Where Mental Asylums Live On

By Rudolf, John | International Herald Tribune, November 2, 2013 | Go to article overview

Where Mental Asylums Live On


Rudolf, John, International Herald Tribune


Institutionalization is just one facet of the broader catastrophe of mental health care in the developing world.

Donald Rodas, a baby-faced man in his late 20s with paranoid schizophrenia, arrived at Guatemala's only public psychiatric hospital last year after being charged with murdering his parents. He says he often wanders freely through the sprawling facility of dilapidated one-story buildings and wooded courtyards, where detainees charged with crimes mingle with ordinary patients and the developmentally disabled.

He sees ugly things. Those who refuse their medication are beaten and put in the "little room," a barren isolation cell, he said. Desperate women sell their bodies for as little as 5 quetzales, or less than a dollar, to afford basic necessities.

"I see when they have sex for money," Mr. Rodas said in halting English. "To buy food. All they have is beans."

The United States began emptying out its asylum system in the 1960s, spurred by scathing reports of abuse and neglect, like a 1946 Life magazine expose that described many insti tutions as "little more than concen tration camps." The transition to community-based care cut the institutionalized population by more than 90 percent by 1994.

But community care resources failed to match demand in the United States, leading to widespread homelessness and an influx of the mentally ill into jails and prisons. Even so, deinstitutionalization is widely credited with ending the abuse and neglect that made mental institutions synonymous with a nightmarish netherworld.

Yet this asylum-based model of mental health care remains the standard across much of the globe. In many poor and developing countries, thousands of mentally ill people are warehoused in dirty and dangerous institutions. Health experts and advocates who monitor such facilities say the picture varies little from country to country: overcrowded wards lacking in privacy; poor sanitation; physical and sexual abuse; routine use of restraints and long-term solitary confinement; and forced treatment, including electroshock without consent. The rights of patients judged to be mentally ill are easily stripped by the courts and are difficult if not impossible to regain.

"People need to wake up to the sad story of widespread human rights violations against people with mental disorders in a number of countries," said Dr. Shekhar Saxena, director of the World Health Organization's department of mental health and substance abuse. "We need to bring these people out of the shadows so the world can see how badly we are treating them."

Institutionalization is just one facet of the broader catastrophe of mental health care in the developing world. According to the World Health Organization, in low- and middle-income countries, up to 85 percent of those with severe illnesses like schizophrenia, bipolar disorder and major depression receive no treatment.

Government and humanitarian funding to treat the most severely afflicted is almost nonexistent. In a world where an average of 80 children die every hour because of a lack of clean water, the absence of a coordinated global response to the mentally ill may represent a triage mentality, in which scarce aid dollars are directed at the most immediate threats to life, like malaria and AIDS.

But governments that put their minds and money to the task can make a difference. In the past decade, under pressure from Disability Rights International, a Washington-based advocacy group, Paraguay, one of Latin America's poorest nations, reduced the population of its national mental hospital by almost half while creating a system of community-based group homes. Far larger countries like Brazil have accomplished even more impressive transitions. …

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