Empowering communities: Transforming mental health care in Honduras
University of Michigan researcher scales mental health interventions globally by training local leaders as community facilitators
Angie Sandoval couldn’t sleep. Lying awake in the early hours of the morning at her home in Tegucigalpa, the capital of Honduras, the 29-year-old felt like she was trapped in a dark tunnel without an exit, overwhelmed with terrifying memories from her past and challenges in her present.
As a child, Sandoval had survived the unthinkable—her entire family was murdered in front of her in what remains an unsolved crime. The trauma of that experience haunted her into adulthood, emerging as depression, anxiety and PTSD. When life got difficult, her symptoms flared. Now, Sandoval was facing one of the hardest moments in her life as a mother: Her 4-year-old twins, Samuel and Ester, had been diagnosed with autism.
“It was the lowest point of my life emotionally,” Sandoval said. “I didn’t want to get out of bed. I spent my days crying. It was terrible, the depression that I had in that moment. I got to the point where I was thinking, ‘Why am I here?’”
Then a phone call brought Sandoval a spark of light. It was from an organization in Tegucigalpa for children with disabilities where her twins were receiving therapeutic services. But the call was about Sandoval, not her kids. The organization was offering free mental health coaching for parents through a program called Rompiendo Fronteras—which translates to “Breaking Barriers” in English—spearheaded by the University of Michigan School of Public Health. “Would Sandoval like to receive coaching from a trained facilitator once a week?” the caller asked.
Rompiendo Fronteras is the brainchild of John Piette, professor emeritus at Michigan Public Health. Piette has worked developing and disseminating public health interventions in Latin America for more than 15 years.
Piette launched Rompiendo Fronteras in 2022, collaborating with several international and national aid organizations in Honduras that work with some of the country’s most vulnerable populations. These populations include people with disabilities and their caregivers, survivors of domestic violence, indigenous groups, LGBTQ people, and migrants returning from the United States.
Rompiendo Fronteras trains leaders from participating organizations to provide short-term mental health support to people in their communities. The program has received support by the Honduran government.
Rompiendo Fronteras is grounded in cognitive behavioral therapy (CBT), one of the most widely used, evidence-based practices for addressing mood disorders, including post-traumatic stress, suicidality, depression and anxiety. Research shows CBT can be effective even in some of the harshest environments globally where people are impacted by violent conflict, crime and extreme poverty. Programs such as Rompiendo Fronteras help participants identify and reframe unhelpful thoughts, develop healthy coping strategies, recognize their strengths, and build problem-solving skills.
While in an ideal scenario, everyone who needs this type of assistance would get it from a psychologist or psychiatrist, that’s not practical in most countries, where demand far outstrips the supply of mental health professionals and the cost of care is beyond what most people can afford.
In Honduras, the need for mental health support is vast due to widespread violence, poverty and traumatic experiences related to migration, Piette said. Rompiendo Fronteras facilitators help fill the gap in services by providing coaching over five to eight weekly sessions via phone, video chat or in person.
“The idea is to teach recipients skills so that they can become their own source of support, rather than depending only on health professionals,” Piette said. “We’re trying to bridge the massive chasm between interventions we know work in ideal settings and what’s realistic in the real world."
Community members helping each other
So far, Piette and his team have trained more than 80 people as Rompiendo Fronteras facilitators. While some trainees are psychologists, most are not formal mental health professionals. They include educators, community health workers, religious leaders, social workers and volunteers within community organizations. What all facilitators have in common is passion and understanding for the people they work with, said Darlin Mancia, a psychologist in Honduras hired by the University of Michigan to lead trainings and program dissemination in the region.
Facilitators are usually from the same community they are helping, and people already trust them as someone they can go to for help with their problems, Mancia said.
Naturally, trainees sometimes ask what to do if the person they’re helping needs a higher level of support. In those cases, Rompiendo Fronteras staff are trained to refer them to mental health professionals. So far, that’s only been needed twice, Mancia said.
“Rompiendo Fronteras is not a complete therapeutic process; facilitators are not trained to do that,” Mancia said. And some participants such as people with bipolar disorder or an active substance use disorder need a higher level of support. “At the same time, we know that this program really helps the community a lot.”
Kelyn Ordoñez is a Rompiendo Fronteras facilitator. An office assistant at the National Autonomous University of Honduras and a mother of a child with autism, Ordoñez said she signed up as a volunteer for Rompiendo Fronteras because she wanted to help other people navigate the emotional rollercoaster of caring for someone with disabilities.
“As a parent, when your child gets a diagnosis like this you confront a lot of emotions,” she said. “People need to know how to process it emotionally in a way that’s proactive so they can help their loved-one rather than closing up and saying, ‘No, I can’t do this, why me?’ You have to convert those feelings into positive actions so you can help your family members.”
Another longtime supporter of Rompiendo Fronteras is Gladis Corea in the Honduran municipality of Santa Cruz de Yojoa. Corea manages a network of women community leaders. She and five other local women took the Rompiendo Fronteras training so they could support people in their community struggling with mental health issues, substance use and domestic violence. Corea said she’s even used the training to help her own brother, who suffers from alcoholism.
“It’s a program that’s worth gold,” Corea said. “Rompiendo Fronteras is the best thing that’s come into my hands—into my life—and I hope it can reach more people, that it can be replicated.”
Someone to listen
Over eight weeks in 2024, Sandoval met regularly with her Rompiendo Fronteras facilitator, a psychologist who works with one of more than 20 organizations affiliated with the Honduran “National Federation of Mothers, Fathers and Families of Persons with Disabilities of Honduras” (known by its Spanish acronym, FENAPAPEDISH).
FENAPAPEDISH has played a major role in disseminating the Rompiendo Fronteras program. Other participating organizations in recent years have included the Kukulcan Association, which advocates for people from the LGBTQ+ community, Doctors Without Borders, Scalabrinians (a Catholic organization supporting migrants), Central American Medical Outreach and—until recent cutbacks from the US government—USAID: the US Agency for International Development.
For Sandoval, just having someone listen to her brought immense relief. She’d kept her distress from her husband, she said, because she hadn’t wanted to burden him. Now, she could talk with someone about the trauma she’d experienced, and about guilt she felt as a mother, especially in the wake of her twins’ autism diagnoses.
With help from the Rompiendo Fronteras facilitator, Sandoval also learned to listen to herself. She began observing her thoughts and realized she was being too demanding and self-critical. She also realized she spent so much energy caring for her family that she was ignoring her own needs.
The facilitator encouraged Sandoval to take time for herself.
“Now, when I feel anxious, I’ve learned to control it,” Sandoval said. “I go out for a walk, I go get a coffee. When I feel very, very overburdened, I slow down and look for something relaxing to do to clear my mind.”
Piette and his team are now working to expand the program within Honduras and, over the next three years, to other countries in Latin America.
One population they hope to reach includes the tens of thousands of migrants being deported to Mexico and Central America from the United States. Returning migrants arrive to their home country with countless issues, including trauma and economic distress, and services in many areas are almost nonexistent. Other plans include creating a digital platform for the Rompiendo Fronteras training materials, so that collaborating organizations in the Spanish-speaking world can access them more easily.
“The ultimate goal is to transfer these evidence-based practices and resources to the people so that they can continue to use them and take them forward,” Piette said.
These days, Sandoval is doing much better. She has learned to embrace the daily mayhem of life with two young children, and she forgives herself when she can’t get all her chores done. When negative feelings arise, she leans into what gives her joy: hugging her kids, going for walks, buying small things for herself.
Rompiendo Fronteras “is a great blessing,” Sandoval said. “Not just for me, but for many other people because, in the middle of all the chaos in the world, what’s really missing is people who listen, and we all want to be heard.”
Written by Claudia Boyd-Barrett
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Destiny Cook
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