Impacto negativo de la pandemia COVID-19 en las de atenciones ambulatorias de salud mental de la Región de Coquimbo, Chile

Introducción: La pandemia por COVID 19 ha tensionado los sistemas de salud en todo el mundo, al mismo tiempo ha generado un impacto negativo en la salud mental de la población. Los servicios de salud mental tienen el desafío de responder  a las necesidades de salud mental de la población en contextos  de emergencia sanitaria.  Objetivo: El objetivo del presente estudio, fue estimar y explicar el efecto que tuvo la pandemia COVID-19 en las atenciones de los servicios públicos ambulatorios de salud mental de la Región de Coquimbo, Chile, para lo cual se  utilizó un método mixto secuencial (DEXPLIS).  Material y métodos: En una primera etapa, se realizó un análisis de serie de tiempo ininterrumpidos en el periodo 2017-2021 de las atenciones de salud mental incluidas en el registro estadístico mensual (REM), con una disminución del 56% al año 2020 de las atenciones ambulatorias. Una segunda fase cualitativa, indagó y profundizó en los hallazgos a través de un análisis de contenido temático de las experiencias y percepciones recogidas a través de grupos focales de gestores, profesionales y representantes de la comunidad.  Resultados y conclusiones: Se concluye que existió una disminución de las atenciones ambulatorias presenciales en la región de Coquimbo. Se sostiene que ante emergencias similares es fundamental la planificación con pertinencia territorial y enfoque comunitario.  Palabras clave: Servicios de Salud Mental, Atención ambulatoria, COVID-19.

Adverse sequelae of the COVID-19 pandemic on mental health services in Chile

Objective. This study seeks to describe the adverse effects of the COVID-19 pandemic on mental health ser- vices in Chile. Methods. This study is part of ongoing multicountry research known as the Mental Health Care – Adverse Sequelae of COVID-19 study (or the MASC study) that includes seven countries. Chile is the only one in Latin America. This study used a convergent mixed methods design. The quantitative component analyzed data about public mental health care collected between January 2019 and December 2021 from the open-access database at the Ministry of Health. The qualitative component analyzed data collected from focus groups of experts that included professionals in charge of mental health services, policy-makers, service users and caregivers. Finally, the data synthesis was performed by triangulation of both components. Results. By April 2020, mental health service provision had been reduced by 88% in primary care; moreover, secondary and tertiary levels had also reduced their mental health activities by, respectively, 66.3% and 71.3% of pre-COVID levels. Negative sequelae were described at the health systems level, and full recovery had not been achieved by the end of 2021. The pandemic affected the essential characteristics of community-based mental health services, with adverse impacts on the continuity and quality of care, reduced psychosocial and community support, and negative effects on health workers’ mental health. Digital solutions were widely imple- mented to enable remote care, but challenges included the availability of equipment, its quality and the digital divide. Conclusions. The COVID-19 pandemic has had significant and enduring adverse effects on mental health care. Lessons learned can inform recommendations for good practices for the ongoing and future pandemics and health crises, and highlight the importance of prioritizing the strengthening of mental health services in response to emergencies

Governance of health care networks: Assessment of the health care integrating councils in the context of the health sector reform in Chile Gobierno de redes asistenciales: Evaluación de los consejos integradores de la red asistencial (CIRA) en el contexto

Objective. This paper aims at assessing the contribution of Chile's Health Care Integrating Councils (CIRA, Spanish acronym) to strengthening governance in health. Materials and methods. A literature review on the official documents related to the process of creation and development of CIRA was carried out; an ad hoc questionnaire was applied to all 29 health services of the country; finally, 35 semi-structure in-depth interviews were carried on a sample of six CIRA. Results. The CIRAs have become a tool for functional integration and a valuable space for dialogue, cooperation and learning for all of the actors of the Chilean public health network. Conclusions. In this study, we conclude that there is room for improvements of CIRA's role regarding governance of the health care network as long as CIRA is authorized to deal with strategic topics, such as investment in infrastructure, technology and human resources, and budgeting

Governance of health care networks: Assessment of the health care integrating councils in the context of the health sector reform in Chile.

Objective. This paper aims at assessing the contribution of Chile’s Health Care Integrating Councils (CIRA, Spanish acronym) to strengthening governance in health. Materials and methods. A literature review on the official documents related to the process of creation and development of CIRA was carried out; an ad hoc questionnaire was applied to all 29 health services of the country; finally, 35 semi-structure in-depth interviews were carried on a sample of six CIRA. Results. The CIRAs have become a tool for functional integration and a valuable space for dialogue, cooperation and learning for all of the actors of the Chilean public health network. Conclusions. In this study, we conclude that there is room for improvements of CIRA’s role regarding governance of the health care network as long as CIRA is authorized to deal with strategic topics, such as investment in infrastructure, technology and human resources, and budgeting

Análisis de la gobernanza en la implementación del modelo comunitario de salud mental en Chile

El presente artículo describe y analiza el rol que ha jugado la gobernanza en el desarrollo del modelo comunitario de salud mental en Chile. Se describen y analizan cinco dimensiones de la gobernanza: 1) el desarrollo de una serie de estrategias para favorecer la participación de los usuarios de servicios de salud mental ha logrado resultados insuficientes; 2) la implementación de tres planes nacionales de salud mental, que han mantenido la misma visión estratégica a lo largo de tres décadas, han contribuido a aumentar la accesibilidad a la atención comunitaria de las personas con enfermedades mentales y disminuir el rol de los hospitales psiquiátricos; 3) la inexistencia de una ley de salud mental persiste aún como un desafío, aunque haya sido parcialmente compensada por distintas leyes y decretos; 4) las regulaciones en la asignación de los recursos financieros, la formación del recurso humano y las directrices técnicas han contribuido a mejorar el acceso y la calidad de la atención; y 5) la construcción progresiva de un sistema de información en salud mental ha permitido conocer principalmente las tasas de acceso, las brechas de tratamiento y las inequidades geográficas. La experiencia chilena confirma la importancia de aplicar un conjunto de estrategias y mecanismos de gobernanza, para favorecer el desarrollo y el funcionamiento de los servicios de salud mental. El tipo de estrategias y mecanismos de gobernanza podrán variar en los distintos países según los contextos y las ventanas de oportunidades