Individuals with severe mental illness face enormous challenges in terms of stigma and accessing effective, appropriate and affordable care. This collaboration is focused on developing and testing models of intervention that aim to close the treatment gap and meaningfully improve quality of life for those living with severe mental illness in multiple urban centers in South America.
RedeAmericas is an NIMH-funded regional network or ‘hub’ for public mental health research in Latin America that brings together an interdisciplinary group of investigators from urban centers in Argentina (Buenos Aires, Cordoba, and Nuequen), Brazil (Rio de Janeiro), Chile (Santiago), Colombia (Medellin), and the United States (New York City). Co-led by Dr. Ezra Susser and Dr. Sandro Galea at Columbia, and Dr. Graciela Rojas and Dr. Ruben Alvarado in Chile, the program’s leadership group includes representatives from all of these sites, each of whom has decades of experience in developing health and/or mental health interventions in Latin America.
Through its support of this network of sites, RA seeks to foster regional leadership for building research capacity and improving mental health services for severely mentally ill people within urban areas in Latin America. The overriding objective of the Hub for Latin America (HLA) is to improve the condition of this vulnerable group through an integrated system of primary care and secondary mental health services tailored to the distinctive context of the urban areas of Latin America. In pursuit of this goal, RA endeavors to narrow the “mental health gap”, so that individuals with severe mental disorders receive care at a level comparable to the best health services offered to people with highly prioritized general health conditions.
Over the 5-year grant period, RA aims to launch strategic initiatives that will generate significant progress toward CHC-SMD in this region, and to build a platform for continued long-term progress. Furthermore, the program will provide intensive training and mentoring for investigators at an early stage of their career in the field of public mental health. Through the promotion of investigators’ individual development, in conjunction with fostering a network of mutual support among them (as well as with their mentors), we believe that RA will effectively be cultivating the next generation of leaders in global mental health. Furthermore, this training and mentorship component will ensure that the initiative will be self-sustaining and dynamic, continually improving upon past experience.
Thus, achieving all of these goals necessitates that RA encompasses three primary components:
A more specific initiative of the program is the development and testing of an approach to community mental health services that may prove adaptable and feasible for wide-scale use across countries throughout the Latin American region. In this regard, RA is testing an intervention for individuals with severe mental disorders — namely, the critical time intervention-task shifting (CTI-TS) — which was adapted over a seven-year period from CTI, a time-limited intervention that is widely used in high-income countries (for further detail on CTI, please visit: http://www.criticaltime.org/).
The RA trial of CTI-TS constitutes the first adaptation of the CTI model to Latin America. Like CTI, CTI-TS targets a period of transition when users first connect (or reconnect) to mental health services, and assessment and intervention plans are forged by partnering with service users in the locales in which they live day-to-day (as opposed to at the clinic site). The CTI-TS model also implements several innovations, such as placing emphasis on peer support workers, coordinating with local primary health care centers, and giving greater consideration to measures of social integration, users’ perceptions of recovery, and stigma. Significantly, we plan to test the feasibility of a regional RCT, which will be conducted in three cities: one in Brazil, one in Chile, and one in Argentina. Although this will be more difficult than carrying out a trial in one site, we believe a regional trial can have a much greater impact and demonstrate whether an intervention is (or is not) effective across various contexts in Latin America.
Global Mental Health Network
RA is one of five ‘hubs’ funded by the National Institute of Mental Health (two in Latin America, two in Africa, one in South Asia) that together, form an innovative global mental health network led by people from the regions in which they are located. By merging global capacity, innovation, and knowledge with regional leadership and culturally appropriate adaptations, these ‘hubs’ will contribute significantly toward advancing the global mental health agenda, while making a meaningful impact at a regional level and improving the lives of some of society’s most vulnerable people.