Scaling-Up Science-based Mental Health Interventions in Latin America

National Institute of Mental Health (NIMH), U19MH109988

6/1/16 – 5/31/23

Lisa A. Marsch, PhD (Geisel School of Medicine at Dartmouth College); Carlos Gómez- Restrepo, MD (Pontificia Universidad Javeriana, Bogotá, Colombia)

Beverly Pringle, PhD (NIMH); Ishmael Amarreh (NIMH), Makeda Williams (NIMH); William Torrey, MD (Dartmouth); Leonardo Cubillos-Turriago, MD, MPh (Dartmouth); Emily Scherer, PhD (Dartmouth); Sophie Bartels (Dartmouth); Miguel Uribe, MD (Consultant); Fernando Suarez, MD (Pontificia Universidad Javeriana, Bogotá, Colombia); Sergio Castro, MD (Pontificia Universidad Javeriana, Bogotá, Colombia); Viviana Cruz (Pontificia Universidad Javeriana, Bogotá, Colombia); Lina Gárafo (Pontificia Universidad Javeriana, Bogotá, Colombia); Paula Cardenas (Pontificia Universidad Javeriana, Bogotá, Colombia); Paulo Rossi Menezes, PhD (Universidade de Sao Paulo, Brazil); David Mohr, PhD (Northwestern University); Paulina Bravo, PhD (Pontificia Universidad Catolica de Chile); Aixa Contreras, MSc (Pontificia Universidad Catolica de Chile); Jaime Sapag, MD, MPh, (Pontificia Universidad Catolica de Chile); Alvaro Aravena (Pontificia Universidad Catolica de Chile); July Caballero, MD, (Peruvian National Institute of Mental Health); Humberto Castillo-Martell, MD (Peruvian National Institute of Mental Health); Ashley Kennedy (DSMB); Paola Paez (Javesalud); Yoys Landazabal (Hospital Regional de Duitama); Lilian Gonzalez (Hospital Regional de Duitama); Leonardo Ayala (Hospital Granja de Lérida); Margarita Bonilla (Hospital Granja de Lérida); Ruben Alvarado (Universidad de Chile); Pablo Martinez Camblor (Dartmouth); Sena Park (Dartmouth)

Mental health disorders are increasingly recognized as a major cause of the global burden of disease, accounting for an estimated 7.4% of the disease burden worldwide and significantly contributing to disability and death.  This challenge is particularly evident in low and middle-income countries (LMICs) where more than half of the world’s population live.  Latin America is one region of the world composed of LMICs where the burden of mental health problems is high and services for mental health are low (and account for <2% of the health budget in the region).   In the Latin American country of Colombia, 8 out of 20 individuals have a lifetime prevalence of one or more mental health disorders.  Depression and substance use, often coupled with other mental health problems resulting from endemic violence in Colombia, are particularly striking concerns in the region.  Only 11% of persons with a mental health disorder in Colombia receive mental health care.

This project brings together a broad array of stakeholders, including leading researchers in both the US and Latin America; governmental organizations (e.g., Ministry of Health in Columbia; National Institute of Mental Health in Peru); patient advocacy organizations; insurance company payers in Latin America; and non-governmental and/or multilateral organizations (PAHO/WHO; The World Bank; industry partners; and primary care systems in Latin America).

This project is designed to create a new mental health service delivery model for Latin America that will enable a rapid scaling-up of access to evidence-based mental health care.  Specifically, in this new mental health service delivery model, we plan to: (1) harness mobile behavioral health technology for mental health (with a primary focus on depression and a secondary focus on problematic alcohol and other substance abuse), (2) launch new workforce training and service delivery models (including the integration of technology into service delivery), (3) launch and evolve an integrated data management system for systematic data tracking and outcomes assessment, and (4) launch and grow a learning collaborative of organizations integrating mental health into primary care.  We will launch this project at multiple primary care sites in various parts of Colombia, with a plan to inform subsequent adoption in several other Latin American countries, including Chile and Peru.

The project includes 3 primary Cores with the following Specific Aims, respectively.

Administrative Core Aims: Support a core organizational structure and management approach to maximally benefit from a broad array of stakeholders and ensure efficient and successful coordination and integration of the activities across project Cores

Aim 1a: To provide scientific and programmatic leadership to ensure efficient and successful coordination and integration of the activities across the proposed activities

Aim 1b:  To provide a novel infrastructure to enhance synergy among an interdisciplinary expert team by facilitating productive communication, centralization of knowledge and resources, and integration of methods and results across research activities

Scale-Up Core Aim:

Aim 2: Conduct systematic, multi-site mental health implementation research in both rural and urban primary care settings with a broad group of stakeholders in the US and Latin America

Capacity Building Core Aims: Use science-based methods and information to build sustainable capacity for conducting mental health implementation research and informing mental health policies and programs in Latin America

Aim 3a:  Establish resources and an infrastructure to aid Colombia and its regional partners of Chile and Peru to build capacity for mental health implementation research

Aim 3b:   Build sustainable capacity to use science-based methods and information for developing mental health policies and programs

Link to NIMH project description

Link to project website

Overall, through the integration of Core activities, this project will create new knowledge to inform unprecedented, science-based approaches to scaling-up mental health implementation research and building sustainable research capacity and science-based policies and programs in Latin America. This project brings together an outstanding expert team to test and refine an entirely new model for delivering widespread, science-based, mental health care in Latin America. This project may also serve as an important demonstration project to LMICs globally as they tackle the significant burden of mental health disorders and scale-up access to evidence-based models of mental health service delivery.

Note:  CTBH Director, Dr. Marsch, is affiliated with the small business that developed a mobile platform tool to be used as part of this project.  This relationship is managed by her academic institution.