Ex-Patients Police Mexico’s Mental Health System
Karla Zabludovsky, October 21, 2013
MEXICO CITY — On a recent morning, a collection of people grappling with mental illness roamed the grounds of a psychiatric hospital here, stepping into dirty, dilapidated rooms; exchanging tales of anguish; and peppering administrators with questions.
But they were not patients. They toted notebooks, pens and cameras as they documented conditions at the crumbling hospital, part of a fledgling movement by former patients to hold the mental health system in Mexico accountable for a record of neglect and abuse that is considered among the worst in the Americas.
“We’ve become activists in order to protect our own rights,” said Raúl Montoya, executive director of Colectivo Chuhcan, an organization of people with psychiatric disorders demanding an end to the systemic problems.
In recent years, citizen groups have emerged in Mexico to fight for a wide range of causes, including broader access to public records, fair trials for those incarcerated under questionable circumstances and an obligatory evaluation system for teachers.
Now, a growing number of people with severe mental illnesses, a population that is largely mocked and ignored here, are joining the fray, pressing a well-documented issue. A 2010 report by Disability Rights International, a human rights group, found evidence of torture and other forms of cruel or inhumane treatment in Mexican psychiatric institutions.
In January, President Enrique Peña Nieto, promising to fulfill Mexico’s previous vows to clean up the mental health system, signed a bill intended to relieve overcrowding, improve treatment and reduce the stigma of mental illness by reintegrating people with psychiatric disorders into the general population.
But experts say that progress has been piecemeal, and that promises to improve the system repeatedly fall short. Often, money and attention focus on short-term or cosmetic improvements instead of the development of rehabilitation programs and other long-term care.
“Mexico, I have to say, is wasting some of its money,” said Dr. Robert L. Okin, a psychiatrist and an adviser for Disability Rights International, who visited several psychiatric hospitals last month to inspect conditions. “It’s rearranging the chairs of the Titanic.”
In one hospital, some staff members admitted that patients had no activities, their days spent in bed or scratching at the walls.
In another facility, construction was under way for three new buildings for outpatient visits and administrative offices.
Yet a pilot program to help patients learn everyday tasks through regular restaurant and supermarket visits has served only six patients, and its expansion has been slow because of a lack of resources. The hospital also had plans for a halfway house for up to five patients, but it struggled to find basic necessities like furniture.
Formed in 2011, Colectivo Chuhcan began as a Disability Rights International project but has since broken off on its own. Its members encourage one another in their rehabilitation, give emotional support to psychiatric patients and mount information campaigns to eradicate the stigma related to mental illness. In August, they began touring psychiatric hospitals and pressuring the government to improve conditions.
Mental health issues are largely taboo and often misunderstood in Mexico. But hints of acceptance are emerging. Radio Abierta, a radio program in Mexico created by psychiatric patients, has been growing steadily since beginning in 2009. It allows guests, many of whom have psychiatric disorders, to own the airwaves for an hour a week, and it has expanded to include experts and students of psychology.
“These are no longer voices that no one listens to; they are empowered,” said Dr. Sara Makowski, a psychiatrist who founded and hosts the program, which fosters discussions about anything from soccer to Buddhism.
The show has its own version of humor — with slogans like “Once you join the crazy boat, it’s hard to get off it” — but also airs serious complaints.
“They bathed me with cold water; I object to this!” Jaime Gustavo, a patient at a hospital near the show’s makeshift recording site, recounted on one recent episode.
Dr. Makowski said fielding such complaints had led administrators at that hospital to cut off her access there. About 20 patients from the hospital participated in the program when it first aired; now, only about 5 contribute regularly.
Dr. Okin, too, knows how closed off mental institutions can be. During one of his hospital visits last month, a physician told him that he could not take photographs and threatened to have him arrested if he tried to do so.
Such restraints on access make observations by members of Colectivo Chuhcan all the more important, experts say.
“Having experienced the toxicity of these conditions, day in and day out,” said Dr. Okin, gives them “an unspoken understanding at a visceral level that we just don’t have.”
During a recent visit to an institution, Natalia Santos, Colectivo Chuhcan’s president, and two other members of the group took detailed notes about the belongings patients were allowed to have, their facial expressions and their extensive inactivity. They frequently asked patients how they felt and what they needed.
“Who better to do this work than someone who has this disability?” asked Ms. Santos, who suffers from paranoid schizophrenia and depression. “I can see that they are not well. Some reflect fear, others anger, others impotence.”
Some patients who recognized them from previous visits tried to tell them — some through moans and gestures — about cases of abuse in the hospital, and others simply craved an opportunity for human contact with outsiders.
The group looked shaken during the tour, overwhelmed by fetid smells and stepping along soiled walkways.
“Sometimes we stop to think that we could end up like that if we don’t control ourselves,” said Ms. Santos, who has been hospitalized twice. “I try to be strong.”