People with Schizophrenia Empowered Through Community Care Model in Peru

Note: The following was originally published in Spanish on Socios En Salud's blog.

The community care model of Socios En Salud, as Partners In Health is known in Peru, seeks to strengthen the health system through activities that bring timely, equitable, and quality medical care to the most vulnerable communities. Thanks to strong community partnerships, the program brings people closer to health facilities and accompanies them during their treatment.

The Many Voices project, part of SES's Mental Health Program, exemplifies this model. Through community strategies aimed at the support and rehabilitation of people living with schizophrenia, 99% of program participants achieved greater adherence to treatment.

Schizophrenia, which affects approximately 1 in 300 people worldwide, is characterized by significant behavioral changes and impairments in perception, including delusions, hallucinations, disorganized thoughts and behaviors, or agitation. Around the world, people with schizophrenia often face social stigma that impacts their relationships with others; discrimination which can limit access to health care, education, housing, and employment, as well as human rights violations due to the symptoms of their condition.

There are effective treatment options including medication, education, family interventions, and psychosocial rehabilitation. Unfortunately, for many people in low- and middle-income countries, this treatment is not always accessible or available. More than two out of three people experiencing psychosis, which can be caused by schizophrenia, do not receive specialist mental health care.

The treatment and care that SES provides through Many Voices is vital in giving people with schizophrenia a sense of community and empowerment.

In 2019, Many Voices began its interventions with the Carabayllo Community Mental Health Center. Following its success, the community care model was expanded to other similar establishments to strengthen activities carried out by Peru's Ministry of Health.

"Currently, there are 307 people living with schizophrenia who are being served [by the project's community health workers], of which 306 are adhering to treatment," said Milagros Tapia, SES's Many Voices project coordinator.

From left to right: Adriana Sánchez, Milagros Tapia, Roli Marin, and Stephani Zegarra work to achieve greater adherence to treatment for the patients of the Many Voices project as members of the Mental Health Program team. Photo by Diego Diaz / PIH.

Consistent, Comprehensive Support

Treatment adherence for patients with schizophrenia is measured by monitoring medication intake and appointment attendance, including psychiatric, psychological, or occupational therapy sessions. Before beginning the Many Voices project, SES staff provide each patient with a baseline test at their local community mental health center, as explained by Tapia. After the evaluation, Many Voices assigns previously trained community health workers (CHWs) to follow up with each patient to assess progress against that baseline.

"[CHWs] check if they are taking their medications, or if they stopped taking them for some reason," Tapia said. This information is recorded in the patient's file, where other challenges, if any, are also recorded.

Each CHW conducts home visits twice a week for between 10 to 15 people living with schizophrenia and their caregivers. To monitor their adherence, the CHW will verify that the patients are taking their medications by asking them to show their prescription and either pills or injectables, and if necessary, asking them to take the medication right then.

Caregivers can also help verify that patients are taking their medication as directed. In severe cases, a caregiver or responsible family member can be responsible for providing the medication to the patient. In mild cases, patients can administer their own medication, but always under the supervision of the caregiver or responsible family member.

During their visits, the CHWs also provide mental health education as needed and link patients or their caregivers to a health facility if they are experiencing additional health conditions.

SES's CHWs also provide support to the families of people with schizophrenia. They help families navigate obtaining their National Identity Document, which can otherwise be a challenge for patients with several mental health conditions, or help complete their registration to the Comprehensive Health System, which helps provide public health insurance coverage.

"We do not work alone, but hand-in-hand with Socios En Salud's Social Protection Program," Tapia highlighted.

Care That Builds Community

Alberto Gamarra, 43, is one of the people in the Many Voices project living with schizophrenia. His mother, Milka Asís, affirms that the community support model has been important so that her son can be social and connect with his peers.

Alberto Gamarra and his mother Milka Asís. Photo by Diego Diaz / PIH.

Despite Gamarra's friendly nature, the deep-seated stigma and discrimination against people with schizophrenia did not allow him to establish friendships with other people. But Asís assured SES that his encounters with more people like him through Many Voices has reawakened his desire to build community and have friends.

Dionila Jiménez found a similar reaction from her mother, 64-year-old Agustina Dionila, who also benefits from the Many Voices project.

For her, accompaniment "has been necessary and indispensable. Now that [my mother] has been following her treatment, she has met people and has been able to function more," Jiménez said.

"This project has been good, and it is good, and I hope it continues," said Julio Gamarra, who takes care of his mother, a Many Voices project participant. "The activities keep her active, going to her group to socialize through workshops, therapy, and taking her medication."