Original research strengthening research capacity and

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Original research Strengthening research capacity and, in particular, for evidence- based mental health reforms; Increasing and improving the public health capacity of mental health leaders; Strengthening the capacity of the ministries of health in implement- ing mental health policy; Promoting international coopera- tion in capacity building, research, and policy development. In addi- tion, outpatient mental health care needs to be decentralized; Collaborative mental health care integrated with primary care needs developing and expansion; Primary child and indigenous men- tal health needs to be prioritized; and National mental health informa- tion systems need to be devel- oped and strengthened. Progress in reducing the mental health treatment gap in the Americas has been slow. In Latin America, the lack of financ- ing and political will have prevented the scaling up of mental health, which has resulted in integrated care, community mental health, and psychosocial rehabili- tation not being successfully imple- mented in the Region on a large scale (51). There are a number of examples, how- ever, of programs that were developed to integrate mental health with community care in Argentina, Belize, Brazil, Chile, Cuba, Jamaica, and Mexico (52); some of these programs have undergone rigorous evaluation, but not all. The Chile National Depression Treatment Program in pri- mary care is touted as a model (53). One of the more notable programs has been the Mental Health Gap Action Pro- gram (mh-Gap). The mh-Gap aims to re- duce the treatment gap by scaling up mental health care in primary care settings and capacitating primary care providers (PCPs) to become the gateway to mental health care. Additionally, an mhGap goal is to reduce barriers to mental health care in the primary health care settings by scaling up PCPs’ knowledge. Well-designed con- trolled studies of mhGap in the Americas are needed, particularly given the failure of other initiatives to train PCPs to provide mental health care in the Region (54). To be successful, interventions should be customizable, transportable to different settings, and have a delineated process for knowledge transfer. As changes at the dif- ferent levels of the mental health systems are implemented, outcome measures need to be included as quality indicators. For example, repeating the WHO-AIMS at specific intervals could be used as a mea- sure of progress. Quality indicators mea- sured at the local level and at the Ministry of Health level need to be established and implemented. At the national level, mental health indicators that could be monitored for adult, children, indigenous popula- tions, and the severely mentally ill in- clude: the number of beds dedicated to mental hospitals, general hospital psychi- atric units, day programs, and rehabilita- tion programs, in both the private as well as the public sector; the rate of involuntary hospitalizations; length of stay in mental hospitals and psychiatric units in general hospital; primary care treatment of men- tal illness; human resources; and expendi- tures for mental health. Mental health
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