Mental health therapy in mexico
Description of the state and its health regions
Mexico is divided into five mesoregions made up of several federative entities. The State of Jalisco is located in the central-western region with a territorial extension of 78,599km2 (Fig. 1). It contains the second largest Metropolitan area in the country: The Metropolitan Area of Guadalajara (ZMG, for its acronym in Spanish).
Jalisco within Mexico
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Jalisco is made up of 125 municipalities, which in turn comprise 13 geographic and health regions (Fig. 2). Each health region has a main municipality or city and several municipalities, as shown in Table 1.
Health regions in Jalisco
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Table 1 Description of the State of Jalisco
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The state has a population of 8,256,000 inhabitants, of which 6,057,265 are people over 15 years of age. Because the state’s mental health system is aimed at the population over 15 years old, this study considers this population as the object of study.
Mental health care in Mexico: conceptual definitions
Mental health services in Mexico are divided into different levels of care. The closest to community mental health care corresponds to the Comprehensive Mental Health Centers (CISAMEs), the second level to outpatient mental health care services in community and general hospitals, and the third level to psychiatric hospitals where outpatient care, and in some cases inpatient care, is provided. In Jalisco, the latter are the Center for Comprehensive Care in Mental Health for Short Stay (CAISAME-EB) and the Center for Comprehensive Care in Mental Health for Long Stay (CAISAME-EP).
The state of Jalisco has eight of the 54 Comprehensive Mental Health Centers (CISAMEs) in the country, being the state with most centers; the two states ranking second have four centers each. It is worth mentioning that eight states of the country do not have any CISAME, even in states with a greater geographic extension than Jalisco.
There are different instruments for the evaluation of community mental health networks, such as the Description and Evaluation of Services and Directories in Europe for Long-Term Care (DESDE-LTC) designed for the description and evaluation of health services for people with disabilities, being currently one of the most complete models . A second instrument is the EvaRedCom–TMS, which was created in Chile to make a rapid evaluation of community mental health services in low and mid-income countries . Its application is based on data that is easy to collect, such as access to care with distances, times and costs, along with information regarding resources and other specific indicators that are useful for the Assessment Instrument for Mental Health Systems (WHO- AIMS). For this reason and the fact that it has been used and validated in low and mid-income countries like Mexico, we decided to use this tool.
For this study, we have included 2 of the 4 components from the EvaRedCom instrument which include the following:
A general description of the community care network including the institutions that make up the network, the human resources of each institution and the number of hours available to provide care considering the general population to which these services are available.
The accessibility to the community care network which includes information on geographic accessibility, that is, travel times, expressed in minutes and hours, to mental health services and the transportation cost of the round-trip to the mental health care center, expressed in dollars (19.90$, value as of December 2019).
The third component which includes the prevalence of people with Severe Mental Disorders within the community care network was not included due to the fact that there is a void regarding the information required to complete this section especially considering the nonurban prevalence of mental illness.
The fourth component contains the information regarding the coordination and operation of the community network, including periodic reviews, technical advice of the network, its management, activities that are developed and a rating of the network coordination strategy .
Source of information
The general description of the community care network was obtained through the health centers databases, which depends on the State Health Secretariat. The main health center of each municipality was taken as a reference and starting point for the analysis of geographic and economic accessibility.
Through direct contact with health institutions, information was requested regarding the number of human resources in mental health (a rate was calculated per 10,000 inhabitants with > 15 years of age) and the hours available for clinical care per week (7.5 h/day and 37.5 h/week for each professional).
Geographic accessibility and transportation costs
The geographic and economic accessibility evaluation was carried out under three methodologies: A (from region one to nine), B (region 10 and 13) and C (region 11 and 12), which are explained below:
Methodology A: for the health regions are located within the state. These are characterized by having a main municipality that is usually the largest and several nearby municipalities. In these regions there is great mobility in the search for resources, services (including health services) or goods, representing a significant amount of time and economic resources spent. These regions have scattered rural, semi-urban rural and intermediate urban municipalities, and may even have urban municipalities.
Methodology B: these are the main urban cities found within the ZMG, so mobility is urban, with multiple public transport services and various private options. These concentrate the largest amount of services, goods and resources. It is made up of populations greater than 100,000 inhabitants.
Methodology C: these two regions have large cities within the ZMG and rural municipalities outside of this area, so it was decided to use both methodologies (A and B).
This section refers to the time it takes a user to get to the nearest mental health service center, or one with a higher level of care, from anywhere in the state, both by public transport (bus) and private transport (car). The information was collected through telephone interviews, data provided by health institutions and computer tools such as Google Maps, Waze and Rome2rio. The route from one point to another (from a health center to a mental health service) was introduced between 8 and 13hrs, obtaining an arithmetic mean of the three computer tools, the result is expressed in minutes.
This section considers the traveling cost required to get from anywhere in the state to the nearest mental health service center, or to one with a higher level of care. For this section, all the mobility options that the population may have were taken into consideration, taking into account the costs of public transport (bus), private transport (taxi, Uber) and private transport (car). The information on the costs of public bus transport was collected through the experience of the workers on the different health institutions and telephone calls to bus terminals, with the information being corroborated with prices found on the internet. The information on private transport (taxi, Uber) was made through the costs referred by the taxi terminals and through the Uber mobile application at different schedules. The costs of private transportation (car) were calculated by estimating gasoline consumption per kilometer of an average car, multiplied by the kilometers traveled on a round trip. For this calculation we considered the cost of a liter of regular gasoline to be1 USD, which yields 15 km/l.
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