ITIC Americas 2026 | Medical Directors’ Forum

The ITIJ team have been reporting live from ITIC Americas in Mexico this week (June 2026) sharing the discussions that took place at the conference. Read all reports

Dr Salvador Belilty, CEO, LOGIMEDEX

Belilty started his presentation by saying that mental health is a state of mental wellbeing that enables people to cope with the stresses of life, realise their abilities, learn and work well, and contribute to their community. It has intrinsic and instrumental value and is a basic human right.

He said people with poor mental health show characteristics such as being anxious, sensitive to external factors,  and vulnerable. “Mental health,” he said, “can be related to physical health.”

He posed the question to the audience and the panel: “What is the importance of mental health in the industry?” For travellers, it is incredibly important, as the conditions of a trip or environment could reactivate psychiatric disorders, help manifest latent problems, or generate new episodes of anxiety or depression.

Belilty said the economic impact of mental health problems is huge, and are one of the main causes of incapacity for work and absenteeism which cause lost productivity, claims and complex repatriations.

He went on to say that according to the World Health Organisation, an estimated 12 billion workdays are lost annually to anxiety and depression, with an estimated global cost of US$1 trillion in productivity.

He then went on to talk about the type of incidences in certain age groups and said that in young adults (18–25 years) there are high rates of anxiety and depression – more prevalent in this demographic than in older adults. He said that in adults aged 26–64, 25% have a general mental disorder every year, and major depression can affect 8.8% of the population.For older adults (65 years and above), depression and anxiety persist (~8-9%).

Dr Belity said business travellers can suffer from chronic stress, anxiety, burnout and loneliness. He added that expats can suffer from shock-related depression, and that their risk level is high.

Finally, he added: “A broken leg activates an ambulance. A broken mind, sometimes, does not even activate empathy.”

Pablo Castillo, Chief Executive Officer, MedBrick

At the start of his presentation Castilo went through a detailed case study about a 17-year-old UK resident who visited Honduras. He talked about the first symptoms, what was done to help the patient, and her eventual repatriation to the UK.

The facts are:

• Psychotic disorders are more common than one may think
• No age group is spared from developing symptoms that may lead to a serious mental illness
• One in seven teens aged 10–19 experiences a mental disorder, with anxiety and depression being the most common
• Travelling can trigger mental challenges due to disrupted routines, jet lag and culture shock
• Around 11.3% of travellers experience some form of mental health issue during their trips, commonly anxiety-related.
   

Castillo said some key aspects of specialised mental health assistance include:

• On-the-ground support (local infrastructure), including immediate access to local, specialised care. This includes mental health professionals (psychiatrists, psychologists, counsellors) and, if necessary, secure, specialised, and culturally appropriate local facilities
• Case management and coordination, with 24/7 access, early intervention, personalised care planning (e.g. repatriation)
• Taking an holistic approach, because support for psychosocial needs can ensure long-term recovery.

To conclude, he said that when dealing with a new case involving mental health, regardless of the patient’s location, specialised assistance is required on the ground as well as from the assistance company managing the case.

He said for international cases, the assistance company is essential in overcoming barriers related to the local infrastructure, language, or culture to connect the patient with appropriate, high-quality care.

Dr Brenda Herrera Marcelino, Co-Founder and Chief Operating Officer, MedOne

Dr Marcelino also spoke about a case study at the start of her presentation, about a German woman who lived on a sailing boat in the Dominican Republic. Dr Marcelino went through the patient’s symptoms, diagnosis, and her lack of insurance coverage.

She went on to talk about the expanding scope of assistance, from logistics and transfers to clinical integration and advocacy, which can involve coordinating visiting specialists to remote settings, and supporting complex decision-making when medical, psychiatric, financial, and social issues intersect. The new ‘scope’ that the industry needs to adopt also means helping design long-term mental-health and travel risk-reduction strategies for high-risk travellers.

Dr Marcelino said the main takeaways for the ITIC audience should be:

• Tropical infections can unmask or trigger severe mental illness in travellers
• Remote settings require flexible, creative models of care when transfer is not an option
• Mental health exclusions do not remove our ethical duty to advocate for safe, appropriate treatment
• Assistance providers can be key partners in bridging tropical medicine, psychiatry, and logistics.

Dr Miguel Cortés Gutiérrez, Senior Flight Physician, Airlink Ambulance

Dr Gutiérrez spoke about why mental health matters in aviation, and started by saying there has been aglobal rise in mental health crises, a post-Covid-19 travel rebound, that there has been increasing psychiatric repatriations, and pointed out that that aviation systems are not designed for behavioural risk.

To underline his point, he shared a case study about a 46-year-old Canadian traveller who suffered from an acute Schizophrenic episode in a remote Mexican area. The patient had a psychotic relapse, loss of judgment and self-care, behavioural dysregulation, and was a risk to herself and others.  

He said the domino effect of a mental health crisis can mean legal issues, detention, embassy involvement, and aeromedical evacuation. But he said in this case, the real risk was not medical. There was no respiratory failure, no haemodynamic instability, but there was severe behavioural and operational risk. The competing risks, he added, were clinical, legal, and aviation safety.

After an initial unsuccessfulmental health management attempt, deep sedation of the patient was required in this instance. Other challenges, Dr Gutiérrez added, were a post-Covid-19 fear of intubation from the family, and issues around a mental health stigma. He said communication with the family in these cases is an integral part of the medical care provided.

Dr Gutiérrez told the audience that when it comes to legal frameworks in mental health cases you need special psychiatric consent, invasive procedure authorisation, and risk mitigation for patient and crew.