In Mexico, 64% of patients admitted to psychiatric hospitals have been abandoned by their families. In the case of Mexico City, despite the lack of a psychiatric hospital run by the local government, none of the patients treated at the Centers for Assistance and Social Integration (CAIS) have any support network.
Through various requests for information, Political Animal sought to know how many people are hospitalized in psychiatric hospitals in Mexico, because after the reforms to the General Health Law in matters of mental health, various debates were generated about what will happen to those who currently receive treatment in these spaces, because the modifications to the law have that psychiatric hospitals should be transformed into general hospitals and hospitalization will be the last treatment option.
With 28 of the 32 entities that responded to the request —with data updated to July 15—, it was confirmed that there are 1,940 people hospitalized in psychiatric hospitals in the country. Of them, thousand 236 (64%) are in a condition of abandonment.
Schizophrenia, bipolar disorder, behavioral disorder, intellectual disability and psychotic drug use disorder are some of the conditions for which patients are hospitalized.
In an interview, psychiatrist Javier Zambrano stressed that the abandonment of psychiatric patients is related to a tradition and bad habit of health systems that has been maintained over time.
He even shared that during his work experience in public institutions he has had to take patients who have been discharged to their relatives’ homes, to deliver them so that they can continue their treatment remotely.
It is common that, once patients are admitted to hospitals, little by little their relatives stop visiting them until the moment arrives when they do not go or answer calls from doctors.
“We have found ourselves in the painful need to make home deliveries, and I am talking about having to go not to the registered address, but to patients who had already come out of their dissociative picture to whom we asked if they remember another relative and we launched with him in an ambulance with a doctor and a social worker,” shared the specialist.
“We have had to make home deliveries at night or on Sunday mornings (…) They cry, they tell you that they are going to sue you, they yell at you…”, he recounted.
In the medical units, when receiving patients, Zambrano explained, they only asked for a copy of an official identification or proof of address. However, for about five years they have been requesting two copies of official identification from different family members.
In order to avoid cases like these, the recently approved reforms to the Health Law regarding mental health contemplate in article 75 the impossibility of hospitalizing patients without their prior consent.
“Internment can only be carried out voluntarily and when it provides greater therapeutic benefits for the person than the rest of the possible interventions; will be carried out for the time strictly necessary and in the General or Pediatric Hospital closest to the user’s home. For no reason can internment be indicated or prolonged, if it is intended to resolve family, social, work or housing and patient care problems”, it is stated.
The abandonment of people is a crime that is contemplated in article 335 of the Federal Penal Code and considers penalties ranging from one month to four years in prison.
Regarding what will happen to all the patients who are currently hospitalized in psychiatric hospitals, Zambrano insisted that “they will not be abandoned or taken out on the street, (as well as) they will not be sent to annexes,” as as the federal Ministry of Health had informed Political Animal and we count in this note.
The specialist announced that they are working on a care model in which, if it is necessary for a chronic patient to be hospitalized, they should not remain in the hospital for more than six weeks.
In CDMX, the abandonment is total
Although the capital government does not have any psychiatric hospital under its charge, it does offer psychiatric care to chronic patients through the CAIS.
These are 11 spaces in charge of the Secretariat of Inclusion and Welfare (Sibiso) that house 1,850 people, men and women who do not have a roof over their heads or a family network that supports them. Of these people, detailed the dependency, 36.7% suffer from psychiatric disorders, psychosocial disability and / or intellectual disability, that is, about 474.
To date, according to the information provided via transparency, all the people who are in these shelters are abandoned.
Regarding the other entities in the country, the State of Mexico stands out as the entity with the largest number of psychiatric hospitals and, therefore, the largest number of hospitalized and abandoned patients.
According to the data provided, three psychiatric hospitals operate in the entity with an installed care capacity of 637 beds. As of July 6, 348 people (55% of capacity) were interned in these spaces, and of these, 217 (62%) were abandoned.
In Puebla, there is only one psychiatric hospital with a capacity to care for 317 people. Currently, there are 210 hospitalized, of which 156 (74%) are abandoned; in Durango, there are 46 hospitalized patients; of them, 28 (61%) are abandoned by their families.
Veracruz is the entity where there are fewer abandoned psychiatric patients. The entity reported that, of the 71 beds currently available, there are 18 hospitalized patients and only one is abandoned.
Guerrero, Morelos, Nayarit, Querétaro and Quintana Roo were the entities that reported not having psychiatric hospitals under their care.
The birth of psychiatric hospitals
Following the amendments to the General Health Law regarding mental health, opinions on the transformation of psychiatric hospitals have been divided. Psychiatric hospitals, as we know them today, began operations in the 1960s and their origin was never to become asylum spaces as they are today.
Doctor Zambrano recalled that, at the beginning of the 1960s, and once the La Castañeda psychiatric hospital —the first of its kind in Latin America— had to close its doors due to overcrowding, in addition to allegations of mistreatment of patients, it was planned build psychiatric hospitals in the states.
These spaces, the expert emphasizes, were planned as hospital-farms where patients would receive their medical treatment and at the same time learn trades so that, once discharged, they could reintegrate into society. However, this plan could not be realized because families began to abandon their patients.
“The idea, which was very good, is that they be hospital-farms to train them in activities in the field so that they are useful and can return to their families and, come on, the number of hospitalized patients can be reduced,” said Zambrano.
“Unfortunately there was no supervision, but what there was was the abandonment of the families towards these patients (…) So what were going to be hospital-farms became asylum hospitals until (the authorities) realized that it was out of any economic budget to maintain them”, he added.
In the 2020-2024 institutional program of the Juan Ramón de la Fuente National Institute of Psychiatry, for example, it is admitted that for the care of the population it was decided to build a parallel health subsystem that privileged the construction of, to date, 41 hospitals psychiatric hospitals that are isolated from the health system and that, in most cases, operate with an asylum model.
In addition, only 13 of the 41 psychiatric hospitals assume 95% of the demand for care.
“In recent years, most have made efforts to transform your operating model to become hospitals for acute care with short-stay hospitalizations, however, there are still around 1,900 institutionalized patients with average stays of between 10 and 50 years”, is stated in the document released in the Official Gazette of the Federation (DOF) on November 27, 2020.
Although work is still being done on the new models of care that will be provided in order to comply with the reforms to the General Health Law, doctor Zambrano explained that it is important to understand that psychiatric hospitals will not disappear: they will not be closed, nor will they be collapse, but its care model will be transformed and what will disappear will be the concept of patients at risk of abandonment.
“There will be hospitalizations but not more than six weeks”, advancement. “The challenge that we set ourselves as specialists in mental illness is that in these six weeks there is a certain diagnosis, (the patient) must have started treatment and I must have started a rehabilitation process and mainly psychoeducation with the family” .