Paper promises: Peruvian frontline health workers' perspectives on mental health policies during COVID-19.

Governments globally deployed various non-pharmacological public health measures to respond to the COVID-19 pandemic (i.e. lockdowns and suspension of transportation, amongst others); some of these measures had an influence on society's mental health. Specific mental health policies were therefore implemented to mitigate the potential mental health impact of the pandemic. We aimed to explore the implementation of mental health regulations adopted by the Peruvian health system by focusing on the care services at Community Mental Health Centres (CMHCs), based on the experiences of health workers. We conducted a phenomenological qualitative study to understand the implementation of mental health policies launched in Peru during the COVID-19 pandemic. Data were obtained from a document review of 15 national policy measures implemented during the pandemic (March 2020 to September 2021), and 20 interviews with health workers from CMHCs (September 2021 to February 2022). The analysis was conducted using thematic content analysis. Most implemented policies adapted CMHC care services to a virtual modality during the COVID-19 pandemic; however, various challenges and barriers were evidenced in the process, which prevented effective adaptation of services. Workers perceived that ineffective telemedicine use was attributed to a gap in access to technology at the CMHCs and also by users, ranging from limited access to technological devices to a lack of technological skills. Further, although mental health promotion and prevention policies targeting the community were proposed, CMHC staff reported temporary interruption of these services during the first wave. The disparity between what is stated in the regulations and the experiences of health workers is evident. Policies that focus on mental health need to provide practical and flexible methods taking into consideration both the needs of CMHCs and socio-cultural characteristics that may affect their implementation.

Provision of community mental health care before and during the COVID-19 pandemic: A time series analysis in Peru.

BACKGROUND: A consequence of the COVID-19 pandemic was that the provision of mental health services was reduced in several countries around the world, while the demand for mental health services increased. AIMS: Our study aims to determine any variation in the number of users served, health appointments, and care activities conducted at 58 Peruvian community mental health centers (CMHCs) between March 2019 and October 2021. METHODS: Our study used an observational design and analyzed information from the care provided in CMHCs. We evaluate the number of users served, health appointments, and care activities performed per month. The main statistical analysis used segmented regression with Newey-West standard errors, taking into account each month of the evaluation. RESULTS: We had 988,456 unique users during the period evaluated. Regarding diagnoses, 7.4% (n = 72,818) had a severe mental problem, 39.4% (n = 389,330) a common mental problem, and 53.2% (n = 526,308) others health problems. The study found a reduction in the number of users served and health care appointments at the 58 CMHCs in March 2020, the month in which the closure measures were declared to reduce COVID-19 infections in Peru. This reduction was followed by an upward trend in the three variables during the pandemic in the 58 CMHCs studied. In, November 2020, 9 months after the pandemic started, the deficit in the average number of users served per month was recovered. CONCLUSIONS: Our study suggests that CMHCs in the Peruvian system were able to regain care capacity approximately 1 year after the pandemic. In addition, we discuss the efforts made to respond to mental health needs in the context of a global health crisis.

Experiencias de usuarios y familiares sobre la atención recibida en centros de salud mental comunitaria de Lima y Callao durante la pandemia de la COVID-19 / Experiences of users and family members on the care received at community mental health centers in Lima and Callao during the COVID-19 pandemic

Objetivos. Comprender las experiencias de usuarios nuevos y continuadores de los Centros de Salud Mental Comunitaria (CSMC) de Lima y Callao, y de sus familiares, en relación a la atención en salud mental que recibieron durante la pandemia de la COVID-19. Materiales y métodos. Estudio cualitativo realizado entre septiembre del 2021 y febrero del 2022, en el que se entrevistó a 24 usuarios y familiares que interactuaron con los servicios brindados por tres CSMC de Lima y uno del Callao, durante la pandemia de la COVID-19. Se realizó un análisis temático de las entrevistas transcritas. Resultados. Los informantes percibieron que la pandemia exacerbó los síntomas de las personas con problemas de salud mental. Durante la pandemia, las atenciones de salud mental se apoyaron en el uso de tecnología, principalmente de llamadas telefónicas, las que sirvieron para monitorear el estado emocional y el tratamiento farmacológico de los usuarios, así como para programar y recordar citas. Los usuarios destacan que las llamadas telefónicas frecuentes les hicieron sentirse acompañados y resaltan el compromiso de los trabajadores de los CSMC. Como dificultades, reportan el incremento en la demanda de atención, problemas para acceder a videollamadas, y menor calidad en las atenciones virtuales. Conclusiones. La COVID-19 impactó emocionalmente a las personas con problemas de salud mental, a su vez, los servicios de los CSMC vieron afectada la modalidad (presencial o virtual), recursos, frecuencia, tiempo y calidad de la atención, encontrando limitaciones y beneficios en el uso de la tecnología.

Objective. To understand the experiences of new and continuing users of Community Mental Health Centers (CMHC) of Lima and Callao, and their relatives, regarding the mental health care they received during the COVID-19 pandemic. Materials and methods. Qualitative study conducted between September 2021 and February 2022, in which we interviewed 24 users and family members who interacted with the services provided by three CMHCs in Lima and one in Callao during the COVID-19 pandemic. We carried out a thematic analysis of the transcribed interviews. Results. Participants perceived that the pandemic exacerbated the symptoms of people with mental health problems. During the pandemic, mental health care relied on the use of technology, mainly telephone calls, which were used to monitor the emotional state and pharmacological treatment of users, as well as to schedule and remember appointments. The users emphasized that frequent telephone calls made them feel accompanied and highlighted the commitment of the CMHC workers. Among the difficulties, they reported an increase in the demand for care, problems in accessing video calls, and low quality in virtual care. Conclusions. COVID-19 had an emotional impact on people with mental health problems; in turn, CMHC services were affected by the type of care (face-to-face or virtual), resources, frequency, time and quality of care, finding limitations and benefits in the use of technology.

Characteristics of undergraduate and second speciality mental health programmes in Peru: a cross-sectional study.

BACKGROUND: This study aims to describe the training offered and the availability of professionals required by the Ministry of Health for mental health problems management in the community. METHODS: A cross-sectional study was carried out on the training offered in mental health in Peruvian universities. A search for programs was conducted using the University Information System database and universities' websites, as well as using the Ministry of Health's database on health personnel and data on the number of enrolled and current students provided by the University Information System database and the Transparency section of the universities. RESULTS: There were 214 undergraduate, 55 specialty and 7 subspecialty programmes, of which 39%, 47% and 100%, respectively, were offered in the capital city. The duration ranged from 5 to 7 years for undergraduate programs and from 1 to 3 years for subspecialty and second specialty programs. The cost of undergraduate programs ranged from free of charge up to USD 6863.75 for the first semester of study. Second specialty programs ranged from 720 up to 11 986 USD and subspecialty programs ranged from 2267 up to 9138 USD, with medicine being the most expensive. On the other hand, there are a greater number of psychology students (n = 78 781) pursuing undergraduate studies than working professionals (n = 5368), while in the second specialty of psychiatry there are far fewer students pursuing the specialty (n = 67) than working professionals (n = 454). CONCLUSIONS: The problem of professional training in mental health requires that the institutions involved in health and education develop policies to decentralize programs, communicate the demand for professionals in certain areas, make them accessible to the low-income population, respond to mental health problems and guarantee their quality. On the other hand, regarding the low number of mental health personnel working, it is suggested to increase the mental health budget to generate more mental health services and employment.

Ethical implications in the evaluation of complex contexts related to COVID-19

Background: The pandemic caused by Sars-cov-2 has generated multiple sustained efforts for its identification, characteristics and mobility of the disease that to date has repercussions worldwide. Given this need, it is necessary to have updated information considering transparent research processes. Method: A critical review of the current literature on COVID-19 research. Conclusions: It is essential to have ethical procedures in the different phases of research that can go beyond personal interests and that guarantee the preservation of people's welfare in the reduction of possible damage to health globally, adequate procedures in the collection of information that is not built to the measure of the researchers, to avoid involuntary segregation of the participants and that this leads to a reduction of significant damage due to implicit biases that are generated by poor planning that pursues the scoop instead of social good.

Introducción: La pandemia ocasionada por el Sars-cov-2 ha genero múltiples esfuerzos sostenidos para su identificación, características y movilidad de la enfermedad que hasta la fecha tiene repercusión a nivel mundial y ante esta necesidad es necesario contar con información de actualiza teniendo en cuento procesos claros de investigación. Método: revisión crítica del cuerpo actual de literatura sobre investigación en COVID-19. Conclusiones: Es imprescindible contar con procedimientos éticos en las diferentes fases de investigación que puedan ir más allá de los intereses personales y que garanticen la preservación del bienestar de las personas en la reducción de posibles daños en la salud de manera global, adecuados procedimientos en la recolección de información que no se encuentren construidos a la medida de los investigadores, para evitar una segregación involuntaria de los participantes y que esto conlleve en una reducción de daños significativos por sesgos implícitos que son generados por una mala planificación que persigue la primicia en lugar de un bien social.