Bringing dignity to healthcare

As a child, Socorro Torres was abandoned on the steps of a Mexican psychiatric hospital. For decades, she endured subhuman treatment there unimaginable in a world of expanding human rights.

When she came to Casa Dignidad - Dignity House - a Mexico City community care facility for the mentally disabled, she wore diapers, and couldn't open a door. Today, "she is a lady," Dignidad's administrators proudly note, caring for herself and participating in group activities.

Until two years ago, Martn Garca was in and out of state mental institutions, called "farms." He lacked clothing, proper hygiene, and was for the most part inactive.

But now Mr. Garca takes public transportation on his own every weekday to Dignidad's day program. The former draftsman is working in painting workshops, prepping for a play, and dreams of returning to his career.

Garca and Ms. Torres exemplify what mental health specialists have maintained for years: that small-scale, community-based care facilities are almost always more humane and produce much more encouraging results than large institutions for the mentally ill. But when it comes to Mexico's mentally disabled, the two are among the fortunate few.

In a report based on three years of visits and studies, a Washington-based human rights organization that focuses on the plight of the world's mentally disabled puts a spotlight on the horrific conditions facing most of the estimated 7,000 adults and children in Mexico's mental institutions. Issued here last week by Mental Disability Rights International (MDRI), the report has Mexican mental-health officials leaping to respond.

"What I saw going on in Mexico is as bad as anything I've seen in the world," says Eric Rosenthal, MDRI's executive director who has been touring Mexican mental institutions - sometimes after sneaking in with video camera in hand - since 1996.

MDRI has completed similar reports on countries in Eastern Europe and South America. And, at a time when the human rights of so many groups from prisoners of conscience to Indians and sexual minorities are receiving expanded international attention, Mr. Rosenthal and his organization's broader goal is to see the mentally disabled brought out of their isolation and guaranteed the same basic universal rights.

"We've seen children abandoned in appalling conditions in Russia, people locked in cages in Hungary, and people forced to live in their own filth in Mexico," says Rosenthal. "But none of it gets the international response that equivalent human rights abuses in other settings would have got."

The MDRI report, which was presented to the Mexican government before its public release Feb. 17, concludes that the vast majority of Mexicans held in mental institutions could be better served in community care programs. To the untrained observer that might seem optimistic, after viewing Rosenthal's videos of institution patients tied to wheelchairs or shuffling aimlessly and barefoot through human waste.

But Mexican mental-health experts confirm MDRI's conclusions. "Eighty percent or more of the people in psychiatric hospitals are able to become self-sufficient," says Virginia Gonzlez Torres, director of the Mexican Foundation for the Rehabilitation of the Mentally Ill. "The other 20 percent need more direct support, but they also should receive that through community services."

The MDRI study found that many of the patients in Mexican institutions are there simply because they were diagnosed as epileptic or mentally retarded, or because they were abandoned there, and had nowhere else to go. Some are Indians who never learned Spanish and were thus labeled mentally incompetent.

"The people you see [in Dignity] are the same people you see in the hospitals," says Ms. Gonzlez, also the director of Dignity House, one of the few community-based mental-health programs in Mexico. "We see many miracles in our work, but so much is a question of treatment and expectations. If you took Socorro and treated her as subhuman again, she would return to that behavior."

MDRI members say the point of their latest report is to impress upon Mexico the need to enforce its own laws regarding the mentally disabled. The report notes that "many of the reforms needed in Mexico have already been established as part of federal law." The law calls for providing long-term care through community services, and federal health authorities acknowledge that such care would be appropriate for the entire institutionalized population - if it were available.

But participants in the report say they also want to help Mexico avoid the mistakes that occurred in other countries, including the United States, during what was called "deinstitutionalization" of mental patients. "We want Mexico to avoid dumping people on the streets, that's no answer," says Robert Okin, chief of psychiatry at San Francisco General Hospital and a former Massachusetts mental-health commissioner.

Mexican health officials have not publicly responded to the MDRI report, but they have already taken steps indicating they take the report seriously. "We think we're getting our response indirectly," says Rosenthal.

The week following an extensive article in the Mexican weekly magazine Proceso on the coming MDRI report and conditions in Mexican psychiatric institutions, Jos Antonio Gonzlez Fernndez became the first health secretary to visit the Fernando Ocaranza Hospital in Hidalgo state. Considered one of Mexico's worst cases of abuse of patients' rights, Ocaranza was the site of some of Rosenthal's videos - and the hospital Martin Garcia was placed in before he found Dignity.

Secretary Gonzlez Fernndez called for an immediate $1.3 million investment in Ocaranza for everything from better staffing to blankets and toilet paper for the patients. And he said he would return in three months to witness improvements. Following release of the report, Mexican health officials discussed in a meeting with Dr. Okin how he might assist them in the reforms at Ocaranza Hospital.

Mexican advocates of the mentally disabled say such steps are encouraging. "The opportunity of the moment is that the person in charge in the government is approaching the problem from the point of view of human rights," says Dignity House's Gonzlez. "And we are ready to assist in this reform because even though places like [Dignity House] are still few, this is not a movement starting from nothing."

(c) Copyright 2000. The Christian Science Publishing Society