Washington, D.C., 10 October 2015 (PAHO/WHO) — Mental health services based in the community and integrated with primary health care are the best way to ensure that people with mental health problems can get the care they need while maintaining their dignity and avoiding violations of their human rights.

This approach has been repeatedly endorsed by member countries of the Pan American Health Organization/World Health Organization (PAHO/WHO) over the past 25 years. On World Mental Health Day, Oct. 10, PAHO/WHO experts are urging continued efforts to shift mental health spending from psychiatric hospitals toward community-based services that are decentralized, participatory, integrated, and focused on prevention.

"Many countries in Latin America and the Caribbean are still spending the bulk of their mental health financing on psychiatric hospitals, at the expense of community clinics and outpatient care," said Dévora Kestel, head of PAHO/WHO's Mental Health and Substance Use unit. "This effectively denies many people with mental illness the right to live and work in the community. In many countries, mental health care is very difficult to find outside those institutions."

In conjunction with Mental Health Day, mental health experts from across the Americas will gather in Santiago, Chile, on October 13 to mark the 25th anniversary of the Caracas Declaration, a 1990 pledge signed in Caracas, Venezuela, to chart a path for bettering mental health systems in the Americas. That pledge promoted community-based health care and called for all countries of the region to treat people with mental illnesses in full accordance with international human rights standards.

While progress has been made since then, gains have been slow, said Kestel. A 2013 PAHO survey found that 20 of 27 countries in Latin America and the Caribbean with psychiatric hospitals devoted more than half their mental health budgets to such institutions. In 14 of the countries, the proportion was over 80%.

Last year, health officials from across the region met once again to confront the persistent problems in mental health care. They pledged to ensure effective mental health services and prevention programs, to ramp up community-based care and rehabilitation and to strengthen human resources in mental health to improve the responsiveness of services.

Given the experience of the last quarter century, Kestel said, health officials have their work cut out for them.

"It is known that one in four people will suffer a mental condition at some point in their life. And at any given time, 20 to 25% of the population of the Americas suffers from mental conditions," Kestel said. "Unfortunately, most of these people do not have access to the services they need. Although many countries in our region have advanced significantly since Caracas—with help from PAHO/WHO—much remains to be done to ensure that all those suffering from mental disorders can find the treatment they need."