A long history of abuses at Mexican institutions for mentally or physically disabled people

From The NY Times:

MEXICO CITY — Ten years ago, a human rights group released a scathing, groundbreaking report on abusive, decrepit conditions in Mexican institutions for the mentally and physically disabled, moving the country to promise change and to take the lead in writing international agreements to protect the disabled.

But in a new report released Nov. 30, the group, Disability Rights International, working with a Mexican human rights organization, said a yearlong investigation revealed “atrocious and abusive conditions” that included lobotomies performed without consent, children missing from orphanages, widespread filth and squalor, and a lack of medical care.

At one institution here in the capital, which a reporter visited with investigators from the groups, men walked around half-naked, feces littered a yard, bedsheets were missing, the smell of urine permeated a day room, bathroom faucets malfunctioned and patients lay sprawled on several patches of grass.

At another institution here, CAIS Villa Mujeres, elderly women sat tied to wheelchairs, staff members hustled to clean soiled floors as investigators moved through, and patients and their caretakers could not fully explain how or why they were institutionalized.

A trembling blind woman said she had been raped by a staff member — who officials said was dismissed during a criminal investigation — and would feel safer on the streets. “I don’t have any hope,” she said. “I don’t have a nickel to get out of this place.”

Eric Rosenthal, director of Disability Rights International, based in Washington, said: “I have witnessed abuses as atrocious as these in the psychiatric facilities and orphanages of some other countries. But only in Mexico have I encountered a system so lacking in protections that children literally disappear and adults remain nameless.”

The Mexican Commission for the Defense and Promotion of Human Rights, which helped compile the report, said the “human rights violations being perpetrated against children with disabilities in Mexico are every bit as serious as any this organization has documented over the last 20 years.”

Mr. Rosenthal said the conditions were particularly galling because Mexico, in response to the earlier report, had championed human rights for the disabled and helped write international standards.

Along with 94 other nations, Mexico ratified the 2006 agreement it is now accused of violating, the United Nations Convention on the Rights of Persons with Disabilities.

Mexico’s first report on its progress toward abiding by the agreement is due this year.

Dr. Carlos Campillo Serrano, the director of psychiatric care for Mexico’s Health Ministry, said he hoped that the report would help generate momentum to improve conditions. “We are attentive to its recommendations,” he said.

The budget for mental health has increased to about 2.2 percent of all health spending, from 1.5 percent in 2006, he said, “but the big problem is how we spend the money.”

Among the problems is the lack of trained personnel. Dr. Campillo, who worked with Disability Rights International to give the group access to the hospitals, agreed with the report’s conclusion that there was no community support that would allow many families to care for disabled relatives at home.

As a start, Dr. Campillo said that the government had included mental health coverage in its basic public health care coverage and that the government was studying new legislation to govern treatment. But the problems in Mexico are deep-rooted and difficult to resolve, he said.

Like the earlier report, this one found many of those in the institutions did not need to be there, but as “abandonados” lacked family members or community-based programs to care for them.

The investigators visited 20 psychiatric wards, orphanages, shelters and other public institutions around the country, housing thousands of people, from August 2009 to September 2010, interviewing patients and administrators and reviewing records when possible.

At three psychiatric hospitals, investigators found that staff members relied on extensive use of psychotropic drugs in place of other forms of treatment for aggression and other behavioral problems.

Two hospitals, Fraternidad sin Fronteras and Hospital La Salud Tlazo Lteotl, reported sending particularly aggressive patients for lobotomies, the surgical separation of the prefrontal cortex from the rest of the brain. The procedure fell into disrepute internationally in the 1950s because it frequently caused irreversible brain damage. But it remains legal in Mexico.

A man at La Salud who had undergone a lobotomy sat slumped in a wheelchair, his speech slow and slurred, the report said.

“The director said that the man had been aggressive in the past, but since the surgery, he was entirely passive,” it said.

At orphanages, the team found that children were unaccounted for and interviewed residents who had said they had grown up in the facilities, though officials had no record of the names they came in with or arrival date.

Human rights officials and unnamed government officials told them there was no registry or tracking system for children placed in public or private institutions, leaving them prey to human traffickers.

“Due to a failure to provide oversight, children have literally disappeared from institutions,” the report said. “Some of these children may have been subject to sex trafficking and forced labor.”

Mr. Rosenthal said he was stunned to find some of the same people this year as he found 10 years ago in similar conditions.

In one case, an article in The New York Times Magazine in 2000 on his work included a picture of a woman whose entire upper body was tied in restraints. This year, he found the same woman in the same facility lashed to a wheelchair.

Administrators complained of a lack of funds to provide basic treatment and materials like soap and clothing.

“Donors help us,” said an administrator at the Villa Mujeres shelter, who spoke on the condition of anonymity about the conditions. “But we are the last link. There is no political impact for not helping the abandonados.”

Another administrator, at the sprawling Samuel Ramírez Moreno hospital in Mexico City, said the budget had been cut 40 percent this year, causing “a delay in response to problems and urgent care.” Some patients are given low-cost, outdated versions of medicine that cause excessive tremors and other side effects.

The report recommends a host of changes, including a shift toward more community-based services; establishing a foster care system for children with disabilities, and more independent oversight of the system.

José Ángel Valencia, an advocate for the mentally ill in Mexico who worked on the report, said the country was slow to adopt changes in part because of a stigma and misunderstanding of people with disabilities.

“People have prejudices and think you are dangerous or do not know how to deal with you,” said Mr. Valencia, who has been treated for bipolar disorder. “But slowly Mexico is recognizing us, and it is changing here.”