Skip to main content

Abstract

Many Latin American countries face the challenge of caring for a growing number of people with severe mental illnesses while promoting deinstitutionalization and community-based care. This article presents an overview of current policies that aim to reform the mental health care system and advance the employment of people with disabilities in Colombia, Costa Rica, and Peru. The authors conducted a thematic analysis by using public records and semistructured interviews with stakeholders. The authors found evidence of supported employment programs for vulnerable populations, including people with disabilities, but found that the programs did not include people with severe mental illnesses. Five relevant themes were found to hamper progress in psychiatric vocational rehabilitation services: rigid labor markets, insufficient advocacy, public subsidies that create conflicting incentives, lack of deinstitutionalized models, and lack of reimbursement for evidence-based psychiatric rehabilitation interventions. Policy reforms in these countries have promoted the use of medical interventions to treat people with severe mental illnesses but not the use of evidence-based rehabilitation programs to facilitate community integration and functional recovery. Because these countries have other supported employment programs for people with nonpsychiatric disabilities, they are well positioned to pilot individual placement and support to accelerate full community integration among individuals with severe mental illnesses.

Formats available

You can view the full content in the following formats:

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 378 - 384
PubMed: 31896339

History

Received: 17 June 2019
Revision received: 6 October 2019
Accepted: 1 November 2019
Published online: 3 January 2020
Published in print: April 01, 2020

Keywords

  1. Individual placement and support
  2. mental health systems
  3. severe mental illness
  4. community mental health
  5. psychiatric rehabilitation

Authors

Details

Leonardo Cubillos, M.D., M.P.H. [email protected]
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
Juliana Muñoz, B.A., M.A.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
July Caballero, M.D., M.H.C.D.S.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
María Mendoza, R.N.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
Adriana Pulido, M.D., M.P.H.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
Karen Carpio, M.A.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
Anirudh K. Udutha, B.S.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
Catalina Botero, B.A.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
Elizabeth Borrero, M.D., M.A.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
Diana Rodríguez, M.A.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
Yuri Cutipe, M.D.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
Rebecca Emeny, Ph.D., M.P.H.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
Karen Schifferdecker, Ph.D., M.P.H.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).
William C. Torrey, M.D.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez).

Notes

Send correspondence to Dr. Cubillos ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard

View Options

View options

PDF/EPUB

View PDF/EPUB

Full Text

View Full Text

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login
Purchase Options

Purchase this article to access the full text.

PPV Articles - Psychiatric Services

PPV Articles - Psychiatric Services

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share