Delivering Lifesaving Mental Health Care In Peru During COVID-19

Content warning: This story contains brief, general mention of suicidal ideation.

The taxis are gone, again.

But it isn’t the first time that Gábriel* has shown up to an empty lot. As one of dozens of motorcycle taxi drivers in San Juan de Lurigancho, an impoverished community just 8 miles northeast of Lima, he knows that motorcycle rentals are in high demand.

It’s why, each morning, he wakes up at 4 a.m. and rushes to the lot, where he must compete with several other drivers for a limited number of motorcycles. It’s always a first-come, first-serve basis. Some days, he’s just minutes too late. And it takes a toll.

“If I don’t work today, tomorrow we have no income,” he says. “That worries me every day because there are days when I don’t manage to rent the motorcycle taxi and I get frustrated…then, at that moment, is when negative thoughts invade my mind and I feel that I can’t take it anymore.”

He has dealt with negative thoughts, connected to his depression, for years. But as COVID-19 swept across San Juan de Lurigancho, leaving him unemployed and struggling to put food on the table, Gábriel could feel his depression deepening. There were days when he didn’t want to live.

But even in his darkest moments, he wasn’t alone. His wife, María*, saw the warning signs. And she knew where to get help.

Mental Health Amid COVID-19

Depression and other mental health conditions have intensified during COVID-19, as the virus has claimed millions of lives worldwide and forced millions more into weeks of isolation.

In impoverished, historically marginalized areas such as Carabayllo, a hillside community on the outskirts of Lima, mental health conditions have been compounded by a lack of access to quality medical care, skyrocketing unemployment, and food and housing insecurity—systemic barriers that, amid a pandemic, make mental health care feel like a last priority, if patients even know where to go for help or have the means to access care at all.

For more than 25 years, Socios En Salud, as Partners In Health is known in Peru, has fought to break down barriers to health access, in partnership with the Ministry of Health, and mental health has been one of its key programs. As Socios En Salud’s broader team focused on the overarching COVID-19 response—such as testing capacity, safety protocols, and supply chains—the mental health team turned its attention to finding patients in need of mental health care and connecting them with that care, whether through in-person outreach by community health workers or through Bienestár, a chatbot app the team launched last year to connect patients with psychologists, virtually.

The timing could not have been more urgent.

From patients coping with the death of loved ones, to those struggling to make ends meet or dealing with their own diagnosis with the virus, there was never a shortage of need in the communities where Socios En Salud works.

But the team pressed on. No issue was too small and no condition, too complicated.

From July 2020 to March 2021, Bienestár reached more than 111,500 people in Carabayllo, San Juan de Lurigancho, Callao and Trujillo, connecting thousands with mental health care ranging from psychological first aid to bereavement therapy and helping patients cope with depression, alcohol and drug use, suicidal ideation, and a range of other mental health conditions.

The effort has saved lives.

Step By Step

When María saw her husband’s mental health taking a turn, she decided to share her concerns with a trusted resource in the community: Socios En Salud. As she filled out the screening questions for the CASITA program—Socios En Salud’s program for caregivers and children with developmental delays, where her son is enrolled—she mentioned Gábriel’s depression and what she had been seeing at home.

Within days, Lucia Caparachin, a psychologist with Socios En Salud, was assigned to the case. Over the next several weeks, Caparachin provided care and support for Gábriel through a strategy called Problem Management Plus (PM+), an intervention from the World Health Organization that uses group and individual counseling to help patients manage anxiety, depression, and stress.

The change was slow, but significant—and Caparachin saw it first-hand.

Gábriel’s mood was improving. He was opening up about his problems and accepting emotional support from those around him. He was identifying the things causing him stress and figuring out ways to reduce that stress or reframe his mindset.

“Having the support of his family and Socios En Salud has been key to improving his physical and mental health,” says Caparachin.

And mental health wasn’t the only aspect of his life improving. Through Socios En Salud’s support, he received food vouchers to help feed his family—meeting an essential need that no amount of mental health care could fix. And his children continued to receive care through the CASITA program, which was helping his son learn to walk.

Step by step, Gábriel was moving forward, too.

‘They Give Me Strength’

Mental health professionals like Caparachin are careful to emphasize that mental health isn’t a linear process—it’s an ongoing journey. When it comes to treating chronic depression, she says, it’s crucial to check in with patients regularly and be aware of any changes that could impact their mental health and exacerbate their depression.

To help Gábriel manage his depression, Caparachin got him a referral to a local health center for ongoing mental health treatment, including weekly support sessions.

It has only been a few weeks, but the sessions have already helped substantially. They’ve reminded him of who he is—and who he can turn to for support.

“My family is the most important thing I have,” he says. “They give me the strength and courage to go on.”

*Name has been changed to protect privacy