Psychiatric Training

in Latin America:
Strengths & Weaks

Guillermo Rivera, MD, PhD.

Bolivian Catholic University

 Declaration of Disclosure

“I have no significant financial or other

relationship with the services I intend
to discuss,”

 30 countries in South
America, 6 in Central
America and 13 located in
the Caribbean Basin.
 Population: 513 million
people, 60% live in South
America and 20% in Mexico
 40% of the population was
15 years or younger in the
year 2000, while individuals
60 years or older
constituted up to 10% of the
total.
 It is estimated that both men
and women in the region
have already lost at least 10
years of life by the time of
birth, compared to their
counterparts in Europe and
North America.
 The greatest majority of
people face significant
economic deprivation, low
educational levels (20% of
the total population obtain
college degrees), deficient
social infrastructure, and
weak political stability.
 The prevalence of mental disorders in communities is
18-25%.
 Between 12 and 29% of diagnosed or diagnosable
conditions are detected in children & adolescents.
 Only 1 out of 5 patients in need of treatment,
actually receive it.
 The most common mental disorders are: The
depression and anxiety in all their clinical variants,
plus somatoform and alcohol and drug abuse
disorders
 Human mental health resources in
Latin America
 1.6 psychiatrists,
 2.7 psychiatric nurses,
 2.8 psychologists,
 1.9 social workers per
100,000
 The greater concentration
is in metropolitan areas
leave unattended at least
The psychiatrist
45% of the total
are among the lowest paid
population in need. professionals
in most countries.
 General Overview
 The training takes place in insufficient facilities
with limited teaching staffs, scarce equipment,
and loose monitorization by academic centers or
governmental agencies.

 In spite of a slight growth in absolute numbers of

psychiatric vocations, for instance, the risk of
emigration by future trainees is still present.
 Mental Health Research Facilities
 Brazil, Argentina, Mexico and Chile are ahead in
resources & productivity, but Mexican authors publish
more consistently, in spite of a proportionately lower
budget than the other 3 countries.
 8 countries have institutes theoretically devoted to
mental health research, but only one (Mexico) works
consistently towards such goal.
 The others may have the infrastructure but lack in
policies, rules, operational systems and qualified
personnel. The absence of solid financial support by
the government seems to be at the root of this
discouraging reality.
Some local initiatives…

 Some countries – like Argentina, Chile, Brazil

and Venezuela - are attempting to create
international training consortia in the region,
taking advantage of their respective strengths
and making better use of technological
innovations
Taking Notice
 Brazil: significant reduction of psychiatric beds and the
establishment of networks of community care
 Chile: integration of the mental health in the network of
public health services
 Cuba: the inclusion of mental health in primary care
and the development of services for children and
adolescents.
 Mexico: “National Model of Mental Health Care Miguel
Hidalgo” that includes prevention, brief hospitalization
and social reintegration in Mexico
Brazilian Psychiatric Training
 A study leaded by Mendoça and cols,
published in february 2005, concluded that
the Brazilian psychiatric medical residency
programs did not adapt themselves to the
new reality of the psychiatry.
 Based on the recommendations of the World
Psychiatry Association, they analyzed
residency programs in Brazil and also in other
countries in America and Europe.
 Conclusions
 Brazilian psychiatric residency programs are
not up to date in relation to the training
criteria proposed by the WPA (and adopted in
several countries, including in Latin America).

 Based on the WPA model, residency

programs in Brazil need to ensure that
psychiatric residents will be provided the
minimum necessary requirements for good
quality training, respecting regional
differences.
Psychiatric training in Buenos Aires
 PT is available in some private psychiatric
hospitals and universities in the form of short
and medium term postgraduate courses, but
the major training centers are Buenos Aires
University and the city Council Schemes.
 Through working in busy out-patient clinics
and accident and emergency departments
and looking after patients with wide range of
psychiatric disorders.
Psychiatric training in Buenos Aires
 Argentinean trainees acquire vast clinical
experience.
 There´s not enough supervision, trainees are
poorly paid and in many cases, vocational
unpaid training is the cause of low morale
and lack of incentive among doctors.
 Academic activities & lectureships are
meagre, outdated and mainly based in
psychoanalisis, but in recent years it has
markedly declined
 Admission,
Graduation and
Certification Process
Program & Admission Graduation Certification
Place Requirements Procedures Process

Santiago, Application Final exam Special

Chile for postgradate Conducted certificatin
school. by the enacted by
M.D. degree. Postgradate the
School University
of the University of Chile.
of Chile.
Program & Admission Graduation Certification
Place Requirements Procedures Process

Medellin, M.D. degree. Three years of

Colombia General approved
Medicine exam , training, and two Not apply.
and an years
admission of elective
interview. research
training.
Program & Admission Graduation Certification
Place Requirements Procedures Process

Based on
Buenos M.D. degree and Completion of either a
Aires, license theoretical and mandatory
Argentina to practice clinical legal
medicine. requirementsdur Process
(Buenos ing the 3 years
Aires Evaluation of training. through the
University) conducted by a Dissertation & Health
Board of oral exam at the Ministry
Admissions. end of training.
R: e/5y
Program & Admission Graduation Certification
Place Requirements Procedures Process

M.D. degree and Completion of Certification

Montevideo, successful all training granted by
Uruguay competition requirements the Ministry
for positions in and two of Health.
medical clinical tests.
residencies.
 The curricula must have definite
objectives on terms of knowledges,
abilities and attitudes.

 Far from the traditional clinical and

individual training, now the trainees
need to use the modern biological,
psychological and sociological
methods of diagnosis, and new
concepts from neuroscience with
reasonable equilibrium between the
various axes.
 Clinical practice with ambulatory patients in
general hospitals (liaison psychiatry) and
community centers (social psychiatry), must
be practice.

 Emphasis on psychosocial research from

latinamerican reality and documentary reports
about academic, governmental and
communitary alternatives, for management of
the psychiatric services in this region is
necessary.
The Challenges
 That mental health services need to face new
cultural and technical mental health
challenges that have become more evident in
the last 15 years, such as:

1. The rising psychosocial vulnerabilities of

selected population groups, e.g.,indigenous
communities and individuals coping with
problems resulting from the chaotic
urbanization of the large metropolis
The Challenges
2. The increasing magnitude of both the
morbidity and of psychosocial problems
affecting children and adolescents;
3. The increasing societal pressure to make
available effective measures for prevention
and management of suicidal behavior and
alcohol abuse, and
4. The increment of different modalities of
violence that require an active involvement on
the part of the mental health services, with
special emphasis on thecare of the victims.
To this effect:
 To raise the awareness of governments
regarding the need to increase investment in
mental health care to confront the dramatic
burden resulting from both the morbidity and
disability of mental disorders
 To collect, document and disseminate
experiences of mental health care based in
the evidence
 To foster inter-country collaboration with
regard to programs of service development,
training and research.
The Urgent Needs
 More support of provision of care, training and
research through inter-sectorial alliances and
initiatives.
 Sharing and dissemination of applied research
findings from collaborative centers of excellence in
the region;
 Implementation and improvement of effective
Psychiatric Training Programs
 Financial collaboration and technical support from
international agencies and organizations.
 Psychiatric Training
in Latin America:
Strengths & Weaks

Guillermo Rivera, MD, PhD.

Bolivian Catholic University