With a novel healthcare model that involves families in lasting prevention, Jorge Cardoso is inspiring a new understanding around mental health in Colombia. Starting with bipolar disorder, a condition that has marked his own life, he is now catalyzing a network that is influencing public policy, public perceptions, and overall diagnosis, treatment, and recovery.
The New Idea
Jorge Cardoso is spearheading a powerful movement to make comprehensive, preventive mental healthcare a reality and a norm in Colombia. Through his Positive Health Care approach, he founded the first Colombian Association of Bipolarity to support patients and their families to overcome bipolar disorder. Having experienced the painful and emotional effects of bipolar disorder himself, Jorge also distinguishes his work from others who possess a more traditional mental health model. Now, his Positive Health Care model has demonstrated a dramatically shortened and more long-lasting treatment time to stabilize bipolar patients, ranging between two weeks to eight weeks, versus the expected two years of treatment that conventional methods take.
Jorge’s mental health association was the first of its kind in Colombia, and the first to apply an “ecosystem” approach to treatment and recovery. Beyond just traditional individualized therapy, patients participate in support group sessions. Most notably, their families also engage in regular support groups with patients and with other families of patients. They learn to practice techniques that can help stabilize patients, neutralize manic episodes early on, and prevent relapses. Such an approach has led to impressive impact and has quickly attracted the attention and support of the mental health profession and the public Ministry of Health in Colombia in Jorge’s association. Jorge is now partnering with the health ministry to make Positive Health Care a nationwide policy and to formalize a relationship with the association.
Through the success of his model with bipolar disorder, Jorge is now seeking to influence the entire mental health field in Latin America. He is helping establish other associations and entities for the treatment of other mental health conditions and encourage them to adopt similar preventive approaches as his pioneer association has done, thereby changing attitudes towards a taboo subject area. Together he is mobilizing them into a powerful advocacy network, which successfully lobbied the Colombian legislature to pass a novel Health Care act, and seeking to build a global network that can support similar associations in other parts of Latin America, most notably in Argentina, Chile and Venezuela. By seeking to scale the Colombian association throughout the country while simultaneously emphasizing the work of the network, Jorge is producing a coalition with the potential to transform the mental health profession in Latin America and how the region perceives and deals with mental health.
Bipolar disorder is a mental health condition caused by an imbalance of serotonin in the brain and is characterized by extreme, manic swings in mood and behavior. Patients undergoing an episode can experience symptoms from utter euphoria to total depression, mania, panic attacks and hysteria. The disorder is often difficult to diagnose, and any number of stimulants—stress, relationships, loss, substance abuse, etc.—can trigger an episode. During the most severe episodes of altered states, bipolar individuals have been known to commit acts with adverse consequences in their workplace, with their families and even against themselves.
An estimated 6% of the total world population suffers from bipolar disorder, and in Colombia, estimates suggest that some 5 million people are bipolar. In Colombia and Latin America more broadly, though, significant stigmas and misunderstandings exist around bipolar disorder and mental health, and as such, records are poorly maintained. Generally psychiatrists diagnose bipolar disorder, as with a number of other mental health conditions, merely a form of depression, which means that patients will often receive inappropriate therapy and treatment for their condition. This is augmented by prejudice that larger society often exhibits toward mental health disorders; people either do not understand the nature of these disorders or they actively discriminate against them. Among the most disadvantaged communities, this problem is even greater, as they have no access at all to appropriate mental healthcare. In those cases when bipolar disorder is diagnosed, though, patients find themselves in a paradox: in many workplaces they are considered disabled, yet health insurance providers do not cover medical costs incurred due to treatment after severe episodes since they do not perceive bipolarity as a disability.
In recent years as the public has slowly come to understand and accept mental healthcare as important, therapy and more resources have come available for people with bipolar disorder. Yet overall traditional models are focused only on patients. In reality, though, manic episodes are often triggered by interactions with family members, colleagues or loved ones, all who are unaware of the effects they might be having. Bipolarity is also a largely hereditary disorder, meaning that many other family members may suffer from it. As such, a more comprehensive approach that involves the entire community around the patient is necessary to have lasting impact in treatment and prevent relapses.
With experiences and learning taken from treatment guides and practice manuals for bipolar disorder in the United States, Jorge launched the Colombian Association of Bipolar Disorder as an initial support group in a single clinic. As he gained more experiences with patients he adapted and improved the methodology and engaged more trained psychiatrists who essentially volunteer to provide therapy to association members—receiving only a nominal remuneration for their time. Originally, many psychiatrists were wary of his nontraditional methodology, but after observing the overwhelming success of the methodology, they started to refer patients in greater numbers and sign up as partners. Jorge is now leveraging his widespread recognition in the space and partnerships with the federal Ministry of Health, the National Academy of Medicine and the Colombian Association of Psychiatry to generate a sea change in the Colombian and Latin American mental health profession.
Jorge’s Positive Health Care methodology revolves around certain crucial elements: psychiatric therapy, patient support groups, interventions and consciousness building among the family, and physical and spiritual wellness. When a patient first arrives at the association, she is connected with a trained psychiatrist, and they engage in regular therapy sessions. The psychiatrist also prescribes appropriate medication for the patient to help restore balance to the neurological chemicals that help trigger manic episodes. Then, after initial counseling sessions with family members, the patient joins a support group of other bipolar patients. In these sessions, they learn to manage the disorder through the so-called “Zero Scale” that helps them achieve and maintain stability and to monitor their wellbeing. Through careful monitoring, they learn to avoid falling into a manic episode, control the symptoms of one at early onset, and seek professional help if it grows severe. Meanwhile their family members also begin to join support groups specific to them. This counseling is essential for the recovery and treatment of the patient, as the families are often unaware of proper behaviors to support their loved ones facing manic episodes. In many cases by helping inform patients’ families about it, they are inevitably supporting other family members who also suffer from it and the stigma around it. In the sessions, held either with or without the patient herself, the family members learn to cope, reduce creating environments that cause stress and relapses and instead promote ongoing therapy and mental stability. Finally, the therapists encourage the patients to develop an active spiritual life and engage in greater physical activity, while not endorsing particular religions or activities, as the association finds that such exposure increases their psychological stability.
Through this more comprehensive, preventive and detailed approach, Jorge’s model has demonstrated that patients can achieve stability and avoid relapses after shorter periods of therapy and to a longer-lasting extent than traditional methods. Because bipolar disorder is not curable, patients learn techniques and behaviors to manage it on a daily basis. They also have lifelong access to the association’s activities; over time patients may attend individual or group therapy sessions less frequently, but they can still call upon them when needed.
Jorge does not deny help to anyone, regardless of whether they can pay. A lifetime membership in the association costs a mere $5 dollars, making it accessible to even the most economically disadvantaged in Colombia. Other sources of income include fees charged for workshops, participation in annual conventions and conferences, and some small donations from families and professional clinics. He will soon be receiving additional public funding to expand the model after having achieved through national legislation a formal contract to provide services to the federal health ministry. Currently he has 600 patients and 1,200 family members enrolled in his first clinic in Bogota. In 2013, Jorge began to expand nationally by opening chapters of the association. He now has or is opening seven chapters, averaging 500 patients per city, meaning about 7,000 patients and their relatives are participating in the association’s work. In the coming years, Jorge seeks to open more chapters and consolidate those that are already active.
Building off of the direct impact of the association and the high esteem he has come to enjoy from professional associations and the health ministry, Jorge saw an opportunity to influence the entire field of mental health in Colombia. Rather than expanding his own clinical focus beyond bipolar disorder, he has spearheaded the development of a powerful network of organizations and associations dealing with other mental conditions, including autism, Alzheimer’s Disease, schizophrenia, depression, panic, eating disorders (like anorexia and bulimia) and Attention Deficit Disorder. In the latter two cases, Jorge was instrumental in founding the associations themselves as well. Like bipolar disorder, these challenges tend to be greatly misunderstood and are inappropriately grouped together under the same “umbrella,” despite differences in their symptoms and treatment. Jorge also helped mobilize this network to create the first group of Conciliators for Mental Health Rights, which successfully advocated for the 2013 national Mental Health Act. Jorge himself was especially influential in the writing of the legislation, which explicitly prioritizes positive mental health and the relationships between mental health, the environment, physical activity and nutrition. The law also includes an overt recognition in Article 28 of the seminal role that the family plays in the treatment of people with bipolar disorder. Now, Jorge intends to establish himself and his initiative as an advocate for improved mental health program that are authorized by the federal public health ministry and the national social security system.
Jorge has also started to draw international attention for his work. The Pan American Health Organization sought out Jorge for his expertise because of an institutional interest in mental health associations across the region. Participating in a PAHO conference and describing success in Colombia’s mental health law, Jorge so impressed a federal deputy of the National Assembly of Argentina and a Ministry official from Chile that they requested Jorge’s help to replicate his strategies on Chile, Peru and other countries where such associations do not exist, extending his reach and influence in Latin America. He also participates in conferences and global associations of professionals working with bipolar disorder in the United States and Spain.
Throughout his life, Jorge has maintained a deep-rooted commitment to enable the lasting treatment and recovery of people with similar mental health conditions as he has. Jorge recalls personally experiences of hysteric bouts of mania and depression, feelings of helplessness and loneliness, helplessness, and even contemplation of suicide. After one of the most painful and account episodes of depression, he started to develop the idea of the association and especially the elements of family and group support. Jorge came to realize that his grandmother was bipolar but went undiagnosed, and she suffered her entire life.
Jorge grew up in a family of prominent leaders who supported him during the most grave and difficult moments of his life. His father was the founder of the Bar Association of Bogotá, a member of the Colombian Academy of Jurisprudence, dean of the law school at the Military University, and renowned lawyer, writer and teacher. His grandfather was a doctor, the Minister of Health, two-time mayor of Bogota, and the ambassador to Switzerland. From this pedigree, Jorge learned the values of perseverance, tenacity and a positive wellbeing. Meanwhile, his mother, who stayed at home to care for him and his family, instilled in him the values of empathy and compassion toward others. Jorge was an outstanding student until his academic performance sank at age 18, during which he suffered his first bipolar episode—unbeknownst to him at the time. He turned around and went on to study law and finance, but after graduation, he faced his most profound and severe personal crisis. Jorge even ran for president, but then underwent a painful personal financial crisis. It was during this time that, with the support of his family, Jorge was diagnosed as bipolar. He began to see consistent patterns in his life—of advancing in a powerful personal and professional trajectory but then being thwarted by the mental condition, his greatest personal obstacle. At this point, Jorge turned his resolve to overcome this obstacle directly.
Once Jorge became aware of his condition, he realized that Colombia lacked the appropriate environment and support for people with bipolar disorder and their families. With help from his psychiatrist, Jorge began to piece together the incipient elements that later became the Positive Health Care model. Jorge has not suffered from a manic episode since, and he has thrown himself into becoming a leader in the mental health profession. He says that the importance of his work is constantly reiterated to him through the personal testimonies of the patients. Once a young man, fresh from his first support group session, confessed to Jorge that the previous night he had contemplated suicide, but through the session and Jorge’s inspirational story, the patient felt hope that he could overcome the disorder, just like so many others whose lives Jorge has helped to touch and impact.