Background and Purpose Violence in Mexico has risen to epidemic levels, with far-reaching implications for mental health. Since 2007, violence associated with the Drug War in Mexico claimed the lives of over 200,000 people and resulted in more than 40,000 disappearances. This research focuses on mental health service access when extreme community violence occurs.
Methods Eighty semi-structured interviews were conducted with physicians (72%) and other health professionals (28%) in five states of Mexico selected for their high incidence of violence. Purposive sampling was conducted through local public health agencies. Recruitment was in person or by telephone. Interviews focused on how violence affects mental health of patients and providers’ perception of mental health service needs/use. Interviews were in Spanish, recordings were transcribed, and coded thematically using ATLAS.ti.
Results Health professionals in all states reported an increase in mental health needs. Patients sought primary care services related to mental health for anxiety, stress, and shortness of breath, insomnia, headache and stomach aches. Psychologists in primary care centers are overbooked. In rural areas there are no psychologists; individuals travel longer distances to seek services. Tertiary psychiatric hospitals are regional and few in the country, referral diagnosis is required. Patients forgo mental health care due to an excess of demand, lack of services or referral, and long distances. Providers use words like ‘psychosis’, ‘nerves’, ‘fear’ and ‘depression’ to describe the mental health needs of patients.
Conclusions and Implications This study underscores the importance of understanding the impact of violence on mental health in vulnerable communities where health inequities exist. Trauma informed mental health services are needed at the primary care level. Greater information and communication of mental health consequences of violence exposure would likely help improve health outcomes and reduce inequities.
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