Peru’s mental health pivot helps youth cope during COVID-19

“Someday I’d like to make a big change in this society. I’m open-minded and I think I could adapt to any situation,” said Andre*, 14 years old, as he looked towards the hills on the northern outskirts of Lima, Peru, where he shares a small room with his mother Roxana* in his aunt’s house.

A few months before the pandemic, Roxana got a call from Andre’s school.

Roxana sought care at hospitals and private clinics, but they were either too far away or too expensive. It wasn’t until they signed up for public health insurance at the local health centre that they got a referral to the Community Mental Health Centre in Carabayllo, a 10-minute bus ride from home.

Integrated care, all in one place

Set up in a repurposed sports stadium and staffed with a multi-disciplinary team, the centre provides specialized care for people with moderate to severe mental health conditions, as well as prevention services. Diagnosed with anxiety and depression, rooted in part in his parents’ separation, Andre started meeting with the centre’s psychologist, psychiatrist, nursing staff and social worker for therapy.

“We made an integrated plan to help him understand and manage what he’s going through,” said psychologist Yesica Chambilla. “We provide him with tools to make his own changes.”

They also provide guidance to Roxana, who plays an active role in his care.

Psychiatrist Dr. Maria Saire highlights that:

From the hospital to the community

Until recently, Peru’s mental health care system was concentrated in three psychiatric hospitals in Lima. In 2013, the Ministry of Health estimated that 1 in 5 people in Peru had mental health conditions and that just 1 in 5 of those in need of care received it.

These service gaps, along with advocacy from the Ombudsperson’s Office, prompted a series of reforms to expand community-based care: adding mental health care coverage to the national health insurance scheme in 2013, establishing a mental health results-based budget programme¹ in 2014 that helped boost public spending, and passing a new national mental health law in 2019.² As a result, Peru’s network of community-based mental health care increased from 22 to 203 centres between 2015 and 2021. The centres are complemented by 30 specialized units in general hospitals and 48 halfway houses.³

“Looking ahead, there are two important challenges,” said Dr. Yuri Cutipé, Executive Director, Mental Health, Ministry of Health. “One, continuing to expand community-based services while ensuring the same quality across the country; and two, developing specific programmes for vulnerable populations as a part of a multisectoral approach.”

COVID-19’s mental toll

The pandemic put Peru’s mental health services to the test. According to an online survey conducted by the Ministry of Health and UNICEF in 2020, a third of children and adolescents experienced socio-emotional difficulties during the pandemic in Peru,⁴ where the government imposed a 106-day national lockdown that left many adults, including Roxana, temporarily unemployed and young people, including Andre, confined at home. The demand for mental health services increased.

To help address adolescent needs, the Ministry of Health, with UNICEF’s support, released technical guidelines for the comprehensive mental health care of adolescents in 2021,⁵ as well as specific guidance for the COVID-19 context in 2020.⁶ Between December 2020 and April 2021, the Ministry also piloted, with UNICEF and the NGO CEDAPP, a free mental health hotline for adolescents and their families that reached 821 people dealing with anxiety, depression and family problems.⁷

Not giving up

While the lockdown was stressful for Andre, he also credits it in part with his recovery: “The pandemic helped me instead of making things worse.” Andre spoke regularly with his psychologist by phone and spent more time with his mother and her family.

“I made up for lost time with my son,” said Roxana, who before the pandemic would only see Andre at night after returning home from work on the other side of the city.

More than a year after his first visit to the centre, Andre is experiencing positive changes.