Moving Beyond the Apparent - One step at a time

Juan leaving our meeting.

There are some things that are just universal. They transcend geography, cultural differences, and even socioeconomic variables. They are the big, gnarly challenges that policy makers, service providers, and thought leaders wrestle with on a regular basis.  The problem, they are not always so readily apparent. They require a deeper level of inspection and understanding.
 
One big, gnarly challenge is the need for expanded access to evidence based mental health and psychiatric services. This is particularly true in developing and middle income environments where infrastructure development and professional formation have not had the benefit of decades long investment. Please don’t get me wrong, we are far from perfect in the U.S. and Western Europe. When it comes to access to evidence based mental health and psychiatric services, we are no where near perfect. It’s just that we’re about 40-years ahead of the developing world.
 
One afternoon in Arequipa on this last trip to Perú, I had the pleasure of meeting with a young man who I had previously work with around accessing mental health supports. I will call him Juan. Juan is in his late twenties. He lives with his sister and her family. He is a shy man who can seem to blend in with his surroundings. A few years back, people in the small town in the mountains where Juan lived with his parents started to notice “strange” behavior. They noticed that he would talk to himself and often isolate from others for days at a time. They noticed that he was erratic in his behavior, bouncing between emotions. One day Juan’s parents decided the best thing they could do was get Juan to a major city for help. So, Juan loaded on a bus and took the long trip to Arequipa. 
 
The plan was for him to stay with his sister and find help. However, finding help was not so easy. Advocating into mental health services can be a trying proposition under the best of circumstances. It requires a good understanding and knowledge of health systems navigation and a lot of self-advocacy skills. Juan had neither. Nor did his family. So, for weeks Juan lived an isolated and lonely life in an impoverished community outside of Arequipa.
 
It just so happened that a group of U.S. physicians working with HBI were in Arequipa. Juan’s sister asked if one of the doctors would see him. They met with Juan and his sister. A plan was set and medication was started. When the team left, they met with Juan and his sister to ensure critical next steps were defined. Everything was in place.
 
A few months later I was in Arequipa. Juan’s sister asked if I would meet with him. He was not doing well. He was isolating again and she wasn't sure what to do. I contacted a psychiatrist colleague in the States and asked for some advice. She provided a psychiatric assessment tool. We administered the tool with Juan. He clearly met criteria for schizophrenia. The next step was to get him into care. We met Juan and his sister, provided as much information as we could and offered to go to the appointment with them. In the end, it took a few weeks – and a number of meetings – but Juan did get into care.
 
He is now meeting with a psychiatrist twice per week for therapy sessions. He is taking his medication. He’s been playing football in the community and helping his sister in the kitchen. He is slowly beginning to recapture the life he deserves.
 
I am, however, left with a deep sense of sadness. Juan is doing great – but what happens to people who don’t have the sort of safety net or support that Juan was able to pull together? Where do they go? What kind of care do they receive? I think the next great challenge for HBI will be collaborating with partners around the world to truly think about how to best help build a safety net to advance access to mental health and psychiatric services and supports. Similar to the work we are doing on the Ines Project, helping families with medically fragile children gain access to the knowledge and skills they need to build their own futures, I think there is a great opportunity to build the kind of bridges that will support better access to evidence based mental health and psychiatric services for all people.
 
Now, where to begin? It will not be an easy process – though that’s never been a deterrent for us in the past. It is an important one. So we will do, as they say in Perú, Paso a Paso - one step at a time.

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