Abstract
Implementation Challenges in Treatment of Psychosis in Chile: The Role of Infrastructure and Resources
APHA 2022 Annual Meeting and Expo
Background: In 2005, a comprehensive healthcare reform took place in Chile which guaranteed treatment of schizophrenia regardless of the type of health insurance coverage. However, goals set by the Chilean Ministry of Health concerning improved mental health treatments and first-episode psychosis (FEP) prevention have not been met. OnTrack is a psychosis treatment program successfully implemented in the United States. The present study examines the implementation challenges of OnTrack in Chile, with a particular focus on infrastructure and resource limitations, and discerns strategies to address these barriers in the Chilean healthcare system.
Method: Semi-structured interviews were conducted with stakeholders, including policymakers (n=5), community mental healthcare managers (n=4), and mental health professionals (n=8). Patients (n=2) and family members (n=13) participated in focus groups (n=6). Interviews were conducted in Spanish by mental health professionals, transcribed verbatim, and translated to English by native bilingual translators. Participants’ roles, quotes relating to their experiences, and opinions were analyzed based on thematic analysis.
Results: Lack of infrastructure and resources were recognized by participants as relevant implementation challenges of OnTrack Chile. Stakeholders identified barriers to the feasibility of the treatment program due to limited physical space, time, economic, and human resources. Importantly, the lack of financial resources deterred mental health professionals from attending necessary training as access to training may be impacted due to the need to utilize working hours to deliver services to patients. In sum, the demands of OnTrack accompanied by the lack of necessary infrastructure were underscored by stakeholders as generating stress for professionals who are already under high pressure. Strategies to alleviate the impact of limited resources include increasing available budget for the treatment program and hiring more personnel. Rehabilitation was also highlighted by participants as a vital component in preventing relapse and thus reducing burden on current resources.
Discussion: Results consistently demonstrated participants’ concerns regarding the training and supervision of professionals as important challenges. Ultimately, our findings suggested that the successful implementation of this psychosis treatment program depends on the capacity of Chilean mental health centers to overcome the challenges imposed by lack of resources and infrastructure.