Proyecto CTI-TS Chile Photo Essay
This photo essay consists of excerpts from a video created by the University of Chile team of the RedeAmericas (RA) project. RA is one of the five ‘hubs’ funded by the National Institute of Mental Health (two in Latin America, two in Africa, one in South Asia). The goal of RA is to improve the lives of people with mental disorders in the urban areas of Latin America. The photo essay focuses on Critical Time Intervention-Task Shifting (CTI-TS), a regional randomized pilot study of an intervention for individuals with severe mental disorders. It was adapted over a seven-year period from CTI and is being tested in three cities: Rio de Janeiro, Santiago, and Cordoba. CTI-TS aims to help people during the period of transi¬tion when they first connect (or reconnect) to mental health services. The intervention is described from the point of view of each member of the team and of the people they have helped. Two of the project’s four principal investigators are among those who were interviewed: Ruben Alvarado at the University of Chile and Ezra Susser at the Columbia University Global Mental Health Program.
Jorge Rodriguez
PAHO/WHO
“Serious mental disorders can produce a great deal of disability and difficulties functioning socially. The world’s health systems have responded to this with asylums or hospitals that isolate patients.”
Alberto Minoletti
Faculty of Medicine, Salvador Allende School of Public Health, University of Chile
“In Chile, people with serious mental disorders are now able to live in the community, that is, with their families, in protected places, in supportive residences. But being in the community doesn’t mean they are included in the community the way other Chilean citizens are, because stigma causes them to be looked down upon.”
Ruben Alvarado
Director of Planning, Salvador Allende School of Public Health, University of Chile
“We organized an intervention, Critical Time Intervention – Task Shifting (CTI-TS), and offer it to people, who have had a psychotic episode, during a critical time in their lives.”
Ezra Susser
Professor, Mailman School of Public Health, Columbia University
“I think [CTI-TS] has the potential to be used throughout Latin America because it’s very adaptable, it can be used in almost any context, and it can be used in countries that don’t have mental health centers, as well as those that do. The other thing that I think might be a lasting impact of the kind of CTI that we’re doing in Latin America is accelerating the use of peer support workers.”
A community mental health clinic in Santiago.
Maria Jose Jorquera
Intervention Supervisor
“This intervention isn’t meant to be a substitute for health services. Instead, the objective is to find a way to reinforce continuity of care for users in the community. The CTI-TS worker-pair consists of a community mental health worker, who doesn’t have a university education but is recognized in the community where he/she lives, and a peer support worker who has a diagnosis of mental illness and is far along in the recovery process.”
Sara Schilling
Fieldwork Coordinator
“The “community-based” aspect of CTI-TS is very important because providers don’t always have time to see what their users’ lives are like in the community with their families, what their role is in the family, what their social roles are. We can look into this and intervene in the specific areas where the person has the most need of support.”
“Right now we are in the process of the supervision meeting that we have every Monday.”- Sara Schilling
Guillermina Astorga
Community Mental Health Worker for Participant #1
“I think the importance of our work is that we really see that it helps in recovery. We have managed to be a bridge so that users are able to become integrated in the community [and] have managed to help families make a commitment to the users’ recovery.”
Cristian Barra
Peer Support Worker for Participant #1
“From my own experiences that I’ve had with my own “crises,” I have tried to see how I can help these other people who haven’t come as far as I have in coping with everyday realities.”
Participant #1
“Guillermina and Cristian told me to start the swimming classes at the public pool.”
Jennifer Diaz
Community Mental Health Worker for Participant #2
“My primary role is to work with the family and with the peer support worker to create links to a social network that didn’t exist for the user before.”
Gerald Faundez
Peer Support Worker for Participant #2
“My work as a peer support worker is to speak with the user, who is a person just like me, about my experience – how I overcame my obstacles, how to flip the switch from negative to positive, how to see life in a different way. It’s telling them, ‘Look, if I could do it, you can do it too.'”
Participant #2
“In the beginning, I spent a lot of time alone. Loneliness isn’t very good. It was one of the triggers for my crisis. During the process I went through with Gerald and Jenny, I told them about my social circle, things I thought were okay and things I didn’t think were okay. I had a hard time discussing this, and they helped me a lot to do it.”
“As you know, we are in the 2nd phase with participant #2, and we have started going out into the community. This has been very important for him because he is getting to know his neighborhood.” – Jennifer Diaz
“We went to the Casa de la Juventud at the San Joaquin mental health center to see other options I have for activities. Even though I’m taking tango lessons, it’s going to end at some point.” – Participant #2
“Cultural centers like this one are a useful tool for us in our work because what we do is link the users with the mental health centers. We find out about the users’ interests, and, based on these interests, the users choose the workshops that work for them.” – Jennifer Diaz
“You are afraid of not finishing projects. What we’d like to get across to you is that this isn’t something to do with an illness or symptom or only with you. It happens to all of us.” – Jennifer Diaz
“Everyone has fears about the future.” – Gerald Faundez
Sister of Participant #2
“The worker pair teaches you how to approach a person. It’s not easy. You think: ‘It’s just something he can get over by himself.’ But it’s not like this. In reality he needs support. This program is so different, so novel, so odd. I’ve never heard of anything like this. It was super interesting how they visited him at home, found out about the context in which he lived, conversed with him. He’s been able to go out, enjoy himself again and do things I never thought he’d do. Given that he’s not very sociable, I couldn’t imagine him having to interact with other people and even asking them out to dance. There has been a very positive change.”