Child and adolescent mental health in Latin America and the Caribbean: problems, progress, and policy research.

The nations of Latin America and the Caribbean (LAC) have many contrasts in the advances that they have made in the areas of child and adolescent mental health policy, research, and training. Within the LAC countries there exist the most sophisticated of child mental health programs based on comprehensive primary care models (Chile), strong advocacy programs with government support at the highest levels (Brazil and Costa Rica), and state-of-the-art research and training programs (Ar-gentina, Brazil, and Chile) (1). Of particular note is the strong understanding and utilization of a rights-based framework for services development throughout LAC. On the other hand, the LAC nations have some of the most intractable child mental health problems seen anywhere on the globe. In-halant use is endemic in parts of Brazil and Mexico, street children with overt mental health problems go totally unattended in Brazil and elsewhere, and youth crime is epidemic in some LAC cities. Economic resources are needed for governments to support mental health care, and families need adequate incomes and stability to be able to access care. However, the LAC countries show some of the most dramatic discrepancies in income distribution in the world. Some studies have suggested that approximately 10% of the population earns 90% of the total income (2). Huge economic problems in the LAC nations in the last two decades have produced a substantial reduction in the proportion of persons who are in the middle class, as well as a tremendous decrease in investments in social and health programs (3). From a psychosocial point of view, many children in the LAC countries face daunting risk factors. Poverty forces a vast number of children to live on the streets and predisposes them to become involved very early in their lives in drug use, crime, violence, and unprotected sex. This has serious consequences for their health, especially mental health (4). These homeless children demonstrate significant deficits in development related to social reciprocity , moral precepts, and self-esteem compared to children who are still living with their low-income families (5). Another important source of mental suffering for children and adolescents in some LAC countries has been social and political unrest. It is estimated that 6 000 to 14 000 children take part in armed conflicts in Latin America, and more than 10 000 children are in the army in Paraguay (6).