Work begins on the new National Mental Health and Human Rights Strategy

The Health Minister, María Begoña Yarza, the PAHO representative for Chile, Dr. Luis Fernando Leanes, and the United Nations High Commissioner for Human Rights for South America, Jan Jarab, kicked off the first round table session for the National Mental Health and Human Rights Strategy.

This initiative is intended to create policies to accompany and provide collective support for people who need it, incorporating a gender and human rights perspective as the central pillar and improving mental health care and community living.

Technical standards, regulations and protocols will be prepared through collective reflection, with the participation of professional and worker associations, scientific communities and notably, experienced experts and users.

Short-term measures

• Constitution of the Mental Health Advisory Council. This unprecedented national entity for social and public participation will have a broader scope than the protection of the rights of people with mental illness. It can play an important role in the short- and medium-term agenda in terms of redefining rights protection policies.
• Reactivation of the National Commission for the Protection of the Rights of People with Mental Illness (CONAPPREM) and the Regional Commissions (COREPPREM). Currently, an interim technical secretariat has been designated by the Public Health Undersecretary to lead this process and has begun the task, with the support of the Department of Mental Health. A regulation and a new commission is expected to be in place and supervisory actions should begin within 3 months.
• Preparation of the Technical Standard for Electroconvulsive Therapy (ECT). This will involve an update of the legislative documents that establish the standards behind the technical procedures, in order to specify application conditions, define the therapeutic indications based on the evidence available, determine the consideration of consent capacities and establish better monitoring indicators. It will be available for public consultation in July, and the process will consider experts through learning (network, clinicians, academics, scientific communities) and notably, experienced experts and users.
• Preparation of psychiatric hospitalization regulations. In addition to technical development by MINSAL (Health Ministry) teams, this incorporates a participatory process that places special emphasis on the inclusion of experienced experts and users. The draft will be available in July and it is estimated that the final version will be available in September, after the participatory process. This initiative is part of the implementation actions of Law No. 21.331, which fall to the Health Ministry.
• Preparation of the protocol for action against violations of rights that occur in contexts of mental health care. This will make it possible to standardize the approach to situations of vulnerability, activating actions by the health network, the National Commission for the Protection of the Rights of People with Mental Illness (CONAPPREM) and the Regional Commissions (COREPPREM), as well as cross-cutting areas. A draft is scheduled to be available in August and the final document, which incorporates expert input, is due to be ready in October. This initiative is also part of the implementation actions associated with Law No. 21.331.
• Implementation of a round table with the participation of the hospital community in the DIGERA working group. This group is made up of the head of the patient safety and quality department, head of the social services department, head of the networks department and the mental health unit, head of the territorial management department, technical expert on human rights and gender, and head of DIGERA. The group will work on the different areas of mental health services for people with mental illness, will examine the resource gap to achieve safety standards, and will redesign the patient care and clinical management model.

Medium-term measures

Development of the National Plan for the Deinstitutionalization of people with psychosocial disabilities living in psychiatric hospitals and clinics. A deinstitutionalization plan requires the implementation of previous steps to ensure the necessary continuity of care and avoid putting people with psychosocial disabilities at risk. The Mental Health Department (DIPRECE), in compliance with the competencies and roles of the Division, can take part in the following processes:

• Technical development and technical support for the adaptation of instruments and implementation of user needs assessment processes, for a more concrete planning of the conditions and requirements of each pathway towards deinstitutionalization. The instruments needed for this task, which can also be adapted as necessary, are the Community Placement Questionnaire (a current WHO project), and the Supports Intensity Scale (SIS) needs assessment tool.
• Assessment of the quality of services from a perspective of rights, to provide an understanding of the qualities of the services to allow and sustain deinstitutionalization processes. (WHO’s QualityRights initiative is a tool kit for building consensus and a skills training plan so that this function can be adopted by health teams and COREPPREM, for example, for short-term design and implementation, with the necessary resources).
• Policies and programs to support independent living. On the one hand, this involves the design and implementation of an interministerial policy to support independent living for people with psychosocial and intellectual disabilities, which involves multisector work and social policy that falls under the sphere of DIPRECE and DIPOL, for example. On the other hand, it involves the development of a technical standard to support independent living, which accompanies the process of restructuring and strengthening the current Protected Homes and Residences Program, led by DIGERA.
• Technical assistance for developing the network of community services, in compliance with the government program on the installation of new Mental Health Centers (COSAMs), as well as improving the quality accreditation of these services.

Comprehensive mental health law, which will promote the development of an organized network in the mental health community model and will ensure the necessary financing. Although Law No 21.331 represents necessary progress, only a broader, comprehensive mental health law will ensure a consistent budget increase for mental health (government commitment). It will secure the key aspects that make a more thorough mental health reform possible based on the development of a community care network. It will guarantee the establishment of cross-cutting policies with stable commitments and well-defined responsibilities. It will also make it possible to address the consequences and implications that a health reform will have for the broad field of mental health, based on the commitment of the Universal Health Fund. The comprehensive mental health law is one of the government’s program commitments.