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Access to mental health care in El Salvador: a case study of progress toward decentralization
OBJECTIVE: To assess the need for decentralization of psychiatric services in El Salvador, based on country-specific evidence, and to generate baseline measures the government and researchers could use to monitor and measure future progress toward decentralization. METHODS: Observations were made an...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Organización Panamericana de la Salud
2018
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385792/ https://www.ncbi.nlm.nih.gov/pubmed/31093200 http://dx.doi.org/10.26633/RPSP.2018.172 |
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author | Nickels, Samuel V. Campos Tomasino, Mariely Flamenco Arvaiza, Nelson A. Hunter, Cynthia A. |
author_facet | Nickels, Samuel V. Campos Tomasino, Mariely Flamenco Arvaiza, Nelson A. Hunter, Cynthia A. |
author_sort | Nickels, Samuel V. |
collection | PubMed |
description | OBJECTIVE: To assess the need for decentralization of psychiatric services in El Salvador, based on country-specific evidence, and to generate baseline measures the government and researchers could use to monitor and measure future progress toward decentralization. METHODS: Observations were made and psychiatric outpatients and their families/caregivers (n = 453) surveyed with a cross-sectional instrument at the National Psychiatric Hospital (Hospital Nacional General y de Psiquiatría “Dr. José Molina Martínez”) in the capital city of San Salvador. Findings were compared with national census data to determine barriers to psychiatric care in a largely centralized system. The following data were collected: department of origin, travel time to hospital, time in hospital, costs, and qualitative comments about accessing services. Descriptive statistics and regression were used to assess the data. Government reports on all psychiatric outpatient consultations provided nationwide in 2015 (n = 61 010) at 10 regional hospitals were also reviewed and compared to population data to determine the proportion of the population of each hospital service area (department or group of departments) that received a psychiatric outpatient consultation. RESULTS: Households from the half of the country (7 out of 14 departments) farthest away from the National Psychiatric Hospital (42% of the general population) spent twice as much time and three times as much money to access the hospital's psychiatric outpatient services, resulting in severe hardship on both patients and families/caregivers. CONCLUSIONS: This report estimates that 45% of those with mental health needs in the seven departments farthest away from the National Psychiatric Hospital departments are still not accessing services compared to the seven departments nearest the hospital. The results of this study support the World Health Organization's call for governments to fully implement community-based mental health systems. This is the first study to assess progress toward decentralization of psychiatric services in El Salvador. |
format | Online Article Text |
id | pubmed-6385792 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Organización Panamericana de la Salud |
record_format | MEDLINE/PubMed |
spelling | pubmed-63857922019-05-15 Access to mental health care in El Salvador: a case study of progress toward decentralization Nickels, Samuel V. Campos Tomasino, Mariely Flamenco Arvaiza, Nelson A. Hunter, Cynthia A. Rev Panam Salud Publica Original Research OBJECTIVE: To assess the need for decentralization of psychiatric services in El Salvador, based on country-specific evidence, and to generate baseline measures the government and researchers could use to monitor and measure future progress toward decentralization. METHODS: Observations were made and psychiatric outpatients and their families/caregivers (n = 453) surveyed with a cross-sectional instrument at the National Psychiatric Hospital (Hospital Nacional General y de Psiquiatría “Dr. José Molina Martínez”) in the capital city of San Salvador. Findings were compared with national census data to determine barriers to psychiatric care in a largely centralized system. The following data were collected: department of origin, travel time to hospital, time in hospital, costs, and qualitative comments about accessing services. Descriptive statistics and regression were used to assess the data. Government reports on all psychiatric outpatient consultations provided nationwide in 2015 (n = 61 010) at 10 regional hospitals were also reviewed and compared to population data to determine the proportion of the population of each hospital service area (department or group of departments) that received a psychiatric outpatient consultation. RESULTS: Households from the half of the country (7 out of 14 departments) farthest away from the National Psychiatric Hospital (42% of the general population) spent twice as much time and three times as much money to access the hospital's psychiatric outpatient services, resulting in severe hardship on both patients and families/caregivers. CONCLUSIONS: This report estimates that 45% of those with mental health needs in the seven departments farthest away from the National Psychiatric Hospital departments are still not accessing services compared to the seven departments nearest the hospital. The results of this study support the World Health Organization's call for governments to fully implement community-based mental health systems. This is the first study to assess progress toward decentralization of psychiatric services in El Salvador. Organización Panamericana de la Salud 2018-10-10 /pmc/articles/PMC6385792/ /pubmed/31093200 http://dx.doi.org/10.26633/RPSP.2018.172 Text en https://creativecommons.org/licenses/by-nc-nd/3.0/igo/legalcode This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. No modifications or commercial use of this article are permitted. In any reproduction of this article there should not be any suggestion that PAHO or this article endorse any specific organization or products. The use of the PAHO logo is not permitted. This notice should be preserved along with the article's original URL. |
spellingShingle | Original Research Nickels, Samuel V. Campos Tomasino, Mariely Flamenco Arvaiza, Nelson A. Hunter, Cynthia A. Access to mental health care in El Salvador: a case study of progress toward decentralization |
title | Access to mental health care in El Salvador: a case study of progress toward decentralization |
title_full | Access to mental health care in El Salvador: a case study of progress toward decentralization |
title_fullStr | Access to mental health care in El Salvador: a case study of progress toward decentralization |
title_full_unstemmed | Access to mental health care in El Salvador: a case study of progress toward decentralization |
title_short | Access to mental health care in El Salvador: a case study of progress toward decentralization |
title_sort | access to mental health care in el salvador: a case study of progress toward decentralization |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385792/ https://www.ncbi.nlm.nih.gov/pubmed/31093200 http://dx.doi.org/10.26633/RPSP.2018.172 |
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