Pachuca Journal: New Model for the Mentally Ill
By Ginger Thompson
Originally published by The New York Times, May 11, 2001
PACHUCA, Mexico — Although it still hulks like a fortress over the desert landscape, the colonial hacienda that became one of Mexico's most notorious psychiatric hospitals has been closed, and the wards once filled with naked patients have been abandoned.
Nestled in its long shadow is a cluster of quaint brick villas, each named for a flower. Inside, they are clean, freshly painted and decorated with lace curtains. Two nurses are posted at the entrance to each villa to make sure that medication is taken on time and that physical or emotional crises are dealt with quickly.
The residents—12 people in each unit—are bathed and dressed in donated secondhand clothes.
This community has become a model for changes in how Mexico takes care of its mentally ill. In November, the secretary of health closed the institution, the Fernando Ocaranza Psychiatric Hospital, and replaced it with 12 four–bedroom units called Villa Ocaranza. The changes, which mental health advocates call a "revolution in care," were made after reports about filthy and unsafe conditions in Mexican hospitals were exposed by a human rights group, Mental Disability Rights International.
In their report, investigators for the organization described wards strewn with feces and urine, alarming numbers of deaths from infectious diseases and dozens of patients who had lost the ability to walk because of the lack of physical therapy.
The investigators, led by Eric Rosenthal and Dr. Robert Okin, a professor of clinical psychiatry at the University of California-San Francisco, found that many patients in mental hospitals were well enough to live outside institutions. But abandoned by their families and friends, most patients were typically locked away for life without any real effort to rehabilitate them.
Armando Tolentino was among them. "They never let me go outside," he recalled. "I was very sad."
Short and stocky with narrow eyes, Mr. Tolentino, 31, said he spent nine years in the old hospital. His wrists are still scarred from the rope that the police used to restrain him when he suddenly became violent and was taken to the hospital.
But social workers and volunteers at Ocaranza recognized that Mr. Tolentino's mild schizophrenia could be controlled with medication. And after the institution was closed, he and 33 other patients were moved 15 miles to Mexico's first publicly financed halfway houses.
Now it is the most ordinary things that make Mr. Tolentino's life extraordinary. He has a job, earning $30 a week at a sweater factory, and has begun saving money so he can move to Mexico City. "I am still young enough to see the world," he said.
With its communal showers, cavernous dining halls and lack of homelike spaces, Ocaranza became the symbol of mistreatment of the 7,000 psychiatric patients in Mexico. In a speech before state and federal health officials to celebrate the day the institution closed, Dr. Okin congratulated them for changes that he said would have taken years to achieve in the United States.
Mexico, he pointed out, had moved carefully not to eliminate hospital beds and evict patients onto the streets. All the Ocaranza Hospital patients had been moved to other institutions, to the villas or to halfway houses.
After an initial investment for construction, state officials said the cost of running the new system, $1.6 million, was just slightly higher than it was to run the old hospital.
"As proven so poignantly by the neglect of the mentally disabled in as wealthy a country as the United States," Dr. Okin said, "the treatment of these citizens is influenced more by the way nations distribute their wealth than by the absolute extent of this wealth."
He cautioned that much remained to be done and urged the government to add halfway houses so that the majority of the mental health patients are not kept isolated from society.
"Unless this is done," he said, "Mexico will perpetuate its historical segregation of the mentally disabled and to continue to violate their fundamental human rights."
The new health minister, Julio Frenk, said that by the end of President Vicente Fox's six–year–term in 2006, the government hopes to establish similar mental health systems in every state and close its 18 government hospitals. He said that an estimated 15 million Mexicans suffered some mental illness or substance abuse problems and that most remained untreated.
In the United States, Mr. Frenk said, the government spends an average of $4,000 a year per person on health care. In Mexico, the government spends little more than $300 a person.
At Villa Ocaranza, much of the money for care is spent creating small exercises in freedom. Twice a week, most of the 120 patients attend crafts classes, where they learn to make clay pots and plaques. The patients are paid 40 pesos a week, or $4, for their work. On Fridays, social workers take the residents shopping.
Maria Luisa Saldívar, 49, who lived in the cottage called Las Buganvillas, usually buys a new cassette tape with her earnings. Proud to show off the bedroom that she shares with two other women, she took a plastic bag of cassettes out of her closet and popped one of them into her small boom box.
Sitting down on the pink gingham comforter on her bed, she smiled as music filled the room and said, "It's pretty here, isn't it."
