When Scaling Up Isn't Enough: The Impacts of Peru's Mental Health Care Reform on Adolescents

In the last 15 years, coalitions of individuals and institutions worldwide have been calling for global policies to close the treatment gap for people living with mental disorders. This paper seeks to contribute to the literature on the effects of the diffusion of these global mental health polices by exploring their implementation and impact in Peru. Aligned with the Movement for Global Mental Health, Peru has carried out a mental health reform aimed at scaling up mental health care in public facilities. Using the human rights-based framework of availability, accessibility, acceptability, and quality, this paper examines the reform's effects on a population prioritized by global and Peruvian policies: adolescents. The analysis, based on qualitative research, illustrates how the reform's overemphasis on scaling up access to pharmaceutical treatment neglects critical issues such as health system capacity, the availability of trained human resources, the need for intercultural approaches tailored to adolescents, and information systems that adequately monitor policy impact. The analysis also highlights how a reform that promotes pharmacological treatment creates risks of abuse by private actors involved in the marketing of psychiatric medications.