Co-prioritization of mental health recovery outcomes and scales for community mental health centers in Peru

Background: Mental health recovery outcomes are scarcely used and monitored in low- and middle-income countries, despite their importance on assessing the results of the care provided and potential areas of improvements. In Peru, the Mental Health Directorate (MHD) monitors mental health services mainly based on the number of people served and not on the improvements or recovery of their patients. This study aims to conduct a co-prioritization process with key stakeholders to introduce recovery outcomes and scales in community mental health centers (CMHC) in Peru. Methods: The co-prioritization methodology combined periodic meetings with MHD’s heads; a literature search and conversations with nine international mental health experts; and eight participatory workshops with Peruvian key stakeholders (policymakers, CMHC workers, and patients). All the information was analyzed using matrices and thematic analysis. Results: Nine outcomes were identified in the literature search and conversations with mental health experts, and five outcomes were finally prioritized by key stakeholders. After revision and discussion of several scales for each outcome, two scales were prioritized by all stakeholders: WHODAS-12 and DIALOG. Policymakers, workers, and patients prioritized three of these outcomes: psychosocial functioning, quality of life, and psychiatric symptoms. The first two were the most important for the three groups, whereas symptoms were more important for policymakers and workers than for patients. Additionally, patients prioritized emotional balance and personal growth, two emerging outcomes that were not identified in our previous literature search and conversations with experts. Scales were prioritized based on their relevance, usability, and feasibility to integrate them into the CMHC routines: WHODAS-12 to assess psychosocial functioning and DIALOG for quality of life. Stakeholders did not agree on a single scale to assess symptoms due to the large array of symptoms that their patients present, and no scale was assessed for emotional balance and personal growth since they only emerged in the final set of workshops. Conclusion: Based on a participatory methodology, key stakeholders at different levels of the Peruvian mental health system prioritized five recovery outcomes to use routinely in CMHC: psychosocial functioning, quality of life, psychiatric symptoms, emotional balance, and personal growth. The first two were deemed as the most important for all stakeholders; and the latter two were novel outcomes that emerged from patients. Two scales were selected to assess the first two of these outcomes. Defining a scale for the latter three outcomes and test their use in CMHC routines remain as pending tasks.