A Community Health Worker Model for Mental Health Care in Rural Guatemala – Needs Assessment and Training

Residents of rural communities in Guatemala suffer from high rates of depression and post-traumatic stress symptoms due to exposure to violence and dislocation during the country's 40 year civil conflict, on-going violence in the post-conflict state, family violence and severe poverty and hardship. Few resources from a meager national health budget are devoted to mental health, the majority of these going to a psychiatric hospital in the capital city, and urban services. This leaves virtually no resources or infrastructure for mental health services in remote rural communities. Sustainable mental health activities must make use of existing resources and personnel. Community health workers (CHWs) are a key component of health services in rural communities. A network of CHWs provides screening, health promotion and health services to 16 remote villages in San Lucas Toliman. CHWs receive regular training and have demonstrated a capacity to take on expanded roles in areas such as TB surveillance and child nutrition. Mental health and depression have been identified as key contributors to the overall diminished well-being of the local population. Using a participatory approach and qualitative methods, we have identified mental health concerns and a vocabulary for describing mental distress. We have developed and implemented training programs in order to build the capacity of CHWs to identify mental health concerns and intervene effectively, within the confines of their role. Our program will evolve as CHWs develop confidence and experience in their expanded role. We will present findings from stakeholder interviews and demonstrate our innovative training methods.