Socios En Salud, through its Mental Health Program has helped more than 111 500 patients access mental health care services in the midst of COVID-19.
Content warning: this story contains a brief general mention of suicidal ideation.
”If I don’t work today, tomorrow we have no income. At that moment is when negative thoughts invade my mind and I feel that I can no longer cope with so much need.”
In Lima, every 22 minutes a person attempts suicide according to epidemiological studies by the Instituto Nacional de Salud Mental (INSM). For its part, the World Health Organization reported that each year about 703 000 people take their own lives.
During COVID-19, the virus that has claimed millions of lives worldwide and forced millions more to spend weeks in isolation. The mental health of the population has been exacerbated by lack of access to quality health care, rising unemployment, and food and housing insecurity among others.
Suicidal ideation: beyond depression
It’s 4:00 a.m. and Gabriel* is ready to go to work. He looks in the mirror and sees the reflection of an exhausted and sad man. Three months ago he lost his mother and did not have the opportunity to be by her side in her last days, as she lives in Cuzco and he lives in Lima.
On a daily basis, Gabriel has to compete with several drivers to rent a mototaxi. It is always on a first-come, first-served basis, and there have already been days when only a few minutes apart prevent him from working.
For years, Gabriel has dealt with negative thoughts, related to his depression, but when the COVID-19 spread through San Juan de Lurigancho he became unemployed and the struggle to get food on his table became more complicated. He could feel his depression deepening. There were days when he did not want to live, but even in his darkest moments, he was not alone. His wife, Maria*, identified the warning signs and was sure who to turn to.
Psychologist and director of the Mental Health Program at Socios En Salud, Carmen Contreras says the links between depression and suicide are getting shorter and shorter. “According to data in our country, half of the people diagnosed with depression have presented suicidal ideation at some point in their lives. Therefore, it is important to identify the warning signs in a timely manner and seek professional help. In addition to involving the family and the local social environment to address this issue and provide a sustainable community response especially to primary mental health care,” he explained.
For more than 25 years, Socios En Salud in partnership with the Ministry of Health, has fought to break down barriers to health access, and mental health has been one of its key programs. As the Socios En Salud team focused on the overall COVID-19 response, through security protocols and supply chains, the mental health team focused its attention on identifying patients in need of mental health care, providing emotional support and connecting them with that care through the search for cases that merited attention by community health agents specialized in mental health or through the chatbot BienEstar, a technological tool that the Mental Health Program in coordination with the Ministry of Health launched last year to connect patients with psychologists, virtually and provide mental health care and attention.
From patients experiencing multiple emotions of uncertainty, worry and fear of COVID- 19 contagion to those dealing with the death of their loved ones. The health care never stopped in the communities where Socios En Salud worked. The team kept going. No problem was too small and no condition, too complicated.
From July 2020 to March 2021, BienEstar reached more than 111 500 people in Carabayllo, San Juan de Lurigancho, Callao and Trujillo, providing mental health care ranging from psychological first aid to bereavement therapy, and helping patients cope with depression, alcohol and drug use, suicidal ideation and a variety of other mental health conditions.
Step by step
When Maria noticed her husband’s behavioral changes worsening, she decided to share her concerns with a trusted ally in the community: Socios En Salud. While filling out screening questions for Socios En Salud’s Early Child Development ProgramCASITA, focused on identifying risk or delay in child development among girls and boys under 24 months of age where her son is enrolled, she mentioned Gabriel’s depression and what was happening at home.
Within a few days, Lucia Caparachin, a psychologist with Socios En Salud’s Mental Health Program, was assigned. Over the next few weeks, Caparachin provided care and emotional support to Gábriel through the Psychological First Aid strategy, a World Health Organization intervention that provides group and individual counseling to help patients manage anxiety, depression and stress.
The change was slow, but significant, and Caparachin saw it firsthand.
Gabriel’s mood is improving. He is coping with his problems and accepting emotional support from those around him. He is identifying things that were causing him stress and discovering ways to reduce that stress or reframe his thinking.
“Having the support of his family and Partners In Health has been key to improving his physical and mental health,” Caparachin says.
“They give me strength.”
Mental health professionals like Caparachin are careful to emphasize that mental health is not a linear process; it’s an ongoing journey. When it comes to caring for chronic depression, he says, it’s crucial to check in with patients regularly and be aware of any changes that could affect their mental health and exacerbate their depression.
Gabriel has improved his mental health however, he needs to receive the attention and care of a mental health specialist on an ongoing basis. So the Mental Health Partners In Health Program made the referral to the Cruz de Motupe Health Center. Likewise, it is in charge of requesting appointments for her psychological care and monitoring her attendance to psychological support sessions every week.
It has only been a few weeks, but the sessions have already helped substantially.
Also, Gabriel goes to the said health facility every month for his medication pick-up, as he takes 4 pills daily to treat the diabetes and high hypertension that has afflicted him for the past 3 years.
”The treatment of depression in any chronic patient, as is the case with diabetic patients, requires constant monitoring. It is necessary to be aware of which changes or aggravations in the state of health will exacerbate depressive symptoms. Therefore, it is essential to work with the family and with the patient’s expectations of improvement, providing coping strategies and mental tolerance to suffering, strengthening the patient’s sense of life with the highest values, which are affective, and in the case of Mr. Gabriel, his tender and solid family,” recommended Lucia Caparachin.
With the arrival of the second wave, Gabriel was infected with COVID-19, forcing him to remain isolated from his family and leaving him without the possibility of working. Faced with this situation, the Social Protection Program of Socios En Salud was able to provide him with nutritional support through the delivery of food vouchers necessary for the family basket.
“No matter how many stones there are in our way, we always try to get ahead. Even if we are tired, we get strength from where there is none and we go on. We don’t want luxuries, the only thing we always ask for is health and to have bread on the table to eat,” said Maria.
Gabriel dreams of one day driving his own motorcycle cab and thus saving money to pay for the upcoming educational expenses of his children.
“My family is the most important thing I have,” he says. “They give me the strength and courage to keep going.” Step by step, Gabriel is moving forward.
At Partners In Health we will continue to promote the development and strengthening of comprehensive care and disease prevention strategies to build a country with a better quality of life for the community.
If you need help or know someone who needs it, call the toll-free hotline 113 or go to the health facility closest to your home. You can also request specialized care at the Community Mental Health Centerss nationwide.