A Critical Overview of Mental Health Policies for the Treatment of Schizophrenia in Chile

Abstract

Background: The Universal Access to Explicit Health Guarantees (AUGE) program in Chile provides clinical guidelines for the treatment of the first episode of Schizophrenia. This study contextualizes these guidelines within Chilean mental health policies and the theoretical framework of cultural biology, examining the balance between biomedical models and person-centered approaches.

Methods: Critical discourse analysis was employed to explore the AUGE guidelines, identifying strengths and limitations in their formulation and implementation. This methodology allowed for the examination of the underlying power dynamics and ideological assumptions embedded within the guidelines.

Results: The findings reveal that the Clinical Guidelines reinforce a normative character through grammatical constructions that often present patients as objects of intervention. Analysis of the social context shows an emphasis on a biomedical perspective and pharmacological interventions, potentially overshadowing rights-based and gender approaches in favor of international guidelines which may not be adequate in Chilean context. The guidelines also lack specific considerations for cultural particularities of ethnic minority, indigenous, and rural individuals. Finally, the guideline's narrative emphasizes deficits and dysfunctions, potentially contributing to stigma and positioning health professionals as the primary decision-makers. This may limit a truly participatory and empowering model of care.

Conclusion: The study underscores the necessity of a shift towards relational trust and co-construction in therapeutic practices. Recommendations on the formulation of mental health care Guidelines for Schizophrenia are proposed. Future guidelines should focus on increasing funding and support for community-based mental health services, implementing mandatory training for healthcare professionals on person-centered and culturally sensitive approaches and establishing mechanisms for ongoing patient and community feedback to ensure policy responsiveness and relevance.