Development of mental health first-aid guidelines for psychosis: a Delphi expert consensus study in Argentina and Chile.

BACKGROUND: Psychotic symptoms may be less common than anxiety or affective symptoms, but they are still frequent and typically highly debilitating. Community members can have a role in helping to identify, offer initial help and facilitate access to mental health services of individuals experiencing psychosis. Mental health first aid guidelines for helping a person experiencing psychosis have been developed for the global north. This study aimed to adapt the English- language guidelines for Chile and Argentina. METHODS: A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of psychosis (either their own or as a carer; n = 29) and another one of health professionals (n = 29). Overall, 249 survey items from the original English guidelines and 26 items suggested by the local team formed a total of 275 that were evaluated in the first round. Participants were invited to rate how essential or important those statements were for Chile and Argentina, and encouraged to suggest new statements if necessary. These were presented in a second round. Items with 80% of endorsement by both panels were included in the guidelines for Chile and Argentina. RESULTS: Data were obtained over two survey rounds. Consensus was achieved on 244 statements, including 26 statements locally generated for the second round. Almost 20% of the English statements were not endorsed (n = 50), showing the applicability of the original guidelines but also the importance of culturally adapting them. Attributions and tasks expected to be delivered by first aiders were shrunk in favour of a greater involvement of mental health professionals. Self-help strategies were mostly not endorsed and as were items relating to respecting the person's autonomy. CONCLUSIONS: While panellists agreed that first aiders should be aware of human rights principles, items based on recovery principles were only partially endorsed. Further research on the dissemination of these guidelines and development of a Mental Health First Aid training course for Chile and Argentina is still required.

Experiencias, actitudes y expectativas laborales de personas con trastornos mentales severos en un hospital de día del sector privado / Experiences, attitudes and expectations towards work among individuals with severe mental disorders in a private day hospital

INTRODUCCIÓN: El empleo es uno de los componentes centrales de la recuperación en personas con trastornos mentales severos y un aspecto clave en la validación social. El objetivo del estudio fue conocer la experiencia laboral, el interés por trabajar, las conductas específicas de búsqueda laboral, el estatus ocupacional y las actitudes frente al trabajo en esta población. MÉTODOS: Un total de 103 personas en tratamiento en una institución de salud mental de la ciudad de Buenos Aires completaron un cuestionario censal en 2018 con preguntas abiertas y cerradas. El análisis fue mixto, con cálculo y comparación de frecuencias según grupos y análisis temático. RESULTADOS: La mayoría de los participantes tenía experiencia laboral, aunque solo el 29% estaba trabajando. El 93% de quienes no trabajaban dijo tener interés en hacerlo. Solo un 33% de quienes no tenían trabajo realizaban actividades para conseguirlo. Un 85% consideró que podría tener problemas en caso de trabajar y el 15% señaló que podría hacerle mal. No se observaron diferencias significativas según diagnóstico o género. DISCUSIÓN: El elevado interés por trabajar de las personas con trastornos mentales severos contrasta con un porcentaje considerable que, pese a ello, no busca trabajo y anticipa dificultades laborales. El estigma podría ser uno de los mayores obstáculos para la búsqueda y la inclusión laboral. Los programas de apoyo al empleo deben considerar algunos de los problemas hallados en este estudio.

Understanding Users' Perspectives of Psychosocial Mechanisms Underpinning Peer Support Work in Chile.

This study explores the beliefs and attitudes about the psychosocial mechanisms of peer support work among users who participated in Critical Time Intervention-Task Shifting (CTI-TS), which tested the acceptability and feasibility of a peer support work model to improve community-based mental health care for individuals with psychosis in Latin America. We conducted a secondary analysis of 15 in-depth interviews with CTI-TS participants in Chile, using the framework method and defined the framework domains based on five major mechanisms of peer support work identified by a recent literature review. The analysis revealed that users' perceptions of peer support work mechanisms were strongly shaped by personal motivations, beliefs about professional hierarchies, familial support, and the Chilean mental health system's incipient recovery orientation. The findings underscore the importance of adopting culturally tailored strategies to promote peer support work, such as involving mental health professionals and fostering equal-powered relationships between PSWs and users.

Mental illness stigma research in Argentina.

Studies regarding stigma towards mental illness in Argentina blossomed after the first National Mental Health Law was passed in 2010. Methodological limitations and contradictory results regarding community perceptions of stigma hinder comparisons across domestic and international contexts but some lessons may still be gleaned. We examine this research and derive recommendations for future research and actions to reduce stigma. These include tackling culture-specific aspects of stigma, increasing education of the general population, making more community-based services available and exposing mental health professionals to people with mental illness who are on community paths to recovery.