October 10, 2022
By Pablo Gaspar & Rocio Mayol
Dr. Pablo Gaspar, psychiatrist and Dr Rocio Mayol, clinical psychologist both from Chile, share an overview of the development of early intervention in South and Central America
About 80% of patients with a first psychotic episode are found in low- and middle-income countries (LMICs) such as South and Central America (Farooq, 2013). Insufficient resources, stigma, and the lack of mental health public policies in these countries are some of the problems that these patients must face (Singh, 2020). Furthermore, the burden of disease in mental health disorders increased among low- and middle-income countries (LMICs) and developed countries during the COVID-19 pandemic (Robles-Sánchez, 2021).
Most severe mental health disorders develop during adolescence and early adulthood and are preceded by a phase during which attenuated or episodic symptoms and functional impairment are observable (Hartmann et al., 2021). Currently, the COVID-19 crisis has had a significant impact on the mental health of adolescents and young adults in Latin America and the Caribbean (UNICEF, n.d.). As a result, the appearance of a higher incidence of anxiety and depressive disorders in South America has been documented and could lead to the appearance of severe mental health disorders at this stage, affecting personal achievements and causing significant disability (Barbeito et al., 2019).
During the last two decades, different groups in the world have focused their efforts on early detection and intervention of severe mental illnesses (Fusar-poli et al., 2012; Gaspar et al., 2019; McGorry & Yung, 2003; Riecher- ro et al., 2013) with the aim of preventing or delaying the onset of these illnesses and reducing functional impairment. A growing number of early detection programs have been developed and have shown positive results at different stages of prevention, which has resulted in a transition in the clinical characterization of these disorders, moving towards early detection and intervention by describing people with potentially prodromal symptoms (Gaspar et al., 2019; McGorry et al., 2018; Riecher-ro et al., 2013). Evidence has shown that early identification and intervention for these conditions delays or prevents the conversion to severe mental illness (Fusar-Poli et al., 2014), improves prognosis (Lin et al., 2015; Polari et al., 2018) and is a cost-beneficial clinical approach for the countries that occupy this paradigm (Arango et al., 2018; Irarrázaval et al., 2016). However, prevention and early intervention in mental health is a current challenge in Central and South America. Since the last decade, the existence of initiatives in this field has been mapped in Mexico, Brazil, Chile and Argentina, mostly in first episode psychosis programs (Aceituno, 2015). Chile is the only country with an established program for prospective follow-up of participants with at-risk mental states with a transdiagnostic perspective (Gaspar, 2019; Salazar de Pablo, 2021). In addition, a multicenter network for early detection and intervention called RED-EMAR (Gaspar, 2021) has recently been created. The objective of RED-EMAR (www.redemarchile.cl) is to recognize and disseminate the value of the at risk mental stateconcept (abbreviated to EMAR in Spanish), establish agreed therapeutic strategies in this field in LMIC, and establish potential new evidence-based local interventions.
The successful experiences of this network include the monitoring and discussion of clinical cases in telemedicine and the development of clinical guidelines for mental health education for cases and families (Gaspar, 2021). The development and access to early detection and intervention services in LMICs could be a window of opportunity to reduce the impact of severe mental health disorders such as psychosis on the population and move towards an approach aimed atprevention or delaying its onset.
Pablo A. Gaspar is the head of the Psychosis Unit of the Department of Psychiatry at the University of Chile, Director of the Translational Psychiatry Laboratory and founder of the Chilean Network of early detection and intervention in mental health (Red-EMAR-Chile). He acts as an associate researcher of the renowned research Centre, “Millennium Nucleus to improve mental health in adolescents and youths (IMHAY)” and Principal Investigator Chilean site of the PRESCIENT project funded by the NIMH. His line of research is early detection and intervention in psychosis and their biological risk factors. He is a well-recognized expert in the field in Chile. Currently, he is IEPA’s Vice President South and Central America and member of the American College of Neuropsychopharmacology (ACNP) Latin American initiative task force.
Dr. Rocío Mayol, PhD is a clinical psychologist expert in psychosis. Dr. Mayol is affiliated with the Faculty of Psychology of the Alberto Hurtado University and the Psychosis Unit of the University of Chile. She acts as a young researcher of the ¨millennium nucleus for Improving the Mental Health of Adolescents and Youth ¨(IMHAY). She has a scholarship as principal investigator of the National Fund for Scientific and Technological Development (Fondecyt).Dr. Mayol’s line of research is the early stages of psychotic disorders, and she is also interested in the development of early psychotherapeutic interventions of severe mental illnesses.
You can follow Pablo on Twitter @pgasparr or LinkedIn
You can follow Dr. Rocio Mayol on LinkedIn
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Declaration of Interests: None
This project was made possible thanks to a sponsorship from H/Lundbeck A/S. The opinions expressed in these materials do not necessarily reflect those of H.Lundbeck.