Peru is a land of mixed cultures, multiple ethnic heritages and severe economic inequities. Its history goes back thousands of years, from accounts of the first inhabitants of the continent to the impressive Inca Empire, the rich Viceroyalty of Peru and the modern republic, which boasts one of the highest economic growth rates in South America. Yet, in spite of such complex cultural development, or perhaps because of it, 21st-century Peruvians have substantial difficulties establishing a national identity and recognising each other as members of the same community.

Persons with mental illness represent with poignant clarity ‘the other’ which we seem to have so much trouble accepting as equals in terms of dignity and rights. When we look at mental health in terms of legislation, services and human rights, therefore, we are faced with exclusion and discrimination, unequal and inefficient use of resources, and lack of public interest.

Mental health as a component of public health

Peruvian psychiatrists have traditionally had a biopsychosocial approach to mental health and illness. Social psychiatry studies, under the leadership of Rotondo and Mariategui in the 1950s and early ‘60s, were fundamental in the conceptualisation of mental health as a cultural construct (Perales, 1989). Another interesting development is that of psychosomatic medicine, under the leadership of Seguin, which originated in the establishment of a psychiatric ward in a general hospital, long before the Declaration of Caracas so suggested, and which also is the precursor of the current interest in women's mental health and in the consequences of violence in the country.

As far back as the 1960s, pioneers such as Baltazar Caravedo and Javier Mariátegui saw mental illness as a major obstacle to the development of the country, and they pointed to the need to devote public effort and money to the promotion of mental health and the prevention and treatment of mental illness. Others have followed this path, especially after the results of a large epidemiological study by the National Institute of Mental Health were made public (Rondon, 2006).

Mental health and disorders

Anxiety, depression and schizophrenia are considered to be the most relevant psychiatric disorders in Peru. The use of alcohol, the prevalence of interpersonal violence and the high tolerance of psychopathic attitudes have also been identified as important (Instituto Especializado de Salud Mental, 2002).