Mental health and territory: A pending debt in comprehensive community care
DOI:
https://doi.org/10.61347/psa.v4i1.144Keywords:
Community gaps, MAIS-FCI, mental health, social determinants, territoryAbstract
Comprehensive community-based mental health care remains an unmet need in Ecuador, where factors such as poverty, unemployment, and violence create territorial inequalities that are not adequately addressed by traditional clinical approaches. In this context, the present study aims to analyze the gaps in the implementation of the Comprehensive Family, Community, and Intercultural Health Care Model (MAIS-FCI) at the primary care level, highlighting the need to integrate territorial and community perspectives to overcome structural limitations of the system. An integrative literature review was conducted, synthesizing evidence on social determinants, service provision within the MAIS-FCI, territorial gaps, and preventive strategies; additionally, a comparative analysis between the regulatory framework and its practical application was included, along with a qualitative description of community-based psychosocial interventions. The results show that poverty increases the prevalence of common mental disorders by 2.15%, and that there is an estimated shortage of 2,056 specialized professionals, with only 2.8 psychiatrists per 100,000 inhabitants; likewise, waiting times of up to 102 days for specialized care were identified, limiting continuity of care. Among the migrant population, 74% report symptoms of stress or depression, with higher prevalence in women (40%) compared to men (30%). In conclusion, mental health requires an intersectoral approach that prioritizes investment in human resources trained in psychosocial and community-based approaches, as well as the strengthening of community empowerment, to reduce territorial gaps and consolidate a more equitable, accessible, and culturally appropriate MAIS-FCI, moving beyond the individual clinical model.
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References
Alegría, M., NeMoyer, A., Falgàs Bagué, I., Wang, Y., & Alvarez, K. (2018). Social Determinants of Mental Health: Where We Are and Where We Need to Go. Current Psychiatry Reports, 20(95), 1–13. https://doi.org/10.1007/s11920-018-0969-9
American Psychiatric Association. (s. f.). Social determinants of mental health: Economic stability. American Psychiatric Association. https://n9.cl/b8zq6
Báscolo, E., Vance, C., Leys, M., & Coitiño, A. (2024). Social participation in health: analysis of progress and challenges for the Region of the Americas. Revista Panamericana de Salud Pública, 48, e70. https://doi.org/10.26633/RPSP.2024.70
Burgess, R. (2023). The struggle for the social: Rejecting the false separation of 'social' worlds in mental health spaces. Social Psychiatry and Psychiatric Epidemiology, 59, 409–416. https://link.springer.com/article/10.1007/s00127-023-02510-3
Dialoguemos. (2024, 27 de marzo). Estudio revela que el 74% de migrantes enfrenta estrés, ansiedad y depresión. Dialoguemos. https://dialoguemos.ec/2024/03/estudio-revela-que-el-74-de-migrantes-enfrenta-estres-ansiedad-y-depresion
Dos Santos Treichel, C., Bakolis, I., & Onocko-Campos, R. (2021). Determinants of timely access to specialized mental health services and maintenance of a link with primary care: A cross-sectional study. International Journal of Mental Health Systems, 15(1), 84. https://doi.org/10.1186/s13033-021-00507-6
Edbrooke-Childs, J., & Deighton, J. (2020). Problem severity and waiting times for young people accessing mental health services. BJPsych Open, 6(6), e118. https://doi.org/10.1192/bjo.2020.103
Greene, M., Wimer, G., Larrea, M., Mejia, I., Armijos, A., Angulo, A., Guevara, M., Vega, C., Heard, E., Demis, L., … Tol, W. (2024). Strategies to improve the implementation and effectiveness of community-based psychosocial support interventions for displaced, migrant and host community women in Latin America. Cambridge Prisms: Global Mental Health, 11, e32. https://doi.org/10.1017/gmh.2024.29
Guédez, A., Chisaguano, L., Lucero, P., Agualongo, J., Verdezoto, M., Vargas, M., Toscano, S., Naranjo, S., & Loaiza, M. (2023). Salud mental en contextos interculturales del Ecuador: Una perspectiva psicoterapéutica (1. ed.). Instituto de Investigaciones Transdisciplinarias Ecuador – BINARIO. https://n9.cl/ymk2s
Hajizadeh, A., Amini, H., Heydari, M., & Rajabi, F. (2024). How to combat stigma surrounding mental health disorders: A scoping review of the experiences of different stakeholders. BMC Psychiatry, 24(1), 782. https://doi.org/10.1186/s12888-024-06220-1
Hernández Sampieri, R., & Mendoza, C. (2018). Metodología de la investigación. Las rutas cuantitativa, cualitativa y mixta (1. ed.). McGraw-Hill Education. https://doi.org/10.22201/fesc.20072236e.2019.10.18.6
Kavanagh, B., Corney, K., Beks, H., Williams, L., Quirk, S., & Versace, V. (2023). A scoping review of the barriers and facilitators to accessing and utilising mental health services across regional, rural, and remote Australia. BMC Health Services Research, 23(1). https://doi.org/10.1186/s12913-023-10034-4
Kirkbride, J., Anglin, D., Colman, I., Dykxhoorn, J., Jones, P., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T., & Griffiths, S. (2024). The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry, 23. https://doi.org/10.1002/wps.21160
Machuca, C., & Pérez, J. (2023). Causas y consecuencias de la desigualdad de género en salud mental. Una revisión bibliográfica. Hygia de Enfermería, 40(3), 116–122. https://n9.cl/uhi174
Marrone, J., & Swarbrick, M. (2020). Long-term unemployment: A social determinant underaddressed within community behavioral health programs. Psychiatric Services, 71(7), 745–748. https://doi.org/10.1176/appi.ps.201900522
Meneses, A., Galárraga, A., Poenitz, A., & Jodar, M. (2024). Mental health and quality of life in Ecuadorian women exposed to gender-based violence. Journal of Interpersonal Violence, 39(21 22), 4285–4306. https://doi.org/10.1177/08862605241234357
Ministerio de Salud Pública del Ecuador (MSP). (2024). Política nacional de salud mental 2024 2030. Subsecretaría de Vigilancia, Prevención y Control de la Salud, Dirección Nacional de Estrategias de Prevención y Control para Enfermedades Crónicas No Transmisibles, Salud Mental y Fenómeno Socioeconómico de las Drogas-MSP. https://n9.cl/qx1e8u
Ministerio de Salud Pública del Ecuador (MSP). (2013). Manual del modelo de atención integral del sistema nacional de salud familiar, comunitario e intercultural (MAIS-FCI). Subsecretaría Nacional de Gobernanza de la Salud Pública.
Moreno-Zambrano, D., Wong-Ayoub, J., Arevalo-Mora, M., Andrés-Suárez, I., Santana, D., Meza-Venegas, J., Urquizo-Rodríguez, E., Jimenez-Zambrano, J., & Garcia-Santibanez, R. (2023). Number of neurologists and neurology training programs available in the public health system of Ecuador: Analysis and recommendations. Revista Ecuatoriana de Neurología, 32(2), 55–60. https://doi.org/10.46997/revecuatneurol32200055
Moroz, N., Moroz, I., & D’Angelo, M. (2020). Mental health services in Canada: Barriers and cost-effective solutions to increase access. Healthcare Management Forum, 33(6), 282–287. https://doi.org/10.1177/0840470420933911
Narváez, D. (2025). Salud mental en las comunidades rurales del Ecuador [Tesis de grado, Universidad Nacional de Chimborazo]. http://dspace.unach.edu.ec/handle/51000/15237
Ochnik, D., Buława, B., Nagel, P., Gachowski, M., & Budziński, M. (2024). Urbanization, loneliness and mental health model - A cross-sectional network analysis with a representative sample. Scientific Reports, 14(1), 24974. https://doi.org/10.1038/s41598-024-76813-z
Oliveros, B., Agulló-Tomás, E., & Márquez-Álvarez, L. (2022). Risk and protective factors of mental health conditions: Impact of employment, deprivation and social relationships. International Journal of Environmental Research and Public Health, 19(11), 6781. https://doi.org/10.3390/ijerph19116781
Organización Panamericana de la Salud. (2025). Barreras de acceso a servicios de salud y percepciones sobre vacunación en población vulnerable en zonas fronterizas de Tacna. https://n9.cl/4ylvm
Pérez-Jorge, D., González-Luis, M., Rodríguez-Jiménez, M., & Ariño-Mateo, E. (2021). Educational programs for the promotion of health at school: A systematic review. International Journal of Environmental Research and Public Health, 18(20), 10818. https://doi.org/10.3390/ijerph182010818
Rameez, S., & Nasir, A. (2023). Barriers to mental health treatment in primary care practice in low- and middle-income countries in a post-COVID era: A systematic review. Journal of Family Medicine and Primary Care, 12(8). https://doi.org/10.4103/jfmpc.jfmpc_391_22
Reyes, V., & Santos, E. (2024). Impacto de la movilidad humana en la salud mental de jóvenes venezolanos reubicados en Ecuador. Revista PSIDIAL: Psicología y Diálogo de Saberes, 3(Edición Especial), e6727. https://revistas.utm.edu.ec/index.php/psicologia/article/view/6727
Ridley, M., Rao, G., Schilbach, F., & Patel, V. (2020). Poverty, depression, and anxiety: Causal evidence and mechanisms. Science, 370(6522). https://doi.org/10.1126/science.aay0214
Salazar, F., Manterola, C., Quiroz, S., García, N., Otzen, H., Mora, V., & Duque, P. (2019). Estudios de cohortes. 1a parte. Descripción, metodología y aplicaciones. Revista de Cirugía, 71(5). https://doi.org/10.35687/s2452-45492019005431
Sterud, T., Lunde, L., Berg, R., Proper, K., & Aanesen, F. (2025). Mental health effects of unemployment and re-employment: A systematic review and meta-analysis of longitudinal studies. Occupational and Environmental Medicine, 82(7). https://doi.org/10.1136/oemed-2025-110194
Thomson, R., Kopasker, D., Leyland, A., Pearce, A., & Katikireddi, S. (2023). Effects of poverty on mental health in the UK working-age population: Causal analyses of the UK Household Longitudinal Study. International Journal of Epidemiology, 52(2), 512–522. https://doi.org/10.1093/ije/dyac226
Wong-Ayoub, J., San Andrés-Suárez, I., Santana, D., Meza-Venegas, J., Urquizo-Rodríguez, E., Arévalo-Mora, M., Avellán, C., & Moreno-Zambrano, D. (2022). Psychiatrists available in the Ecuadorian public health system and psychiatry residency programs in Ecuador – A cross-sectional analysis. Revista Ecuatoriana de Neurología, 31(2), 59–64. https://doi.org/10.46997/REVECUATNEUROL31200059
World Health Organization. (2021). Comprehensive mental health action plan 2013–2030. https://iris.who.int/handle/10665/345301
World Health Organization. (2021). Guidance on community mental health services: Promoting person-centred and rights-based approaches. https://apps.who.int/iris/handle/10665/341648
World Health Organization. (2022). World mental health report: Transforming mental health for all. https://www.who.int/publications/i/item/9789240049338
World Vision Ecuador. (2024, 20 de marzo). Estudio nacional revela impacto de la salud mental en migrantes en Ecuador. World Vision Ecuador. https://n9.cl/cwvi3
Yousefi Nooraie, R., Naghibi, D., Hernández-Torres, R., & Cupertino, P. (2025). A social network lens to community health worker influence and impact. Journal of Primary Care & Community Health, 16, 21501319241306706. https://doi.org/10.1177/21501319241306706
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