Rates of depression/anxiety are growing globally. It is fundamental to develop a system that provides access and treatment; it is also vital to provide educational offerings that increase the confidence and competence of family medicine/primary care physicians (FM/PCP) in the care of patients with mental health disease.

This project identified and quantified practice gaps of FM/PCP in Argentina, Brazil, Chile, Colombia and Mexico so education is targeted to bridge gaps. The findings demonstrate significant opportunities to enhance mental health care and mental health education.

The assessment included:
 Literature review on competencies, delivery of care, and care systems within Latin America.
 Work with an Expert Advisory Panel (EAP) during the project.
 Interviews with practicing physicians in the five selected countries.
 Survey of Latin American FM/PCP on attitudes, behaviors, and barriers in caring for patients with depression/anxiety.
 Outreach, engagement and collaboration with organizations/institutions in the five countries.
 EAP review of survey results to provide recommendations on educational offerings to be shared with interested organizations/institutions and WONCA.

These themes should serve as the backbone of future work.
1. While COVID lessened the stigma, continued focus and addressing stigma and attitudes toward mental health is needed.
2. Training and education on mental health conditions is not currently part and parcel of the FM/PCP curricula but needs to be integrated.
3. The five countries do not have enough physicians trained or willing to care for the number of patients.
4. Education/training needs to be supported by easily accessible, easy-to-use, literacy-level appropriate tools and resources for clinicians and patients.
5. The division of private vs. public sectors creates alternate care pathways with varied resources, access and costs.
6. Mental health care is provided by individuals with different educational backgrounds and experiences; education needs to address everyone working in primary care.

- Societal stigma about mental health disease, stigma against patients with severe conditions, and stigma physicians who treat patients with mental illness face are all issues that must be addressed. Attitudes toward patients must also be changed.
-  A set of core competencies in the full scope of care of depression and anxiety are needed. These core competencies are those important to all physicians, but beyond the core competencies is a need to recognize the local environment, localize options for practice setting, system, team members, and patient needs.
- More training is needed, not only in the diagnosis and treatment to mental diseases, but in the perspective toward the complete mental health … training for health, counseling, conflict resolution techniques, gender perspective, psychological first aid using methodologies like play role, simulation, training for peers, work in and with the community and in the scholar spaces.

The aim of this presentation is to explore how literary reading can ameliorate our personal and vicarious experiences of suicide. It will consider how literature enables us to acknowledge the deeply unconsolable, to ‘think’ reality when ordinary human thought falls short, to allow for the possibility of imagining the ‘shabby, confused, agonised crisis which is the common reality of suicide’ and to develop empathy towards individuals who seek it.

It will involve a case study of a patient – ‘Charlie’ – whose history of domestic abuse, breast cancer and alcohol misuse, with loneliness exacerbated by the forced isolation of the COVI\D pandemic, puts her at high risk of suicide. This will be linked with literary representations of suicide through a seminal text, Leo Tolstoy’s novel Anna Karenina. The focus will be on the account of the last day of Anna’s life, describing her stream of consciousness in the final moments before her death.

Participants will be invited to consider their personal reactions to the text; ways in which this text resonate with elements of their own clinical experience; and what other literary or poetic works might be relevant to their clinical encounters with patients in despair.

The intended outcome is to expand participants’ understanding of the recursive relationship between literature and mental health, and in particular to see the potential value of literary reading as a means of broadening our approach to suicide prevention.

At the concluson, attendees will:
1. Understand the recursive relationship between literature and mental health
2. See the potential value of literary reading for suicide prevention.
3. Reflect on the impact on their own clinical practice.

Abstract summary

Background

Patients with mental illness have an increased risk of cardiovascular morbidity and mortality, which is partly related to unhealthy lifestyle habits. To individualise lifestyle counselling in primary care, the Swedish-developed Health Dialogue (HD) can be used as an educative tool at recurrent measurement points with the goal to improve non-healthy lifestyle habits. HD has not been aimed specifically at patients with mental illness, and the effect of a systematic approach with repeated HDs in patients with mental illness in primary care has not been previously studied.


Aim

The aim of this pilot study was to assess the feasibility of the study design for a larger-scale study using repeated HDs focused on the improvement of lifestyle habits in patients seeking primary care due to anxiety, depression, sleeping problems or stress-related symptoms.


Methods

Patients were recruited after a visit to a Primary Health Care Center due to mental illness between 2019 and 2021 and underwent a HD, including an assessment of cardiovascular risk factors through a Health Curve. Specific feasibility objectives measured were dropout rate, time to follow-up and risk improvement rate for different lifestyle habits.


Results

Sixtyfour patients were recruited at baseline, and all participants had at least one elevated cardiovascular risk level on the Health Curve for the assessed lifestyles. Twentynine (45%) attended a second HD, with a mean follow-up time of 15 months.
More than 10% of the participants improved their risk levels for any of the lifestyle areas, except for tobacco use.


Conclusion

Despite a higher dropout rate than expected, we suggest that the proposed methodology for a full cohort study within general practice of patients with mental illness in primary care is both acceptable to practices and feasible.

1. There is a need for interventions for patients with mental illness focused on the improvement of unhealthy lifestyle habits
2. Our results show modest feasibility with a higher drop-out rate than expected but an acceptable proportion of follow-up attendees adopting recommended changes in lifestyle habits.
3. Health Dialogues at repeated measurements for patients with mental illness might be a feasible method in Primary Health Care for improving lifestyle and lowering the cardiovascular risk