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