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OBJECTIVE: Communication between patients and mental health professionals by means of messaging platforms in the interval between synchronous encounters became a kind of asynchronous teleconsultation (AT) whose usefulness and effect on providers' workload have not been explored. Method: Mental health providers working in Argentina were invited to answer a survey exploring the intensity and usefulness of AT, and the resulting overload. RESULTS: A total of 527 responses from professionals working throughout the country were received. As much as 69% of respondents exchanged messages with a mean of 1-10 patients/day and 31% with more than 10 patients/day; 75% answered messages over mobile phones on weekends. While 68% rated these interactions as positive for clinical follow-up, 47% considered them as a source of work overload. CONCLUSIONS: The generalized adoption of AT may require additional self-regulation by clinicians and regular monitoring of overload levels (particularly, among psychiatrists) to make their daily clinical practice efficient and sustainable.

OBJETIVOS: La comunicación entre pacientes y profesionales de la salud mental mediante plataformas de mensa- jería en el intervalo entre encuentros presenciales o virtuales se convirtió en una modalidad de teleconsulta asincrónica (TA) cuya utilidad y efecto en la carga de trabajo de los profesionales de salud mental no se han explorado. Método: Profesionales del campo de la salud mental que trabajan en Argentina fueron invitados a responder a una encuesta que exploraba la intensidad y utilidad de la TA, y la sobrecarga resultante. RESULTADOS: Se recibieron un total de 527 respuestas de profesionales que trabajan en todo el país. El 69 % de los encuestados mensajes con un promedio de 1-10 pacientes/día y el 31 % con más de 10 pacientes/día; el 75 % respondió mensajes por teléfono móvil los fines de semana. Mientras que el 68 % calificó estas interacciones como positivas para  el seguimiento clínico, el 47 % las consideró una fuente de sobrecarga laboral. CONCLUSIONES: La adopción generalizada de la TA puede requerir una autorregulación adicional por parte de los profesionales y un seguimiento regular de los niveles de sobrecarga (especialmente, entre los psiquiatras) para que su práctica clínica diaria sea eficiente y sostenible.

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Background: Mental health problems represent a growing global concern. This has intensified since the coronavirus pandemic and is also partly due to greater awareness of the extent of mental health problems and the lack of attention they have received over time. In many high-income countries, increases in service provision have been accompanied by efforts to increase the mental health literacy of the general population. One example of this in Australia, is the mental health first aid training program which is informed by the mental health first aid guidelines created to promote mental health literacy among the general population, reduce stigma, and enable lay people to provide timely support, and facilitate access to health services for a person developing a mental health problem or in a mental health crisis. Methods: Between March 2020 and May 2023, a consortium of researchers from Australia, Argentina and Chile carried out the cultural adaptation of five guidelines (drinking problems, depression, suicide risk, trauma, and psychosis) using the Delphi consensus methodology. Health professionals with expertise in each of the topics and people with lived experience (their own or as informal caregivers) from Argentina and Chile were grouped into separate panels. Over two survey rounds, they evaluated the items from the Australian guidelines and gave their opinion on the importance of their inclusion in the local guidelines. Additionally, they suggested items not included in the Australian guidelines. Results: This report presents the details of the methodology used and the most significant results of each of the five adapted guidelines, particularly, those of relevance to the Argentinian and Chilean context. The general acceptance of the role of the first aider stands out as an important outcome. However, in comparison to Australia, the first aider's role was reduced and the health professional role was expanded. Self-help recommendations were typically not endorsed by local experts, suggesting skepticism toward these strategies. Other specific recommendations for each of the guidelines are described and analyzed in this report. Conclusions: A study of the implementation of training courses based on these guidelines is required to make the necessary adaptations and determine their local usefulness.

Introducción: Los problemas de salud mental en la comunidad representan una preocupación global creciente, intensificada desde la pandemia por coronavirus y gracias a una mayor conciencia respecto de su extensión y del bajo nivel de atención que recibieron a lo largo del tiempo. En Australia se crearon las primeras guías de primeros auxilios en salud mental para promover un mayor conocimiento de temas de salud mental en la población general, brindar apoyo oportuno, facilitar el acceso a los servicios de salud por esta problemática, y disminuir el estigma asociado al padecimiento mental. Método: Un consorcio de investigadores de Australia, Argentina y Chile, entre marzo de 2020 y mayo de 2023, realizó la adaptación cultural de cinco guías (consumo problemático de alcohol, depresión, riesgo de suicidio, trauma, y psicosis) siguiendo la metodología de consenso Delphi. Profesionales expertos en cada uno de los temas y personas con experiencia vivida  (propia o como cuidadores informales) conformaron sendos paneles con miembros de Argentina y de Chile. En dos rondas de consulta evaluaron los ítems provenientes de las guías de Australia y opinaron sobre su pertinencia para formar parte de las guías locales. Adicionalmente, sugirieron ítems que no estaban contemplados en las guías australianas. Resultados: El presente reporte presenta el detalle de la metodología empleada y los resultados más significativos de cada una de las cinco guías adaptadas y, particularmente, su aplicabilidad para Argentina y Chile. Sobresale la aceptación general del rol del asistente de primeros auxilios en salud mental, aunque también con limitaciones en el rol y funciones en favor del privilegio de profesionales de la salud. Las recomendaciones de auto-ayuda fueron mayoritariamente no aceptadas por los expertos locales, sugiriendo desconfianza respecto de estas estrategias. Otras recomendaciones específicas para cada una de las guías se describen y analizan en este reporte. Conclusiones: Se requiere un estudio de la implementación de la capacitación en base a estas guías para realizar ulteriores adaptaciones y determinar su utilidad local.

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BACKGROUND: Exposure to potentially traumatic events increases the risk of a person developing a mental disorder. Training community members to offer support to a person during and after a traumatic situation may help lower this risk. This study reports on the cultural adaptation of Australian mental health first aid guidelines for individuals exposed to a potentially traumatic event to the Chilean and Argentinian context. METHODS: A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of trauma (either their own or as a carer; n = 26) and another one of health professionals (n = 41). A total of 158 items, drawn from guidelines developed by Australian experts in 2019, were translated to Spanish and evaluated in a two-round survey process. The panellists were asked to rate each item on a five-point Likert scale; statements were included in the final guidelines if 80% of both panels endorsed the item as "essential" or "important". RESULTS: Consensus was achieved on 142 statements over two survey rounds. A total of 102 statements were included from the English-language guidelines, and 40 locally generated statements were accepted in the second round. Local experts endorsed a larger number of items compared to their counterparts in Australia and emphasised the importance of acknowledging the first aider's limitations, both personally and as part of their helping role. Additional items about working as a team with other first responders and considering helping the person's significant others were endorsed by the local panellists. CONCLUSIONS: The study showed a high level of acceptance of the original actions suggested for inclusion in the guidelines for Australia, but also a significant number of new statements that highlight the importance of the adaptation process. Further research on the dissemination of these guidelines into a Mental Health First Aid training course for Chile and Argentina is still required.

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BACKGROUND: Psychotic symptoms may be less common than anxiety or affective symptoms, but they are still frequent and typically highly debilitating. Community members can have a role in helping to identify, offer initial help and facilitate access to mental health services of individuals experiencing psychosis. Mental health first aid guidelines for helping a person experiencing psychosis have been developed for the global north. This study aimed to adapt the English- language guidelines for Chile and Argentina. METHODS: A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of psychosis (either their own or as a carer; n = 29) and another one of health professionals (n = 29). Overall, 249 survey items from the original English guidelines and 26 items suggested by the local team formed a total of 275 that were evaluated in the first round. Participants were invited to rate how essential or important those statements were for Chile and Argentina, and encouraged to suggest new statements if necessary. These were presented in a second round. Items with 80% of endorsement by both panels were included in the guidelines for Chile and Argentina. RESULTS: Data were obtained over two survey rounds. Consensus was achieved on 244 statements, including 26 statements locally generated for the second round. Almost 20% of the English statements were not endorsed (n = 50), showing the applicability of the original guidelines but also the importance of culturally adapting them. Attributions and tasks expected to be delivered by first aiders were shrunk in favour of a greater involvement of mental health professionals. Self-help strategies were mostly not endorsed and as were items relating to respecting the person's autonomy. CONCLUSIONS: While panellists agreed that first aiders should be aware of human rights principles, items based on recovery principles were only partially endorsed. Further research on the dissemination of these guidelines and development of a Mental Health First Aid training course for Chile and Argentina is still required.

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BACKGROUND: Neighbors are an important component of personal social network (PSN) and despite their peripheral role and being considered as familiar strangers, they typically provide instrumental support. For people who is discharged after long-term psychiatric hospitalizations, neighbors would offer other types of social support and play a different role fostering the process of becoming full member of a given community. AIMS: To analyze the effects of neighboring on both, those who have had long-term psychiatric hospitalizations and their neighbors. METHOD: Data was collected between 2020 and 2021, including interviews with formal care staff of three housing support experiences in Argentina, and short testimonies from formerly discharged mental health service users living in the community and their neighbors. We analyzed the data using the Framework Method with a focus on the different aspects of social support and equity and reciprocity theories. RESULTS: Results suggest that emotional support was a frequent function displayed by neighbors toward people with a history of long-term psychiatric hospitalizations, which differs from typical neighboring relationships. CONCLUSIONS: Despite reciprocity was observed, users and neighbors displayed an unbalanced helping relationship.

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BACKGROUND: Suicide continues to pose a significant global public health challenge and ranks as one of the leading causes of death worldwide. Given the prevalence of suicide risk in the community, there is a significant likelihood of encountering individuals who may be experiencing suicidal thoughts or plans, creating an opening for non-health professionals to offer support. This study aims to culturally adapt the original Australian Mental Health First Aid Guidelines for suicide risk to the Chilean and Argentine context. METHODS: A two-round Delphi expert consensus study was conducted involving two panels, one comprising individuals with personal experience in suicide thoughts/attempts or caregiving for those with such experiences (n = 18), and the other consisting of professionals specialized in suicide assessment and support for individuals at risk (n = 25). They rated a total of 179 items mainly derived from guidelines developed by Australian experts and translated into Spanish (168), and new items included by the research team (11). The panel members were requested to assess each item utilizing a five-point Likert scale. During the second round, items that received moderate approval in the initial round were re-evaluated, and new items suggested by the local experts in the first round were also subjected to evaluation in the next round. Inclusion in the final guidelines required an 80% endorsement as "essential" or "important" from both panels. RESULTS: Consensus of approval was reached for 189 statements. Among these, 139 statements were derived from the English-language guidelines, while 50 locally generated statements were accepted during the second round. A significant difference from the original guideline was identified concerning the local experts' reluctance to discuss actions collaboratively with adolescents. Furthermore, the local experts proposed the inclusion of an entirely new section addressing suicide risk in older individuals, particularly focusing on suicide methods and warning signs. CONCLUSIONS: A Delphi expert consensus study was conducted to culturally adapt mental health first aid guidelines for assessing suicide risk in Chile and Argentina. This study involved professionals and individuals with lived experience. While many items were endorsed, some related to inquiring about suicide risk and autonomy, particularly for adolescents, were not. An additional section for older individuals was introduced. Future research should explore the implementation and impact of these adapted guidelines in training courses. This is vital for enhancing mental health support and implementing effective suicide prevention strategies in Chile and Argentina.

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A psychiatric reform is underway in Latin America and the Caribbean. Specifically in Argentina, a model of community mental health is being built, and prolonged psychiatric hospitalizations are still taking place, especially in neuropsychiatric hospitals. Therefore, it is necessary to closely monitor the psychiatric reform. One of the possible ways to monitor the reform is by analyzing society's attitudes towards prolonged psychiatric hospitalization as a mean of mental health treatment. Thus, an analytical observational study was conducted at the Buenos Aires Province, Argentina, in 2021, to analyze the behavior of neighbors of people who had prolonged psychiatric hospitalizations and who received housing support. Questionnaires were applied to neighbors and non-neighbors, addressing the behaviors toward prolonged psychiatric hospitalization as a mean of treatment, social distance toward people who were hospitalized, as well as specific interviews with key informants from neighborhoods where people with severe mental health disorders and who receive housing support live. Based on the answers of neighbors and non-neighbors, no statistically significant differences were identified in behaviors toward prolonged psychiatric hospitalization as a mean of treatment, nor for social distance in relation to people who were hospitalized. Key informants conditioned their assessment of prolonged hospitalization and valued the role of support teams in making community life viable.

La reforma psiquiátrica se encuentra en proceso en la región de América Latina y el Caribe. Específicamente en Argentina, el modelo de salud mental comunitaria está en construcción, siendo aún observable la presencia de internaciones psiquiátricas prolongadas, principalmente en hospitales neuropsiquiátricos. Resulta así necesario monitorear la reforma psiquiátrica, siendo una de las vías para ello el análisis de las actitudes de la sociedad hacia la internación psiquiátrica prolongada como modalidad de atención en salud mental. Así, se realizó un estudio observacional analítico en la Provincia de Buenos Aires, Argentina, en el año 2021, en donde se analizaron las actitudes de vecinos de personas que tuvieron internaciones psiquiátricas prolongadas y que recibían apoyos a la vivienda. Se hicieron cuestionarios a vecinos y no vecinos, indagándose por las actitudes hacia la internación psiquiátrica prolongada como modalidad de tratamiento, así como la distancia social hacia personas que tuvieron internaciones psiquiátricas, y también entrevistas a profundidad con informantes clave de barrios en donde habitan personas con problemáticas severas de salud mental y que reciben apoyos a la vivienda. No se identificaron diferencias estadísticamente significativas en las actitudes en relación a la internación psiquiátrica prolongada como modalidad de tratamiento de vecinos y no vecinos, ni tampoco respecto a la distancia social hacia personas que tuvieron internaciones psiquiátricas. Los informantes clave condicionaron su valoración sobre la internación prolongada, y valoraron el rol de los equipos de apoyo para posibilitar la vida en comunidad.

Uma reforma psiquiátrica está em curso na América Latina e Caribe. Especificamente na Argentina, um modelo de saúde mental comunitária está sendo construído, ainda acontecendo internações psiquiátricas prolongadas, principalmente em hospitais neuropsiquiátricos. Faz-se necessário, portanto, o acompanhamento da reforma psiquiátrica. Uma das formas de fazê-lo é analisando as atitudes da sociedade frente à internação psiquiátrica prolongada como forma de tratamento da saúde mental. Assim, foi realizado um estudo observacional analítico na Província de Buenos Aires, Argentina, no ano de 2021, onde foram analisadas as atitudes de vizinhos de pessoas que tiveram internações psiquiátricas prolongadas e que receberam apoio habitacional. Foram aplicados questionários a vizinhos e não vizinhos, questionando as atitudes em relação à internação psiquiátrica prolongada como forma de tratamento, bem como a distância social em relação às pessoas que foram internadas, e também entrevistas específicas com informantes-chave de bairros onde vivem pessoas com problemas graves de saúde mental e que recebem apoio habitacional. Com base nas respostas de vizinho e não vizinhos, não foram identificadas diferenças estatisticamente significantes nas atitudes em relação à internação psiquiátrica prolongada como forma de tratamento, nem em relação à distância social em relação às pessoas que foram internadas. Os informantes-chave condicionaram sua avaliação da hospitalização prolongada e valorizaram o papel das equipes de apoio na viabilização da vida comunitária.

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BACKGROUND: Depression is one of the most common mental health problems worldwide and, while prevalence rates in Latin America are relatively high, most people who meet the criteria for diagnosis do not receive treatment. Family and friends of a person with depression can play an important role in supporting a person to seek and engage with treatment. However, many people do not have the necessary skills or confidence to help. English-language mental health first aid guidelines have been developed to support people to provide such help. The aim of this study was to culturally adapt these guidelines for Chile and Argentina. METHODS: A Delphi expert consensus study was conducted with two expert panels, one of people with lived experience of depression (either their own or as a carer; n = 26) and one of health professionals (n = 29). Overall, 172 statements from the English-language guidelines were translated and compiled into a questionnaire. Participants were asked to rate statements based on how essential or important those statements were for Chile and Argentina and to suggest new statements if necessary. RESULTS: Data were obtained over two survey rounds. Consensus was achieved on 172 statements. A total of 137 statements were adopted from the English-language guidelines, whereas 35 new endorsed statements were generated from panel suggestions. There were similarities between the English-language guidelines and those for Chile and Argentina. The adapted guidelines did not include some of the items from the English-language guidelines related to commenting on a person's strengths or making judgements about their character, and also incorporated new items related to the incorporation of sociocultural considerations as causes of depression and attention to inequities in mental health. CONCLUSIONS: The significant number of new items underscores the importance of undertaking a careful process of cultural adaptation. Further research on dissemination and incorporation of the guidelines into the Mental Health First Aid training course for Chile and Argentina is still required.

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Objetivo: Caracterizar el impacto de la pandemia por COVID-19 en las internaciones psiquiátricas en la región de América Latina y el Caribe. Métodos: Estudio descriptivo. Se realizaron 85 entrevistas semiestructuradas con trabajadores de hospitales generales (HG) y hospitales especializados (HE) en salud mental en 18 países de la región de América Latina y el Caribe entre el 8 de mayo y el 30 de junio de 2020. Los datos se analizaron cuantitativa y cualitativamente. Resultados: Se reporta una disminución inicial en la demanda de internación, atribuida al temor de la población a acercarse a los servicios, así como a restricciones en la movilidad. Se indican criterios más estrictos para internar con una doble focalización de lo agudo dentro de lo agudo. Los tiempos de internación presentaron un comportamiento mixto, tanto de aumento como de disminución en HG y en HE. La oferta terapéutica durante la internación se vio drásticamente reducida, y se restringió la interacción de las personas internadas con sus redes de apoyo. Conclusiones: La internación pareciera estar siendo no la última, sino la única alternativa de tratamiento psiquiátrico en el contexto de la pandemia. La reducción de camas en los HE podría ser un aspecto positivo para la reforma de la atención, pero es puesto en duda, ya que dicha reducción también se produce en los HG.

Objetive: To characterise the impact of the COVID-19 pandemic on psychiatric hospitalisations in the Latin American and Caribbean (LAC) region. Methods: Descriptive study. 85 semi-structured interviews were conducted with health workers involved with psychiatric hospitalizations in general hospitals (GHs) and specialised psychiatric hospitals (SHs) from 18 LAC countries. The interviews were done between 8 May and 30 June 2020. The data were analysed quantitatively and qualitatively. Results: An initial decrease in the demand for hospitalization is reported, attributed to the population's fear of approaching health services as well as restrictions on mobility. Stricter criteria for hospitalization were reported with a double focus on the acute within the acute. The length of hospitalizations were mixed, with both increases and decreases in GHs and SHs. The therapeutic offer was drastically reduced, and interaction between hospitalised people and their support networks was restricted. Conclusions: In the COVID-19 context, hospitalization seems to be not the last but the only alternative for psychiatric treatment. The decrease in the number of beds in SHs could be a positive aspect for the reform of psychiatric care, but it is questioned since this reduction also occurs in GHs.

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INTRODUCCIÓN: El empleo es uno de los componentes centrales de la recuperación en personas con trastornos mentales severos y un aspecto clave en la validación social. El objetivo del estudio fue conocer la experiencia laboral, el interés por trabajar, las conductas específicas de búsqueda laboral, el estatus ocupacional y las actitudes frente al trabajo en esta población. MÉTODOS: Un total de 103 personas en tratamiento en una institución de salud mental de la ciudad de Buenos Aires completaron un cuestionario censal en 2018 con preguntas abiertas y cerradas. El análisis fue mixto, con cálculo y comparación de frecuencias según grupos y análisis temático. RESULTADOS: La mayoría de los participantes tenía experiencia laboral, aunque solo el 29% estaba trabajando. El 93% de quienes no trabajaban dijo tener interés en hacerlo. Solo un 33% de quienes no tenían trabajo realizaban actividades para conseguirlo. Un 85% consideró que podría tener problemas en caso de trabajar y el 15% señaló que podría hacerle mal. No se observaron diferencias significativas según diagnóstico o género. DISCUSIÓN: El elevado interés por trabajar de las personas con trastornos mentales severos contrasta con un porcentaje considerable que, pese a ello, no busca trabajo y anticipa dificultades laborales. El estigma podría ser uno de los mayores obstáculos para la búsqueda y la inclusión laboral. Los programas de apoyo al empleo deben considerar algunos de los problemas hallados en este estudio.

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