In Peru, Caring for Patients with Schizophrenia

PIH serves hundreds living with chronic mental health conditions

Posted on Jan 20, 2022

Sonia Sánchez was diagnosed with schizophrenia when she was 16 years old.
Sonia Sánchez was diagnosed with schizophrenia when she was 16 years old. Photo by Melissa Estefany Toledo Soldevilla / PIH.

Each morning, Sonia Sánchez wakes up, makes her bed, and cooks breakfast. Some days, she goes with her sister to the market. There was a time when she didn’t know if those tasks would be possible.

Sánchez has lived with schizophrenia since she was 16 years old.

Schizophrenia is a serious mental health condition that affects the way people think, feel and behave. The disorder can lead to hallucinations, delusions, and extremely disorganized thinking and behavior and requires lifelong treatment, though early detection can help prevent serious complications.

In impoverished communities like Carabayllo, Peru, people living with schizophrenia were historically hospitalized, put in mental health institutions, or, for those without caregivers, left to roam the streets.

Since Socios En Salud, as Partners In Health is known locally, began working in Peru in 1994, it has partnered with the Ministry of Health to change that reality—opening the country’s first-ever safe house for women with chronic mental health conditions and providing medical care and social support to 515 patients, such as Sánchez, who live with schizophrenia.

For months, Sánchez, 52, didn’t have treatment or medication to manage her condition, since the hospital where she had received care suspended its mental health services when COVID-19 began. That led Sánchez, who lives with her mother and sister, to experience constant hallucinations. Terrified, she would hide under her bed out of fear or throw things off the table. She was once hospitalized for weeks.

Then, she found Socios En Salud. She learned of the organization and its work through the ASIRI community mental health center in Carabayllo, about 15 minutes from her home, where health workers were able to recognize the signs and symptoms of schizophrenia.

Early detection is critical for chronic mental health conditions like schizophrenia, which can worsen over time. And treatment is more effective if doctors can diagnose the condition early.

As part of its mental health program, Socios En Salud has trained doctors and nurses—in partnership with the Ministry of Health—to identify the signs and symptoms of chronic mental health conditions, including schizophrenia, among patients who visit Lima’s 350 primary care clinics.

Roli Martin, a psychologist on Socios En Salud's mental health team, walks through the streets of Carabayllo. Photo by Melissa Estefany Toledo Soldevilla / PIH.
Roli Martin, a psychologist on Socios En Salud's mental health team, walks through the streets of Carabayllo. Photo by Melissa Estefany Toledo Soldevilla / PIH.

Those efforts at early detection have also extended to Socios En Salud’s team of 90 community health workers, including 23 hired specifically to care for patients with schizophrenia and support their caregivers.

These community health workers—residents hired from the communities where Socios En Salud works and trained to provide basic health services—can help identify the condition during their routine visits to patients’ homes. In 2020, the team identified 417 people with schizophrenia.

Those efforts have proved crucial for Sánchez, helping her access a diagnosis and care.

Each month, she travels to a community mental health center just 20 minutes from her home to get her medications and see a doctor. It’s one of 203 community mental health centers that Socios En Salud supports in northern Lima, in partnership with the Ministry of Health.

To manage her symptoms, she takes daily pills and a monthly injection. She also meets with a community health worker, Rosa Silva, twice a week.

“I consider Rosa a friend,” says Sánchez. “She is always calling me. She asks me how I feel and if I have taken my pills. She is very kind to me.”

Safe Houses

Not everyone has that level of support. Many patients living with schizophrenia in Lima and surrounding areas don’t have caregivers—putting them at risk of being homeless, jailed, or hospitalized. The widespread stigma and discrimination against people with schizophrenia often prevents them and their families from accessing health care.

That reality led Socios En Salud to open a safe house in 2015 for women living with chronic mental health conditions, in partnership with the Ministry of Health and local governments. The house, located in Carabayllo, serves women between 18 and 65 years old who have no family or friends to care for them.

Each day, the women are given medications and support to help manage symptoms ranging from panic to hallucinations. They also learn basic skills such as making the bed, cooking, and washing dishes—preparing them for eventual re-entry into society.

A resident of the safe house practices baking skills under the supervision of a community health worker. Photo by Julio Medina for SES.
A resident of the safe house practices baking skills under the supervision of a community health worker. Photo by Julio Medina for SES.

Since the women have no caregivers, each woman is assigned a community health worker who provides 24/7 care and support. A team of doctors, psychologists, and nurses is also on-call. All of the women are provided health insurance, and the house itself is just minutes away from a community mental health center and a hospital.

In its first year, the safe house welcomed six women. All six made a successful transition back to society and are now living on their own or with family.

The safe house has since provided a model for schizophrenia treatment and care nationwide, leading the Ministry of Health to build 235 more safe houses across the country—bringing schizophrenia care and treatment to hundreds more patients.

Caring For Caregivers

Socios En Salud’s mental health initiatives have included care and support for caregivers as well as patients.

Sánchez’s sister, Violeta, used to accompany her sister to every doctor’s appointment or to the pharmacy to get her medications—even as she managed her own health issues and supported their mother.

“Many times, I felt overwhelmed,” says Violeta. “It is difficult to assume all this burden alone.”

She wasn’t the only caregiver struggling. In May 2021, she joined a free support group organized by Socios En Salud, connecting her with other caregivers of patients with schizophrenia and helping her feel less alone.

The program ultimately served more than 296 caregivers.

Sonia stands with her mother (left) and sister (right). Photo by Melissa Estefany Toledo Soldevilla / PIH.
Sonia stands with her mother (left) and sister (right). Photo by Melissa Estefany Toledo Soldevilla / PIH.

Such support for caregivers and patients has become even more crucial amid COVID-19, as demand for mental health services has surged along with the pandemic.

The community mental health centers in Carabayllo have only seen such demand increase, even as COVID-19 has led to staffing shortages, supply chain issues, and temporary disruptions in services.

“We have assumed our role in the community as a primary care center, providing support to all those people and families who need emotional support, especially those who have chronic mental health conditions,” says Roxana Ceron, coordinator of the ASIRI community mental health center.

For Sánchez and hundreds more patients with chronic mental health conditions, that support is making a world of difference.

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