The paper reviewed here is ‘Mental Health Services in Mexico’ by Berenzon and colleagues. This is a concise article which runs to just over 2 pages but which gives a useful overview of the subject. The authors describe the structure of health services in general which are broadly divided into three categories – those funded by social security for employees, private service providers for those able to afford it and provision for the poorest members of the population funded by the popular insurance scheme. Within this context, the mental health services operate and follow mental health policy and legislation from 1983 followed by a Mental Health Program of Action initiated i in 2001 and a National Health Programme that commenced in 2007. The article continues with a look at the resources in Mental Health Services, the organisation of these services, training in psychiatry, research and a look at future challenges. There were two items in the article that I found of particular interest. The first was a breakdown of resources sourced from the WHO – 44 psychologists (presumably in mental health) per 100,000 of the population compared to 2.8 psychiatrists per 100,000 of the population. The authors have included a table that allows comparison with other countries in the Americas including the USA and Cuba both of which have substantially more psychiatrists and psychiatric beds per 100,000 of the population. The other point I found quite interesting was that in rural areas there is limited access to the psychiatrist and people may instead consult ‘traditional doctors and informal agents’. Discrepancies between rural and urban mental health care extend to other countries where solutions such as telehealthcare have been adopted in an effort to utilise limited resources more efficiently. The authors note the relative concentration of mental health resources in Mexico City. After reflecting on this, I thought it would be interesting to see what relationship exists between the size of a city and the proportion of a country’s mental health resources that are accessed by the same city. So for instance, is there a linear relationship between the proportion of mental health services and the proportion of the population contained within a city or is there a non-linear relationship (e.g quadratic). In practical terms, if the population density is higher then there might be less far for both parties to travel to the consultation which in turn might impact on DNA rates. On the other hand, patients might live further away from the consultation centres or it might take longer to travel to the centres meaning that this question would benefit from an analysis of the relevant data. Similarly could such issues impact on the type of research that is carried out in different locations. These types of questions could be important. For example if we wanted to compare services between countries, would we need to compare urban centres against urban centres and rural centres likewise against their counterparts in the country of interest.
The authors have written a concise article which raises a number of questions and allow for a relatively rapid (but limited) qualitative comparison of services between countries.
Berenzon, S, Senties H and Medina-Mora E. Mental health services in Mexico. International Psychiatry. Vol 6. Number 4. October 2009. pp93-95.
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