The Research Study 3 2.1. Background of the Study 2. The Research Study Mental disorders account for 22% of diseases within Latin America and the Caribbean, as noted in the World Health Organization’s (WHO) recent mental health assessment in 2009 (“WHO-AIMS,” pg. 9). In 1990, rough estimations showed that neurological and mental disorders within these regions were reported at 8.8% (pg. 11). This shows a dramatic increase in the rate of occurrences for countries located in this region. The Pan-American Health Organization (PAHO) states in their 2005 study on community-based mental disorders that there is a 1% annual increase for affective psychoses, 4.9% for major depression, and 5.7% for alcohol abuse and substance dependence (pg. 11). Within this framework the majority of services available to populations in need are located within capital cities and urban areas (pg. 37; Santana and Rathe, pg. 93). Though most servicing is centralized, the current most affected areas are rural. Of the six countries evaluated by the who, the Dominican Republic reported that rural users are substantially underrepresented in their use of inpatient and outpatient services (“WHO-AIMS,” pg. 22). Given this situation, it is of extreme importance to identify what services are available to rural users and the rates of occurrence in order to provide servicing and highlight any links that may occur with other national problems such as drug usage and HIV/AIDS. While servicing is limited in rural populations, providers have managed to persevere with the resources at their disposal. Primary care health providers are the main purveyors of mental health servicing in rural areas, though they are poorly trained to handle psychosocial problems. Data collected on mental health training for physicians and nurses in the Dominican Republic shows that 4% of training hours are devoted to mental health in nursing schools and 3% in medical schools or faculties ("WHO-AIMS,” pg. 25, Table 9).
4 Research and Ideas Series While solutions to evolve a more efficient and effective social and health system are elusive, new explorations are needed to better understand how to efficiently address mental health disorders within the Dominican Republic. Mental health disorders have a tremendous impact on a country’s resources, its levels of poverty, and future projections. The need for research on this topic must to be addressed to optimize the health resources available to this population in need and to highlight any pertinent findings. Treatment gaps identified in studies show a correlation between lack of servicing, poor health, and premature deaths (Celentano et al, 2008). Research shows that there is a strong link between development outcomes and mental health status (WHO, 2004; Herman et al, 2005). New research in this area will help contribute to closing this gap by creating unique intervention strategies to reduce the severity of symptoms. 2.2. Objectives of the Study • Contribute to the body of literature on mental health development in Latin American and Caribbean countries. • Observe and report on the current situation of mental health development at the primary care level in the Dominican Republic. Identify strengths and weaknesses within the system and formulate recommendations. • Identify stakeholders and the links between mental health care and overall developmental goals. • Provide information on the impact of mental health law on the primary care level through a case study of BRA Dominicana. • Formulate recommendations with the intent to advance and strengthen the development of mental health at a primary level in the Dominican Republic.