The COVID-19 crisis has generated mental health problems among previously healthy people and has exacerbated those problems among people with existing conditions. This challenge is not new for Latin America and the Caribbean, where mental health disorders are one of the five main causes of disability-adjusted life years (DALYs). At the global level, the World Health Organization conducted a study in 130 countries between July and August of 2020. Surveys undertaken as part of the study focused on how the delivery of health, neurological, and substance abuse services has changed due to COVID-19. The results indicate, for example, that more than 60% of those surveyed experienced interruptions in mental health services for vulnerable persons, including children and adolescents (72%), older adults (70%), and women who require post- and pre-natal services (61%).

Seven issues that have exacerbated mental health problems during the pandemic are deaths among family members, chronic conditions among people who had recuperated, stress and uncertainty, domestic violence, the management of chronic care, social isolation, and the interruption of education, among many others.   

In light of such issues, the pandemic has prompted, for example, a dramatic increase from 29% to 72% in the level of anxiety of pregnant women and new mothers. Worldwide, many health workers are suffering from anxiety, depression, and exhaustion due to the crisis. Given that health services in Latin America and the Caribbean have had difficulties incorporating adequate mental health services in their systems of care, it is essential to explore new formats in order for public services in general and the health sector in particular to provide effective responses in the years ahead.

A Partnership between Tele-Medicine and Mental Health

Many providers and patients have turned to technology to provide and obtain mental health services. Therapy sessions and even meditation via Zoom and other video call platforms have been commonly used during periods of quarantine. This change, born of necessity, has been made possible thanks to regulatory changes that allow for greater access. During the pandemic, tele-medicine has offered a bridge for care and now offers an opportunity to reinvent virtual and hybrid (virtual/in-person) care models with the aim of improving access to healthcare, healthcare results, and affordability.

In the United States, 60% of the diagnoses treated in June 2021 were related to mental health. The main mental health diagnoses treated were general anxiety disorders (28.3%), major depressive disorders (23.6%), and adjustment disorders (18.3%).

Although tele-medicine is usually accepted by both patients and doctors, it also poses numerous challenges, particularly in Latin America and the Caribbean:

1. Limited access to the Internet or to devices such as smartphones, tablets, or laptops.
2. Lack of familiarity with the technology that can be an obstacle for certain patients.
3. Virtual visits might not always being appropriate for certain persons due to their level of acuity or to the need to conduct an in-person physical exam or diagnostic tests.

Tele-Medicine in Latin America and the Caribbean

In Brazil, Argentina, El Salvador, Uruguay, and other countries, the Inter-American Development Bank (IDB) is working to develop or expand tele-medicine in order to increase coverage and facilitate access to specialists.   

• In Uruguay, there was a 63% reduction in in-person outpatient consultations (including both urgent and non-urgent ones). Access to mental health services improved during the COVID-19 crisis through the use of telephone services. A total of 2,000 consultations were conducted monthly by 200 psychologists.    
• In Brazil, an interoperable health platform was put in place and tele-medicine and electronic pharmacy modules were added to facilitate 180,000 medical consultations.
• In Argentina, more than 131,000 telemedicine services were provided in 2020, seven times the number of such services provided in 2019  (18,000). 
• In El Salvador, the ECHO Project is being implemented to improve the capacity of front-line personnel to deal with the “new normal” through tele-mentoring, with support from the Universidad de la República de Uruguay, the region’s sole Super Hub for the ECHO Project. 

With the increase in anxiety and uncertainty during more than a year due to the pandemic, the mandatory quarantine prompted many people to turn to mental health professionals through tele-medicine. This could be the first step toward providing quality services, increasing access, and reducing the stigma associated with mental health in Latin American culture.

Are you interested in measuring how prepared your organization is to implement tele-medicine? Take a look at this tool from the Pan American Health Organization and the IDB:   COVID-19 and tele-medicine.