Mental Health in Costa Rica: Week 3

Posted on August 09,2012 by latinomentalhealth

Hola from Costa Rica! This is Becca W, Valerie, and Zach checking in.

Growing knowledge of Costa Rican healthcare

Last night, we attended a seminar led by Dr. Andrea Mesén-Fainardi, a local psychiatrist. He studied at NYU and UC Irvine, and has been a pioneer for many mental health programs and hospitals here in Costa Rica. In addition, Dr. Mesén-Fainardi speaks four languages (English, French, Italian, and Spanish) and is clearly an asset to Costa Rican mental health.

Dr. Mesén-Fainardi taught us about the health care system in Costa Rica, explaining that although universal healthcare exists, there are also insurance plans. Those with insurance are often seen in private clinics (if affordable), are seen quicker, and are given medications for longer periods of time (i.e., 1 month versus 3 days). Thus, the emergency rooms are often full and have incredibly long waiting lists (days) due to the guaranteed healthcare and treatment.

If a person becomes ill in Costa Rica, he will first go to the ebais (a small clinic that treats common illnesses such as a cold). If the sickness is more serious, he will go to "la clinica," or a larger clinic with more advanced medical equipment and medicines. If even more serious, he will go to one of the nearby hospitals. If the illness is very critical and requires the utmost attention, he will go to one of the three state hospitals in Costa Rica.

There are currently three psychiatric hospitals in Costa Rica.

1. Hospital Nacional Psiquiátrico in San José. This hospital has 811 beds. Patients who have attempted suicide are usually sent to this hospital. They are released when the doctor feels comfortable with their status.

2. Hospital Chacon Paut. This hospital has 185 beds, 16 acute beds.

3. Hospital Calderoón Guardia. This hospital has 12 beds and is the only hospital with an on call psychiatrist at all times.

There is 1 private hospital with 4 psychiatric beds, but this hospital requires insurance. Clients usually stay inpatient for 2-3 weeks. This does not depend on insurance, but on doctors observations. All of the hospital beds are generally at full capacity at any given time, with most clients displaying suicidal ideation or behavior. In addition, psychiatric medication is limited. For depression, most clients are prescribed a generic form of Prozac. For psychosis, clients are given Risperdal (which is top of the line) or Haldol. These treatments are very expensive as well.

Finally, for those with a forensic interest: incompetent clients are usually sent to a hospital. However, there is a new prison being built to house mentally ill inmates (i.e., similar to our Bridgewater State Hospital back in MA).

It was very interesting to learn about the mental health system in Costa Rica. It appears that the field of psychology is rapidly growing, allowing for better, and more specific care. While the Costa Rican mental health system certainly has some growing edges, I am thankful for experiencing their system as it becomes more developed and advanced.

Becca W, 3rd year PsyD, LMHP

Understanding the links

This morning some students visited the children's psychiatry clinic associated with the Hospital Calderón Guardia, which, as Becca mentioned above, is the only national hospital that maintains beds for psychiatry purposes. We were attended to by one of the hospital’s four psychiatrists who took time to explain the variety of services and programs offered to children, pre-teens, adolescents and their families. The staff use a collaborative approach in all of their programming, even going as far as sending staff members to schools to educate teachers about services that students might receive through the clinic. A major percentage of the work involves psychoeducation for all those involved as stigma continues to challenge the progression of mental health services in Costa Rica. For example, adolescents whose afternoon group or individual sessions require that they miss their language classes may be approached by the teacher. The teachers, despite having been contacted by program staff, take it personally if students miss their class in pursuit of mental health services. This is just one of many challenges that staff continue to face on a routine basis.

The clinic offers a wide variety of mental health services to children and their families in the surrounding communities. Staff find that parents are most commonly challenged by the task of setting limits for their children. Groups on limit-setting, for example are conducted in twelve sessions. With this and other programs, the design of the various sessions and workshops is such that staff meet with just the parents, then just the children, then both parents and children together, depending on the particular needs of the family and clinician’s intuition. We learned that an overwhelming majority of the parents who bring children for services are single mothers who have their own trauma history. This is one of the many reasons why collaborative interventions on the familial level are so helpful. In these types of situations, staff are ready to make the necessary referrals to put in place the services that would be most supportive and helpful to the family. Hopefully as these types of programs continue to grow in both size and specialization, they will become even more widely available to the greater communities across Costa Rica.

Valerie, 2nd year MA Counseling, LMHP