Meso-level comparison of mental health service availability and use in Chile and Spain.
OBJECTIVE
There is a demand for international comparisons of mental health care in Latin America. The purpose of this study was to describe mental health care in catchment health areas in Chile and Spain in order to complement information reported at the macro-level (countries or regions).


METHODS
Availability and utilization of services for the adult population were assessed in two urban areas in Chile and in three urban areas in Spain by using the European Service Mapping Schedule (meso-level data). Indicators from a previous data envelopment analysis (DEA) model of basic community care were applied to this analysis.


RESULTS
For the two countries, local data on beds and staff differed from data provided at the national level. In Chile meso-level data indicated more available beds and more psychologists per capita than did macro-level data. Quantitative indicators of community care were described, and the main gaps in Chile's urban areas were identified, particularly in day care and nonhospital residential care. There was nearly a tenfold difference in use of residential and day care between the benchmark area in Spain and the areas explored in Chile. In Chile's catchment areas there was no availability of nonacute hospital services, any work-related services for persons with mental disorders, or 24-hour mobile or nonmobile emergency psychiatric care. The meso-level data indicated that delivery and use of care in Chile was more similar to the pattern found in the poorer area in southern Spain than macro-level data would indicate.


CONCLUSIONS
The European Service Mapping Schedule was useful for describing mental health care outside of Europe and allowed for an international comparison between Chile and Spain. The meso-level description gathered in this study adds to the macro-level information on the mental health care system that has been provided in other reports. The gap between mental health treatment needed and mental health treatment received in Chile may be lower than expected.
Salvador-Carulla
Luis
L
Psicost Scientific Association, San Marcos 6, Jerez, Cadiz 11403 Spain. luis.salvador@telefonica.net
Saldivia
Sandra
S
Martinez-Leal
Rafael
R
Vicente
Benjamin
B
Garcia-Alonso
Carlos
C
Grandon
Pamela
P
Haro
Josep Maria
JM
D000552:Ambulances / Q000706:statistics & numerical data; D002391:Catchment Area, Health; D002677:Chile; D006801:Humans; D001523:Mental Disorders / Q000208:ethnology* / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data* / Q000600:supply & distribution*; D011446:Prospective Studies; D011584:Psychology; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013030:Spain; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D000078329:Workforce