Development & Aid, Headlines, Health, Human Rights, Latin America & the Caribbean

HEALTH-ARGENTINA: Fighting Mental Illness with Companionship

Marcela Valente

BUENOS AIRES, Feb 4 2008 (IPS) - An innovative mental health plan developed in a town in the Argentine province of La Pampa has reduced to a minimum relapses among patients discharged from hospital, while at the same time providing new and valued employment for jobless people living on state subsidies.

The Mental Health Home Companionship Programme began 14 years ago as an initiative of the professional team serving acute psychiatric patients at the Gobernador Centeno Hospital in General Pico, a town of 60,000 in the north of La Pampa, 600 kilometres northwest of Buenos Aires.

"We had 16 beds, for acute psychiatric patients only, within the general hospital," social worker Cristina Proia told IPS.

"We saw that they were staying in hospital for three or four months, which is a long time for an acute patient, and after they were discharged they would relapse," she said.

So an alternative way to support patients in the community and prevent new admissions was devised. The team of health professionals interviewed about 25 unemployed people who were receiving a government subsidy, and selected eight who were given training to provide companionship to discharged patients.

"We try to work with the patient’s healthy side. It’s not useful for us to know about his or her diagnosis or about the medication. We just provide companionship," Gladys Mamani, a woman who was unemployed and joined the programme 11 years ago, and whose experience now qualifies her to work in public and private healthcare, told IPS.

Proia, who works alongside psychologist Ana Viglianco and other professionals, says that over 100 patients have used the programme in the past 14 years. Among them were people suffering from different forms of psychosis or depression, and people at psychosocial risk such as low-income teenage mothers.

Many of the people in the programme are psychiatric outpatients who need support to ensure they take prescribed medication, and someone to alert health professionals about behaviour that may suggest a risk of relapse. But the programme also seeks to prevent people with mental problems who have not required hospital admission from developing a chronic illness.

"Among the unemployed people who showed interest in our project were some highly perceptive people whose vocation and skill became more clear as they worked with each patient," said Proia.

Initial training lasts less than two months, because theoretical instruction is not given. Essentially, the would-be companionship providers analyse and confront their prejudices.

"The basic training is for them to work on their preconceptions about madness, their feelings about the patients, and how to be committed to patients while preserving sufficient distance to really see and observe. We don’t teach the companions about psychiatric profiles or medication, because the professionals see to that," she said.

The idea of the programme is that the companionship providers should "maintain a certain degree of naivety" which will help them detect changes in the patients’ behaviour.

Health professionals then decide whether the behavioural change is a symptom that requires attention, and whether to adjust the patient’s medication or readmit him or her for a day or two.

Each companionship provider looks after five or six patients, who call him or her whenever they feel the need.

They may be called at daily, weekly or monthly intervals, until the patient can manage independently. The health care team supervises the activity of the companionship providers on a daily basis.

"Only a few companionship providers misunderstood their role, and tried to tell the patients what they should do and how they should live, instead of providing support for the patients’ needs. Most, on the other hand, have found paid employment in this work, even in the private health care system," said Proia, who added that the new focus is now widely accepted.

For instance, the family of a patient who was discharged six years ago offered to pay the companionship provider, who continues to be supervised by the state hospital, however.

At present there are only two companionship workers in the programme because of a lack of funds. Instead of the government subsidy they are now paid salaries out of the provincial public health budget.

"I hope this programme can continue with more funding, and that it can be developed in other places. If it were carried out at a national level, it would be extraordinary, because it would improve the quality of life of a great many patients. But of course, that would require strong political will," Proia said.

She estimated that the number of psychiatric admissions in General Pico has fallen by 90 percent because of the programme. The average cost per patient is over 1,100 dollars a month. However, Proia said the main thing is not the potential cost reduction, but the improvement achieved in the lives of people with mental illness.

"The ‘deinstitutionalisation’ of mental patients is often talked about, but we say that alternative arrangements must be made so that they are not abandoned to their fate," she said. Not all the discharged patients have relatives willing or able to take them in, and mental conditions, to a greater of lesser degree, tend to be chronic.

Having spent over a decade looking after children, teenagers, adults and elderly people, Mamani says that the core idea is simply being there. "For instance, I go to birthdays and other gatherings when I am invited, and often I’m the only person there who isn’t part of the family, but to all of them I’m ‘a friend.’" One might say she is "the" friend.

"Once I was out walking with a 30-year-old woman, and she asked me to sing nursery rhymes with her, and I did, although I knew that I looked ridiculous singing them. The point is you don’t have to do anything for them, just be with them," she says, smiling.

The hardest times, on the other hand, are when the patients can’t even talk, but she still knows that at some point they will connect. "Once I went into a darkened house where there was only silence and no one spoke, until after a while a voice said ‘stay with me.’ That’s what this work is like," she said.