Development of Mental Health Services in a Major City in Latin America: Santiago

Abstract

Two health systems coexist in Chile, with 80% of the population belonging to the public system, supported by general taxation and workers’ regular contributions, and 18% to the private health sector, financed by copayments and prepaid insurance plans, with varied coverage and costs, depending on the characteristics of each client and plan.

In 1990, the public sector initiated the formation of mental health service networks based on the community-centered model of care. In the capital city of Santiago, there are currently 147 primary care centers, 35 secondary-level community mental health centers (COSAMs), 8 day hospitals, and 7 short-stay psychiatric services, which serve approximately six million people. Primary care centers resolve around 85% of mental health complaints, typically common mental disorders, while more complex and chronic conditions are referred to COSAMs. However, problems persist in the detection and management of certain disorders, such as psychotic episodes. The lack of effective community-based psychosocial interventions involving users’ support networks, as well as prevalent stigma, has made it difficult to achieve treatment adherence and full social inclusion.

This chapter focuses specifically on mental health service developments in Santiago, while analyzing future challenges, related to incorporating psychosocial interventions into the care model, increasing capacity to detect mental health cases early on in their evolution, and orienting policies toward the promotion of the population’s mental health and subjective well-being.