REPORT ON THE MENTAL HEALTH TREATMENT SYSTEM IN PARAGUAY

UNCLAS ASUNCION 000795 SIPDIS SIPDIS STATE FOR CA/OCS/WHA - S. CRAWFORD WHA/BSC - SMURRAY POSTS FOR CONSULAR E.O. 12958: N/A TAGS: CASC CMGT PA SUBJECT: REPORT ON THE MENTAL HEALTH TREATMENT SYSTEM IN PARAGUAY ¶1. Summary: Vice-Consul conducted an assessment of Paraguay's mental health treatment resources using interviews and a site visit. There are 31 publicly funded treatment centers scattered throughout the country. At these public facilities no one is turned away for inability to pay. There are also private resources available for those with access to funds. Patients can contact treatment providers and facilities directly to access treatment. End Summary. INTRODUCTION ¶2. This report contains information obtained during meetings in May and June of 2006 with the Director of the Department of Mental Health, Dra. Nora Gomez, and with the director of the Neuropsychiatric Hospital in Asuncion, Dra. Nancy Monges. Vice-Consul also toured the Neuropsychiatric Hospital after interviewing Dr. Monges. THE DEPARTMENT OF MENTAL HEALTH ¶3. The Department of Mental Health (DMH) is part of the Ministry of Public Health and Social Welfare. One division of this Ministry is the Directorate of Health Programs. The Department of Mental Health is a very small section within this Directorate, with only 230 employees out of a total of 17,000. Expenditures on mental health programs are approximately $250,000 per year, which represents only .05% of the total budget. ¶4. The DMH is divided into five sections: administration, prevention, service provision, research and certification. Paraguayan law requires that recipients of scholarships, immigrants and those who wish to carry guns be evaluated for mental health problems and the certification section is responsible for carrying out these evaluations. ¶5. Since 2002 the DMH's strategic plan has emphasized decentralization. Decentralization entails increasing the number of residential and community-based treatment facilities while moving away from the traditional, long-term hospital-based approach to mental health treatment. This parallels a trend in the United States towards treating individuals with mental health problems in residential and community-based treatment facilities as opposed to confining them in isolated hospitals. THE MENTAL HEALTH OF THE PARAGUAYAN POPULATION ¶6. Dra. Gomez stated that one of the most pressing problems the DMH is currently facing is the rapidly increasing suicide rate in Paraguay. The suicide rate has more than doubled in the past five years and suicide is now the third leading cause of death in Paraguay. Dra. Gomez attributes this increase to the deteriorating economic situation in Paraguay, which has led many adults to leave the country in search of employment and subsequently has resulted in family fragmentation. ¶7. The problem of suicide is particularly acute in the areas of Caazapa, Alberdi, Caaguazu and San Pedro, zones which Dra. Gomez states have been particularly affected by Paraguay's economic difficulties. In response, the DMH has developed a mobile mental health unit that provides services in these areas. In addition, they have partnered with Peace Corps and have several volunteers working in suicide prevention in Caazapa. ¶8. Dr. Gomez stated that youth are at particularly high risk for suicide. DMH statistics reflect this high prevalence of mental health problems among Paraguayan youth - in 2005, 63% of all treatment episodes involved minors. THE NEUROPSYCHIATRIC HOSPITAL ¶9. The largest mental health treatment facility in Paraguay is the Neuropsychiatric Hospital in Asuncion. Curiously, for historical reasons, this hospital is administered by the Directorate of Social Welfare and not by the Directorate of Health Programs. The hospital houses approximately 400 individuals and is divided into an emergency assessment unit, a short-term (three to five day) crisis resolution unit, a unit housing those who have been involuntarily hospitalized and a long-term unit, which treats chronically mentally ill patients who are unable to function in the community. This wing is virtually closed to new admissions as the hospital now emphasizes community-based treatment. The hospital also has a small wing where patients can pay an extra fee and receive a private room. ¶10. Vice-Consul toured the grounds and found them to be pleasant and well-maintained. The hospital receives some supplementary funding from the Itaipu Foundation and has thus been able to maintain its facilities reasonably well. Brief conversations with patients and their family members indicated satisfaction with the services provided. Staff members were courteous to the patients and general morale seemed to be good. ¶11. The hospital does not treat patients in need of inpatient drug or alcohol treatment. The National Center for Addictions, located adjacent to the hospital, treats these patients. It also does not accept children nor teens nor those whose primary diagnoses are autism or mental retardation. Elderly patients are usually sent to a residential treatment center in the Santo Domingo neighborhood of Asuncion which specializes in geropsychiatry. OTHER TREATMENT OPTIONS ¶12. The DMH has opened many community-based treatment facilities in accordance with its strategic plan emphasizing decentralization . There are 30 of these facilities scattered throughout Paraguay. All provide outpatient treatment, which usually consists of medication monitoring approximately every three months with conjoint supportive counseling. This level of care is similar to that provided at public mental health treatment facilities in the US. Sixteen of these facilities also provide brief inpatient care, which can extend up to three weeks. ¶13. Minors are accepted at all of the facilities, although there are two facilities, both in Asuncion, that are dedicated exclusively to the treatment of minors. These two facilities are the Costa Nu public hospital and the hospital affiliated with the National University of Asuncion. ¶14. There are also private mental health facilities available in Paraguay. Dra. Monges mentioned the Baptist Hospital in Asuncion as a facility with a good continuum of psychiatric care. There are two private hospitals that accept long-term psychiatric patients, one run by the Mennonites in Filadelfia and one in Los Pilares, Itaua. ¶15. Mental health providers are in short supply in Paraguay. In the whole country there are only 60 psychiatrists and only four psychiatrists specializing in children and adolescents. This is a ratio of one psychiatrist per 100,000 people, compared to the United States' ratio of 14 per 100,000. ACCESSING AND PAYING FOR TREATMENT ¶16. The Neuropsychiatric Hospital in Asuncion has an assessment center open 24 hours per day which is appropriate in crisis situations. In less urgent cases, an individual may call the mental health center closest to their residence to schedule an appointment for an intake. According to Dra. Gomez, most centers are able to schedule an appointment for a new patient within a few days of the call. To access private treatment, the prospective patient contacts the facility or provider directly. ¶17. Costs for mental health treatment vary widely. At the public mental heath centers, the fee is 10,000 guarani (approximately $2) per visit. Medications cost 10,000 per prescription filled. The fee for hospitalization at the Neuropsychiatric Hospital is 20,000 guarani (approximately $4) per day. Patients with access to funds can pay 50,000 guarani per day (approximately $10) and be housed in a wing with private rooms. At these public facilities, no one is ever turned away for inability to pay. The private hospitals in Filadelfia and Los Pilares charge 6,000,000 guarani (approximately $1100) per month for hospitalization, a sum few Paraguayans can afford. Costs for other private services vary by type of treatment provided and facility. ¶18. Comment: Considering the lack of resources available, the Department of Mental Health in Paraguay provides a reasonable level of services. The strategic plan of decentralization is in keeping with current thinking in mental health treatment. Although Vice-Consul did not visit the community based facilities, the Neuropsychiatric Hospital, the largest treatment facility in Paraguay, appeared well-organized and well-run. Services seem to be relatively easy to access and costs are reasonable. CASON