We assessed the mental and neurological health (MNH) situation of Ecuador in 2006–8, using the Mental and Neurological Health Country Profile (MNHCP) (Gulbinat et al, 2004; Jenkins, 2004; Jenkins et al, 2004), an instrument which helps to develop evidence-based MNH policy and services (Townsend et al, 2004). An extensive review of the literature was undertaken and consultations and consensus meetings (Schilder et al, 2004) were conducted with key mental and neurological health stakeholders, including consumers, carers and clinicians from the government and nongovernment sectors.

Context

Ecuador, in the north-west of South America, has an area of 256 370 km2 and a population of around 13 400 000. The population distribution has become younger in recent decades, with 61.9% aged 15–64 years. Nearly two-thirds (63.4%) of the population live in urban areas. The national fertility rate is 22.9 births per 1000. Life expectancy is 78 years for women and 72 years for men. The major ethnic groups are Mestizo (65%), Native Indigenous (25%), White (7%) and Black (3%). Official languages are Spanish and Quechua. Most of the population (95%) is Roman Catholic.

Other significant data are presented in Table 1.

Internal and external migration is significant. Over one million Ecuadorians emigrated to the USA and Europe following economic problems in 2000. The Colombian guerilla movement has forced the displacement of half a million Colombians into Ecuador and rural migration continues to increase the size of the slum areas in major cities.

Positive mental health and well-being is understood as emotional health; mental disorder and mental illness as loss of reason; neurological illness is described in terms of the associated disability; and personality disorder is understood as antisocial or delinquent behaviour. Discrimination against people with mental or neurological illnesses exists owing to cultural influences and ignorance. Mental and neurological disorders are considered physical and cultural ailments, and approximately 30% of the population (particularly those in the rural sector) regard mental and neurological conditions as punishments of nature.

Women primarily bear the burden of caring for people with mental and neurological disorders. There are significant levels of stigma and discrimination shown to people with MNH problems and to other vulnerable groups, including those who experience physical or intellectual disability, poverty, disease, the young and the aged.