Peru expanded mental health services across the country between 2018 and 2024, but the people with the most serious psychiatric conditions did not benefit. A population-based study published in Lancet Regional Health Americas found that service use among people with psychosis actually declined over that period, even as access improved for people with other mental health conditions.
Researchers analyzed outpatient data from the Peruvian National Superintendence of Health covering six years. Monthly service utilization per 100,000 people fell for psychosis from 28.2 in 2018 to 19.2 in 2024, a rate ratio of 0.68. By contrast, utilization for non-psychotic mental disorders rose from 225.2 to 304.6, a rate ratio of 1.35. General medical conditions saw a slight decline from 12,688.1 to 12,370.4.
The COVID-19 pandemic hit all three groups at roughly the same moment and with comparable force. In March 2020, service utilization fell to 37.9 percent of expected levels for psychosis, 37.0 percent for non-psychotic mental disorders, and 35.3 percent for general medical conditions. Recovery after that initial drop differed by group. Monthly increases following the lowest point were 1.3 percent for psychosis, 2.6 percent for non-psychotic mental disorders, and 2.2 percent for general medical conditions, meaning people with psychosis recovered more slowly and never caught up to where they started.
The study also examined whether Peru's push to decentralize services reached the most underserved regions of the country. A shift from tertiary to primary and regional facilities was seen for both mental disorder groups. But greater utilization in underserved regions was observed only for non-psychotic mental disorders. People with psychosis in areas that previously lacked services did not show the same gains.
The researchers were funded by the Canadian Institutes of Health Research and the Canada Research Chairs program. They drew on sex data available in binary male and female coding but noted that gender identity and race and ethnicity data were not available, which limits the ability to analyze disparities along those dimensions.
The study's authors concluded that despite a nationwide expansion of mental health services, individuals with psychosis did not experience higher service use. They called the pandemic's impact on this group acute and enduring. The findings, they wrote, underscore the need to examine reasons for this stagnation in service utilization and evaluate the acceptability and appropriateness of Peru's current service model for psychosis.
The gap between people with psychosis and those with other mental health conditions is not unique to Peru. Worldwide, people with severe psychiatric disorders face higher rates of stigma, more complex care needs, and greater difficulty navigating health systems. Peru's reform appears to have made meaningful progress for a broad population seeking mental health care while leaving its most vulnerable group further behind in relative terms.
The study covers data through 2024 and was published July 10, 2026. It represents one of the first population-level analyses of how Peru's reform performed specifically for people with psychosis across the pandemic period.