According to Valcárcel et al. [8] professionalization is a process that begins with initial training and must continue uninterrupted throughout one’s working life in a dialectical and developmental manner, refining professional skills; it fosters superior competitive performance (leading to individual satisfaction and the resolution of social problems) while necessitating new studies and validations characteristic of advanced education theory [9]. On the other hand, González et al. [10] posits that it is a pedagogical process involving both training and self-training, originating in initial vocational training and extending to the lifelong, continuous training of practicing professionals.

Drawing on our academic experience and supported by participatory observations regarding this topic, we have formulated the following research questions: Why is there no university degree program for health promoters in Cuba? How can positions for health promoters exist within primary healthcare without a corresponding university degree program? What are the causes of the inadequate professional preparation of individuals serving as health promoters in Cuba? Does this factor limit the care provided to people with mental disorders at the primary healthcare level? How do insufficient teaching and research activities during medical student training in Cuba contribute to the limited preparation of mental health promoters? What obstacles hinder the training of students as mental health promoters in Cuba? Rather than merely creating dilemmas, these questions indicate areas for academic improvement, potentially leading to solutions for pressing social issues in Cuba.

Cuba’s healthcare system is structured across three levels of care: the tertiary level consists of specialized institutes and hospitals; the secondary level comprises general hospitals; and the primary level is represented by polyclinics (health zones) distributed throughout the country. Within these polyclinics, a professional role known as “health promoter,” a position open to physicians, nurses, psychologists, social workers, and epidemiologists. This is because Cuba lacks a specific university degree program for health promoters, allowing any health professional to fill the role—unlike in Nicaragua, Chile, Colombia, and Mexico [11], where university-level training programs for health promoters do exist.

Municipal centers for hygiene, microbiology, and epidemiology conduct training for professionals in the health promoter role in Cuba. This professional development focuses primarily on chronic communicable diseases, with a central emphasis on sexually transmitted infections. Indeed, the emergence of such morbidity (specifically, the first cases in Cuba of individuals carrying the virus that causes acquired immunodeficiency syndrome) was the driving force behind the creation of the health promoter role within the health zones.

At times, in an effort to curb the scourge of sexually transmitted infections (STIs), Cuban health experts enlist individuals diagnosed with these conditions to serve as peer health promoters (working with others diagnosed with the same pathology) to help prevent the psychosomatic consequences associated with STIs. Requirements for becoming a peer health promoter include: the individual’s voluntary participation, the absence of mental disorders, the completion of at least a secondary education, and the demonstration of certain communication skills. However, this raises a question: do other regulated health programs in Cuba (such as those addressing maternal and child health, mental health, cancer, elderly care, oral health, and chronic non-communicable diseases) not also require health promoters?

The World Health Organization [12] coined the slogan “There is no health without mental health,” highlighting the urgent need for treatment (both psychopharmacological and psychotherapeutic), monitoring, and care for individuals with mental disorders within the primary health care system. This principle is further reinforced by specific objectives 3, 4, and 16 of the 2030 Agenda and the Sustainable Development Goals [13].

Regarding this topic, experts from the Pan American Health Organization [14] define mental health as a state of well-being in which the individual is aware of their own abilities, can cope with the normal stresses of life, and can work productively and fruitfully, thereby contributing to their community. A report by SAPIEN LABS [15] indicates that residents of eight English-speaking countries experienced a 3% decline in mental health, followed by Latin American populations; the countries where residents reported the highest levels of distress were Colombia, Puerto Rico, Mexico, and Venezuela, with women showing the highest degree of impact.

Furthermore, 7% of the subjects studied who were over the age of 65 were struggling with their mental well-being, a situation exacerbated by COVID-19. In this regard, the World Health Organization [16] has issued a report calling for effective strategic programs focused on health promotion and prevention; achieving this would require reinforcing human values and collective commitment, as well as restructuring academic environments to enable the creation of a mid-level technical training program for health promoters in Cuba.

It should be noted that psychosocial risks contributing to mental disorders exist in Cuba, such as stress, psychoactive substance use, an inverted hierarchy of needs, and emigration. Consequently, since 1998, a Community Mental Health Center has been established in each of the country’s 168 municipalities. These centers are staffed by a multidisciplinary team comprising three psychiatrists (one child and adolescent psychiatrist and two general psychiatrists), three nurses, three psychologists, a psychometrist, a social worker, and an occupational therapist. Their mission is to implement health-oriented actions designed to improve community mental health and comprehensively address health issues and their determinants.

Furthermore, given the rising number of consultations at these Community Mental Health Centers, medical students urgently need training as online mental health promoters [11]. This training aims to improve community members’ and fellow students’ mental health by comprehensively addressing sociocultural determinants, a goal achievable through the “significant semantic core” method [17]. This proposal draws on Serge Moscovici’s theory of social representations and integrates Valdez Medina’s “natural semantic networks” psychological test, while incorporating a perspective on the distortion of perceived realities introduced by Professor Armando Alonso.

Modern civilization is navigating the digital age, driven by the proliferation of technologies that often make human life easier (though some individuals known as technophobes, disagree). Given this context, would it be feasible for medical students in Santiago de Cuba to use a technological platform to disseminate information on healthy mental health habits to provide support? Creating an online platform would be highly advantageous; the initiative would offer a support service led by students trained as mental health promoters, a type of health intervention not currently implemented in Cuba.

Cuban undergraduate medical education lacks any specific course (let alone a workshop) to prepare future physicians to serve as online mental health promoters. While subjects such as psychiatry and medical psychology touch on this topic, their curricula could be refined to enhance the public health skills of medical students through virtual platforms, thereby benefiting individuals experiencing mental health struggles.

According to Gómez-Díaz [18] and Chen, Huang, and Torous [19], mental telehealth involves providing support and guidance to an individual or group seeking mental health assistance through advanced technology, bypassing traditional face-to-face methods (such consultations may be conducted by psychologists, psychiatrists, rehabilitation specialists, and health promoters). Telehealth offers several advantages: it eliminates the need for travel, reduces healthcare costs, and allows for connections at various times using multiple communication channels. Conversely, disadvantages include the risk of addiction, the potential for decision-making capacity to be influenced by Generative Artificial Intelligence [20], limited access to the patient’s non-verbal cues, risks of digital identity theft, and potential difficulties for patients with severe sensory impairments (such as deaf-blindness) in accessing the service.

Within Cuba’s healthcare system, the Council of Ministers has established regulations, specifically GO-2024-578-099, published in the Official Gazette, on the national system for comprehensive life care. This initiative aims to create the National System for Comprehensive Life Care as an instrument with a strategic vision of care. It is implemented based on a model that fosters coherence and coordination among policies, programs, and actions, as well as collaboration among Central State Administration bodies, local People’s Power organs, and other economic and social stakeholders, from the national to the local level.

There are precedents for telemedicine within the Cuban National Health System; examples include the Siboney International Clinic (a paid service for foreigners), the 10 de Octubre mental health center in Havana (which offers only a telephone helpline), the Cuba Mundo Médico portal (a paid service for foreigners), and the Havana court system (with its 103 helpline). Additionally, there is a free online resource (albeit one associated with pseudoscientific content) available to Cubans experiencing mental health issues.

On the one hand, telemedicine in Cuba exists to generate foreign currency, while domestic telemedicine services are limited to telephone helplines (focusing primarily on substance abuse); on the other, online services lack academic credibility. Given this situation, there is an urgent need for an interactive virtual platform that provides free mental telehealth services to Cubans. Practicing mental health professionals should oversee the platform, and a health institution or scientific association should endorse it. In Cuba, this service would be provided in Spanish (the official language) and would be available 24 hours a day. Sponsored by a scientific association or the Cuban Ministry of Health, this virtual platform would aim to provide free mental telehealth to Cubans over the age of 19 seeking mental health support. Services would be delivered in accordance with bioethical principles. They would ensure anonymity, allowing users to choose between video calls, instant messaging, or telephone calls, offering practical alternatives to support their mental health.

The proposed virtual platform will be hosted within the repository of Cuba’s Medical Information Center and will feature end-to-end encryption, operating under the following principles:

The platform, designed to provide mental telehealth services to Cuban citizens, will feature a logo incorporating elements of Cuban culture and a slogan. It will also list the names, professional backgrounds, and workplaces of the professionals volunteering to assist Cuban citizens. The homepage will prominently display the project’s sponsor, mission, and vision (in accessible, conversational language), along with options for citizens to request assistance, while always informing them of the option to remain anonymous.

Furthermore, the proposed virtual platform could be linked to the social media networks used by Cubans to identify and report potential suicidal and/or aggressive behaviors to the relevant health authorities within a regulatory framework, thereby reducing mortality associated with mental health issues. A precedent for this is the methodology developed by Pompeu Fabra University [21], which stratifies social media users into high-risk or low-risk categories. High-risk users are characterized by speaking more frequently in the first person, using a higher number of negations, expressing anxiety online, having fewer online friends, using fewer characters in their writing, or exhibiting increased activity during the night [22]. Reports generated by Generative Artificial Intelligence and supervised by specialized clinical staff would enable the planning of psychoeducation campaigns, without targeting any specific user.

Another useful tool for mental telehealth via the proposed platform is Virtual Reality (VR) psychotherapy; Feixas and Alabèrnia-Segura [23] demonstrated the effectiveness of VR in treating a controlled sample of adolescents and older adults suffering from anxiety, cognitive impairment, self-esteem issues, and eating disorders. The advantage of VR is that it provides a scenario controlled by the mental health professional; the disadvantage is that the patient may feel alienated from reality or develop an addiction to the technology. Additionally, the patient could (if they so choose) create a virtual avatar representing the psychotherapist of their choice psychological treatment.

Furthermore, a virtual program could analyze images [24] and the non-verbal behavior of patients during the mental telehealth process, generating a post-session report that the mental health specialist could integrate into the analysis, diagnosis, and treatment plan to foster the patient’s progress.

Scientific Project: Estrategia para la atención a consumidores de Cannabinoides sintético. Código: NA241LH0028/0992.