data points for all CEECA and for groups of countries based on former political alliances and income levels. FINDINGS: Primary national data were retrieved from 25 out of 30 countries. Data from international registries were used for the remaining five countries. For all of CEECA, the median decrease of the general psychiatric bed rates was 33•8% between 1990 and 2019. Median increases were observed for forensic psychiatric beds (24•7%), residential facility beds (12•0%), and for prison populations (36•0%). Greater reductions of rates of psychiatric beds were observed in countries with lower per capita income as well as in countries that were formerly part of the Soviet Union. Seventeen out of 30 countries showed inverse trends for general psychiatric beds and prison populations over time, indicating a possible shift of institutionalisation towards correctional settings. INTERPRETATION: Most countries had decreased rates of general psychiatric beds, while there was an increase of forensic capacities. There was an increase in incarceration rates in a majority of countries. The large variation of changes underlines the need for policies that are informed by data and by comparisons across countries. FUNDING: Agencia Nacional de Investigación y Desarrollo in Chile, grant scheme FONDECYT Regular, grant number 1190613.

Salud mental primaria para niños, niñas y adolescentes institucionalizados: perspectiva de equipos de salud / Primary mental health care for institutionalized children and adolescents: a health team perspective / Saúde mental primária para crianças e adolescentes institucionalizados: uma visão das equipes de saúde

Resumen (Analítico) La salud mental de los niños, niñas y adolescentes institucionalizados en hogares es un desafío clínico y ético para Chile y América Latina. Con el objetivo de explorar experiencias y desafíos percibidos por profesionales de la atención primaria de salud que atienden esta población, se realizó una investigación cualitativa, utilizando un cuestionario con preguntas abiertas. Los datos se analizaron mediante teoría fundamentada. Los resultados mostraron que la atención era parcializada y discontinua. La información sobre el desarrollo vital, la familia, los contextos de vulneración e institucionalización era insuficiente y fragmentada. Además, existía escasa coordinación entre las instituciones que intervienen simultáneamente con los niños, niñas y adolescentes. Se discuten las implicancias para la formación de equipos de salud mental de la atención primaria de salud y la implementación efectiva del trabajo intersectorial y multinivel.

Abstract (analytical) Mental health care for vulnerable and institutionalized children and adolescents is a clinical and ethical challenge in Chile and Latin America. This study explores experiences and challenges encountered when providing mental health care among primary health care professionals. Qualitative research was conducted using an open-ended questionnaire for interviewing professionals in a rural area of Chile. The data was analyzed using Grounded Theory. The results show a fragmented and discontinuous delivery of care as a large portion of the children's clinical and social history is unknown. There is lack of coordination with other institutions that intervene in this area. The authors discuss implications for primary health care training for children's mental health teams and the need for the implementation of effective integrated and multilevel care systems.

Resumo (Analítico) A saúde mental de crianças e adolescentes vulneráveis e institucionalizados é um desafio clínico e ético no Chile e na América Latina. O presente estudo explorou experiências e desafios do cuidado por profissionais da atenção primária à saúde que atendem esta população. A pesquisa qualitativa foi realizada utilizando um questionário de perguntas abertas para entrevistar profissionais da área rural do Chile. Os dados foram analisados usando a Grounded Theory. Os resultados mostraram um atendimento fragmentado e descontínuo. As informações sobre parte da história clínica e social das crianças, e os contextos de vulnerabilidade e institucionalização são insuficientes. Além disso, existia pouca coordenação entre as instituições que intervêm simultaneamente com os crianças e adolescentes. São discutidas implicações para o treinamento de equipes de saúde mental na atenção primária à saúde e para a implementação de sistemas efetivos de atendimento integrado e multinível.

Telepsychiatry Consultation for Primary Care Treatment of Children and Adolescents Receiving Child Protective Services in Chile: Mixed Methods Feasibility Study.

BACKGROUND: Children and adolescents living under the supervision of child protective services have complex mental health care needs. The scarcity and uneven distribution of specialized mental health teams in Chile may limit the provision and quality of care for this vulnerable population. Telepsychiatry can address such health inequities. OBJECTIVE: The objective of this study was to evaluate the feasibility of a telepsychiatry consultation program for primary health care (PHC) treatment of children and adolescents living under the supervision of child protective services. METHODS: We developed a telepsychiatry consultation program for two rural PHC clinics located in central Chile (Valparaíso Region) and evaluated its implementation using a mixed methods study design. The program consisted of videoconferencing mental health consultation sessions scheduled twice per month (each 90 minutes long), over a 6-month period, delivered by child and adolescent psychiatrists based in Santiago, Chile. We described the number of mental health consultation sessions, participant characteristics, perceived usefulness and acceptability, and experiences with the telepsychiatry consultation program. RESULTS: During the 6-month study period, 15 videoconferencing mental health consultation sessions were held. The telepsychiatry consultation program assisted PHC clinicians in assigning the most adequate diagnoses and making treatment decisions on pharmacotherapy and/or psychotherapy of 11 minors with complex care needs. The intervention was perceived to be useful by PHC clinicians for improving the resolution capacity in the treatments of this patient population. Limitations such as connectivity issues were resolved in most sessions. CONCLUSIONS: The telepsychiatry consultation program was feasible and potentially useful to support PHC clinicians in the management of institutionalized children and adolescents with complex psychosocial care needs living in a poorly resourced setting. A larger scale trial should assess clinical outcomes in the patient population. Regulations and resources for this service model are needed to facilitate sustainability and large-scale implementation.