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Introduction Research on psychiatric deinstitutionalization has neglected that reforms in this field are nested in a health system that has undergone financial reforms. This subordination could introduce incentives that are misaligned with new mental health policies. According to Chile’s National Mental Health Plan, this would be the case in the Community Mental Health Centers (CMHC). The goal is to understand how the CMHCpayment mechanism is a potential incentive for community mental health. Methods A mixed quantitative-qualitative convergent study using grounded theory. We collected administrative production data between 2010 and 2020. Following the payment mechanism theory, we interviewed 25 payers, providers, and user experts. We integrated the results through selective coding. This article presents the relevant results of mixed selective integration. Results Seven payment mechanisms implemented heterogeneously in the country’s CMHC are recognized. They respond to three schemes subject to rate limits and prospective public budget. They differ in the payment unit. They are associated with implementing the community mental health model negatively affecting users, the services provided, the human resources available, and the governance adopted. Governance, management, and payment unit conditions favoring the community mental health model are identified. Conclusions A disjointed set of heterogeneously implemented payment schemes negatively affects the community mental health model. Formulating an explicit financing policy for mental health that is complementary to existing policies is necessary and possible.

Objective. This study seeks to describe the adverse effects of the COVID-19 pandemic on mental health services in Chile. Methods. This study is part of ongoing multicountry research known as the Mental Health Care – Adverse Sequelae of COVID-19 study (or the MASC study) that includes seven countries. Chile is the only one in Latin America. This study used a convergent mixed methods design. The quantitative component analyzed data about public mental health care collected between January 2019 and December 2021 from the open-access database at the Ministry of Health. The qualitative component analyzed data collected from focus groups of experts that included professionals in charge of mental health services, policy-makers, service users and caregivers. Finally, the data synthesis was performed by triangulation of both components. Results. By April 2020, mental health service provision had been reduced by 88% in primary care; moreover, secondary and tertiary levels had also reduced their mental health activities by, respectively, 66.3% and 71.3% of pre-COVID levels. Negative sequelae were described at the health systems level, and full recovery had not been achieved by the end of 2021. The pandemic affected the essential characteristics of community-based mental health services, with adverse impacts on the continuity and quality of care, reduced psychosocial and community support, and negative effects on health workers’ mental health. Digital solutions were widely implemented to enable remote care, but challenges included the availability of equipment, its quality and the digital divide. Conclusions. The COVID-19 pandemic has had significant and enduring adverse effects on mental health care. Lessons learned can inform recommendations for good practices for the ongoing and future pandemics and health crises, and highlight the importance of prioritizing the strengthening of mental health services in response to emergencies.

BackgroundUniversal health coverage (UHC) is a goal of the member states of the United Nations. The negative impact of the COVID-19 pandemic on mental health, inequalities in access to care, and financing gaps set a problematic scenario for universal mental health coverage. In Latin America, depression and anxiety disorders have increased by more than 30%. Chile implemented a reform for UHC in 2005 generating a mandatory guaranteed plan for health insurance (GES) that covers schizophrenia, depression, bipolar disorders, and Alzheimer's disease. We assume that the pandemic increased cases of mental illness in GES of public and private insurance.ObjectivesThis study aimed to explore the effects of the pandemic on the use of the GES mental health plan of public and private insurance.MethodsA descriptive analysis of secondary data from public and private insurance on the use and expenditure of the GES plan in mental illness between 2005 and 2020 was carried out. An aggregate analysis of the use of psychiatric consultations without a guaranteed plan and sick leave was performed.ResultsBetween 2005 and 2020, 18.5% of GES cases corresponded to four mental health illnesses (1,682,021 cases). Public insurance covered 80% of cases. In the pandemic, cases of mental illness fell by 10.5% in public insurance and 28.7% in private ones, reducing spending by 33 and 6.2%, respectively. Psychiatric consultations without using the GES plan doubled in 2020 in private insurance, and medical discharges due to mental illness also increased. Leave due to mental illness increased by 20% in both types of insurance.ConclusionThe results suggest that the demand for mental healthcare increased during the pandemic, but public and private health insurance reduced admissions to the GES universal plan for schizophrenia, depression, and bipolar disorder. A universal guaranteed plan in an individual contribution system can have essential weaknesses for people when the principles of social security are not complied with, especially concerning the solidarity of the health insurance system.

Introducción: La pandemia por COVID 19 ha tensionado los sistemas de salud en todo el mundo, al mismo tiempo ha generado un impacto negativo en la salud mental de la población. Los servicios de salud mental tienen el desafío de responder a las necesidades de salud mental de la población en contextos de emergencia sanitaria. Objetivo: El objetivo del presente estudio, fue estimar y explicar el efecto que tuvo la pandemia COVID-19 en las atenciones de los servicios públicos ambulatorios de salud mental de la Región de Coquimbo, Chile, para lo cual se utilizó un método mixto secuencial (DEXPLIS). Material y métodos: En una primera etapa, se realizó un análisis de serie de tiempo ininterrumpidos en el periodo 2017-2021 de las atenciones de salud mental incluidas en el registro estadístico mensual (REM), con una disminución del 56% al año 2020 de las atenciones ambulatorias. Una segunda fase cualitativa, indagó y profundizó en los hallazgos a través de un análisis de contenido temático de las experiencias y percepciones recogidas a través de grupos focales de gestores, profesionales y representantes de la comunidad. Resultados y conclusiones: Se concluye que existió una disminución de las atenciones ambulatorias presenciales en la región de Coquimbo. Se sostiene que ante emergencias similares es fundamental la planificación con pertinencia territorial y enfoque comunitario. Palabras clave: Servicios de Salud Mental, Atención ambulatoria, COVID-19.