Providing Lifesaving Mental Health Care in Rural Chiapas

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PIH provides mental health care to hundreds of patients each year

Posted on October 7, 2022

Ángel Morales, 32, is one of hundreds of patients who have received mental health care from Compañeros En Salud. (Photo by Francisco Terán for Partners In Health)

Content warning: This story relates to suicide.

Ángel Morales is 32 years old and originally from Laguna del Cofre, Chiapas. For most of his life, Morales, like many farmers in his community, dedicated himself to growing coffee and corn—crops that provide income for him and his wife and children.

Chiapas is one of the poorest states in Mexico; many are forced to migrate to higher-income countries such as the United States to seek better opportunities for their families. In 2021, Morales migrated to work “up north.” That’s when the health problems started.

While Morales was working in the U.S., he was diagnosed with the stomach flu. Fortunately, he was able to access medical care and antibiotics and recovered. But the memory of that experience still haunted him. Negative thoughts began to snowball in his mind. What if he had experienced some serious and complicated illness? What if this illness had led to his death? What would happen to his wife and children if he was missing?

He started to isolate himself and stopped sleeping, eating, and working. He was no longer the man he had been months before. Everywhere he went, guilt, shame, and sadness seemed to follow.

He decided to return to Mexico and live with his family again. But the thoughts only grew worse.

“I couldn’t control my nerves,” he recalls. “I had panic attacks [and] headaches. My whole body ached and I couldn’t sleep.”

He began to lose hope that he would ever recover. Slowly, the impulse to take his own life became stronger and stronger.

It was at a local clinic, just steps away from his home in Laguna del Cofre, that he found help.

Morales had come to the clinic seeking treatment for the panic attacks and other physical symptoms. During his appointment, he also received a mental health screening, which led to a diagnosis: anxiety and acute depression. Within days, he began treatment, including medication and psychotherapy, working with one of the nine community mental health workers hired and trained by Partners In Health.

Comprehensive Care

Partners In Health, known locally as Compañeros En Salud, has worked in Mexico since 2011, partnering with the Ministry of Health to provide medical care and social support in the rural communities of the Sierra Madre region of Chiapas. Since 2014, Compañeros En Salud has provided mental health care at local clinics and through house calls from community health workers—care that, before the program, would have been at least five hours away.

In the years since, hundreds of patients have been able to access mental health care in an area once underserved. Between July 2018 and June 2021, Compañeros En Salud helped more than 1,200 patients access treatment for mental health conditions like depression, anxiety, and schizophrenia.

Mental health conditions have been on the rise globally, as people grapple with challenges such as the pandemic, climate change, and global inequities. Many factors put people at risk of suicide, including mental health conditions, substance use, lack of a strong support network, and physical, sexual, or psychological violence.

More than 700,000 people die of suicide each year; 77% of global suicides occur in low- and middle-income countries. In Mexico, 7,896 people died by suicide in 2020.

The mental health team at Compañeros En Salud is determined to provide care that saves lives.

The team includes mental health workers hired from the communities, trained on how to support patients with depression and anxiety, and dispatched to make home visits to patients with these conditions.

It was a community mental health worker, Zoemia Morales, who helped Ángel Morales understand his condition and develop a safety plan, which consists of healthy, effective coping strategies and sources of support in times of crisis—a tool used in combination with psychotherapy and medication.

“I like to learn about mental health because it is very different from physical pain,” she says. “Sometimes people do not realize that what is hurting them are their feelings and that is what I am here for—to give them a safe place where they can talk about it.”

Now, with Compañeros En Salud’s support, Morales is receiving mental health care and regaining his sense of freedom, fulfillment, and purpose.

“I thank Compañeros En Salud for supporting me,” he says. “They have always supported me. Even when I stopped taking my medications, they were looking out for me. That is how I have been able to get through this.”

If you or a loved one are experiencing suicidal thoughts, help is available. In the U.S., call 988 for the Suicide & Crisis Lifeline. In Mexico, call 800-911-2000 for Línea de la Vida.

Originally published on pih.org

Two years later, PIH’s co-lead psychiatrist reflects on the challenges, progress, and work yet to be done in mental health care globally. Click to learn more about how PIH’s work in mental health is grounded in Dr. Paul Farmer’s concept of accompaniment and social support for the most vulnerable.

Every person, no matter who they are or where they’re from, deserves the best health care we know how to offer.

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