30 years from the Caracas Declaration: the situation of psychiatric hospitals in Latin America and the Caribbean prior, during and after the COVID-19 pandemic

Latin America and the Caribbean (LAC) recently celebrated 30 years from the Caracas Declaration, which, in 1990, set forth the principles to transition from hospital-based mental health care into community mental health services. Since then, significant efforts have been made to reduce the number of psychiatric hospital beds, increase mental health teams within general hospitals, integrate mental health into primary care, implement outpatient mental health facilities, and encourage the participation of community members in the provision and implementation of mental health care. Nonetheless, progress has been uneven across countries. Many large psychiatric hospitals (PHs) still exist and consume most of the scanty national mental health budgets. Moreover, PH residents in LAC were poor and socially excluded even before the COVID-19 pandemic hit. The COVID-19 pandemic has worsened the living conditions of these people, especially in resource-constrained settings.