Community Mental Health as Part of a CBR Programme

1
Community Mental Health as Part of a CBR Programme
2
Characteristics of the CBR Programme

• CBR for people with disabilities (sensorial,
  physical, intellectual) in the highlands of Peru
• 6 NGOs with focus on community development work
  in 60 rural indigenous communities in provinces
  of Puno and Cusco
• Regional OPDs participate in planning,
  monitoring, evaluation and the steering committee
  of the programme.

3
Special characteristics of the CBR Programme

• Partner organisations have a focus on development
  work, but not on disabilities.
• Need for intensive training on disability issues
  for staff and community volunteers
• Advantage build on well established roots,
  respect and trust in the community
• Build on indigenous traditions like minka

4
New Needs come up

• CBR programme focused on children and people with
  the classical disabilities.
• 2 years ago families and communities approached
  the programme with other needs.

5
Needs Analysis

• People with epilepsy lacked access to quality
  health care and supply with antiepileptic drugs.
• People with severe mental health problems lacked
  access to mental health services. Communities and
  families worried about disruptive behaviour and
  disrespect of traditional norms.
• Needs for prevention of mental illnesses and
  promotion of MH high level of domestic violence,
  alcohol abuse, physical and sexual abuse of
  children

6
Context

• Centuries of oppression, racism, structural
  violence and extreme poverty
• Loss of lands, soil erosion
• Migration of young adults to urban areas leaving
  behind children and elderly people
• Armed conflict area (military and Sendero
  luminoso)

7
Strategies

• Networking with PHC, training of health workers,
  provision of psychotropic and antiepileptic drugs
• Networking with NGOs and public agencies to raise
  awareness about MH issues, reduce stigma and
  domestic violence, improve agricultural
  activities and foster income generation.
• Motivate people with neuropsychiatric problems
  and their families to engage in self-help groups
  and in the organisations of PwD.

8
Outcomes (so far)

• Quality of life improved in some people, above
  all with epilepsy
• Alliance with PHC strengthened
• Supply with antiepileptic drugs guaranteed
  through public health system

9
Weaknesses and Challenges

• Changes in attitudes and practices are very slow,
  in communities as well as in the PHC. Communities
  have only survived under extremely harsh
  conditions valuing their own traditions
  (reciprocity).
• Empowerment of people with MH problems difficult
  population dispersed, isolation, continuing
  discrimination
• Quality of treatment?
• Sustainability ?