Global mental health: transformative capacity building in Nicaragua

Figures & data

Table 1 Nicaraguan context: demographic and mental health facts.

Demographic facts

Mental health facts

Population: 5.9 million Poverty rate: 44.7% (2009) Literacy rate: 96.6% (2010) Infant mortality rate: 29/1,000 live births (2006) Life expectancy at birth: 74.5 years (2010)

Less than 25% of population has access to mental healthcare 1% of national health spending is allocated to mental health 90% of mental health spending is allocated to psychiatric hospitals Fewer than 3 psychiatric beds per 100,000 inhabitants 66% of municipalities have no mental health services 60% of psychiatrists are located in capital city 8% of mental health services focus on children and adolescents 2.2% of medical school class hours focus on mental health

Sources: PAHO. Health in the Americas. Washington: Panamerican Health Organization; 2012.

WHO-PAHO. Informe WHO-AIMS sobre el Sistema de Salud Mental en Nicaragua, El Salvador, Guatemala. World Health Organization and Panamerican Health Organization; 2006.

Table 2 Timeline of the collaborative process

2008 August November	Preliminary meetings at CAMH with UNAN-León faculty member Inter-Institutional Agreement at UNAN-León with CAMH staff: ‘Letter of Understanding’
2009 March November	Leadership Training at CAMH attended by UNAN-León faculty member Participatory needs assessment First International Workshop: ‘Strengthening Mental Health in Primary Care in Nicaragua’ Participant evaluation of First Workshop
2010 March	Mental Health Symposium at CAMH with Latin American Faculty
2011 February	Second International Workshop: ‘Assessment and Treatment of Addiction in Nicaragua’ Participant evaluation of Second Workshop
2012 May	First Session of Mental Health and Addiction Diploma Program at UNAN-León
2012 November	Launch of Master Program at UNAN-León

Table 3 Results of participatory needs assessment

Strengths	A large pool of motivated professionals working in mental health and addictions. New practical training programmes in mental health and addictions at UNAN-León. Political will to improve healthcare, using the Family and Community Health Model (MOSAFC). Strong networks within the country between primary healthcare providers and community agencies.
Weaknesses	Ineffective distribution of human and material resources. Lack of infrastructure and awareness. New training programmes do not focus enough on prevention and health promotion. Outdated psychosocial intervention approaches.
Expected Competencies	Early detection and brief intervention strategies. Psychosocial assessment and intervention techniques for individuals, families, and groups. Psychology and biology of addictions. Interdisciplinary work, including regional networking and international collaboration. Understanding of stigma, mental health promotion, and ethics/confidentiality.
Suggested Methodology for Diploma Programme	30 participants, selected via assessment test and interviewer: appropriate attitude and aptitude. Clinical as well as theoretical content, using case studies, group, and individual work. On-going process, with supplementary training each year. Health promotion focus (monitoring health trends, media campaigns, etc.). In-class and online learning, as well as research and fieldwork.

Fig. 1 Overall satisfaction with the capacity-building programme (2009).

Fig. 2 Overall satisfaction with the capacity-building programme (2011).

Fig. 3 Concrete learning gained from the workshop (2009).

Fig. 4 Concrete learning gained from the workshop (2011).

Table 4 Workshops: summary of qualitative findings

Year	Knowledge	Skills	Attitudes
2009	Interdisciplinary work International collaboration The national context Health promotion Disease prevention The human rights perspective	Psychosocial assessments Interprofessional work	Viewing clients as whole people Encouraging respect and empathy for clients Recognising social and economic barriers to good mental health
2011	Sociological basis for addictions care Stages of change Acceptance and recovery model Client-centred approach Treatment modalities	Motivational interviewing Narrative therapy Active listening Family integration	Viewing patients as whole people Reduced stigma regarding addiction in workplace Increased motivation

Figure 5 Educational pyramid for mental health and addiction in primary healthcare.