The Chamber of Deputies approved reforms to the General Health Law in matters of mental health and addictions, with which it seeks to provide community care and eliminate psychiatric hospitals, among other actions. However, to transition to this new care model, extraordinary resources will not be authorized it has not been explained what will happen to the patients who are currently hospitalized in the country’s psychiatric hospitals.
“This idea of deinstitutionalization is go to the street? It seems naive to me to believe that this is possible. If there is no way to send people somewhere, we are assuming that they have a place to go”, criticized Cecilia Guillén, founder of En Primera Persona, AC.
Guillén pointed out that first it would be necessary to know what support networks the users of these centers have, because the reality that many of them are abandoned by their relatives is omitted.
For the human rights defender, it is important to know how the approved reforms will materialize gradually and progressively, because the paradigm shift in mental health care, which for years has privileged the isolation of patients, “is more beyond just closing hospitals.”
In accordance with the approved reforms, at least the 33 psychiatric hospitals in charge of the federal Ministry of Health —which have the capacity to serve just over 4,000 people— must be converted to general hospitals or outpatient centers and no more monospecialized psychiatric hospitals should be built.
The Community Mental Health Centers will be the spaces that will provide all services, from the primary ones, such as promotion, prevention and treatment, to those of high complexity.
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Separately, and during a discussion that took place to address the approved changes to the General Health Law, Víctor Lizama, a member of Orgullo Loco México, emphasized the need to inform the actions that will be carried out to serve those who currently are admitted to psychiatric hospitals, as well as the route that will be taken for their reintegration into the community. Otherwise, he said, the commitment made by the authorities to make a real transformation of the mental health care model will only be limited to paper.
“Before the Olympics were held in Mexico, in the 1960s, it was decided to close La Castañeda (the psychiatric hospital), and what happened to the population that was hospitalized there? He went to other institutions,” recalled the human rights activist.
Guillén, from En Primera Persona, pointed out that the closure of the La Castañeda hospital was not based on a public policy decision on mental health. It wasn’t that Mexico “has anticipated the desanicomialización, that was a process rather with urban interests and land use speculation,” he said.
The people who were there, he added, were moved to smaller, less visible hospitals, which were not necessarily close to where their support networks lived, if they had any.
“I already saw that movie, that doesn’t happen,” he said. “The closure of asylums is not deinstitutionalization, it is part of the process, it is the administrative part and that’s it. The part of the process of reincorporating into society is something else, ”she insisted.
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Not even the countries that have legislated on the matter, such as Argentina, which did so in 2010 and set a goal of 2020 to make a change in its care model, have managed to advance towards that goal.
In accordance with the fourth transitional article of the approved decree, all expenses generated by the entry into force of the reforms must be paid for with the budget that the dependencies have approved, because “no extensions to their budget will be authorized for the current fiscal year nor subsequent”.
The reforms to the General Health Law in the area of mental health and addictions are the first step towards the creation of the National Council for Mental Health and Addictions (Conasama) —a decentralized body that will act as the governing body, normative and conduction of national policy of mental health and addictions—, which implies the merger of the Technical Secretariat of the National Mental Health Council (Consame), the National Commission against Addictions (Conadic) and the Psychiatric Care Services (SAP).
According to the Specific Attention Program for Mental Health and Addictions 2020-2024, in Mexico barely 2% of the health budget is spent on mental health. Of that percentage, 80% goes solely to operating expenses of psychiatric hospitals.
Once the decree amending the General Health Law is published in the Official Gazette of the Federation (DOF), the Federal Executive Power will have no more than 180 calendar days to issue the regulatory provisions to specify in the administrative sphere the corresponding provisions or, where appropriate, update current regulations.