Human rights group: Mexican mental hospitals performing lobotomies without consent

Ten years ago a human rights group released a scathing, ground-breaking 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 Tuesday, 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, bed sheets 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.

“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 and the human rights groups said it issued their report as a “shadow,” independent assessment.

The Mexican government received the report on Monday, but as of Tuesday morning had made no comment.

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 1950’s 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 children were unaccounted for and interviewed residents who had said they had grown up in the facility, though officials had no record of the names they came in with, arrival date or other data.

Human rights 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 had 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 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 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 Ramirez 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.

Jose Angel 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.”

Source: Randal C. Archbold, “Abuses Found at Mexican Institutions for Disabled,” New York Times, November 30, 2011

Official report seeks to shut down psychiatric “house of horrors” in Mumbai

The 110-year-old Masina Hospital – which boasts of one of the city’s foremost psychiatry wards – has been slammed by the Directorate of Health Services (DHS) for rampant violations of the Mental Health Act of 1987.

The hospital has been asked to put its act together or face a shutdown.

A report filed by the five-member committee, appointed by DHS, states that the hospital has been illegally detaining patients in its psychiatry ward and forcefully administering psychotropic drugs to the detainees.

The head of the psychiatry ward, Dr. Yusuf Matcheswala, however is of the opinion that these are only “minor drawbacks,” which do not warrant a shutdown or similar punitive measures.

The matter came to light after Kemp’s Corner resident Pushpa Tolani filed a complaint with the Maharashtra Human Rights Commission (MHRC) claiming that her friend Neela Shete was detained in the hospital illegally.

Tolani in her complaint pointed out that many other patients like Shete were detained without a reception order from the district magistrate – a mandate under the Mental Health Act.

Shete, 55, a resident of Altamount Road was admitted in July. She was discharged two months later. “The doctors’ claim that she had schizophrenia may or may not be true. However, they cannot detain any adult for such a long time without a reception order,” said Tolani, adding that Shete has been untraceable since her discharge. “They have similarly detained many patients without their consent and in all possibility, they are administering drugs which may be worsening their condition,” she alleged.

Dr. Matcheswala however rubbished these claims saying, “Shete was my patient for the last three years. Her admission for two months was also voluntary and we had not detained her illegally.” He added that he has not heard from Shete since September.

Meanwhile, the MHRC refused to take Tolani’s allegations lightly and directed the DHS to file a detailed report after an investigation. “After surveying the hospital and cross checking all the allegations we learnt that about 20 more patients were detained illegally at the hospital.

They were administered treatment which has been banned, and their relatives were overcharged. Often the patients are being drugged even when it was not required,” said Dr. Sanjay Kumavat, who is heading the DHS committee.

The committee including Kumavat, advocate Chaya Haldankar, clinical psychologist Dr. Vinayak Mahajan and psychiatrist Dr. Geeta Joshi personally met these patients.

While Dr. Matcheswala said that he was aware of the enquiry, and vowed to “rectify” the “shortcomings” once the report from DHS was made available to him, Dr. Kumawat and the investigating committee were in no mood to for any leniency.

Psychiatrist Dr Yusuf Matcheswala

“If the hospital fails to straighten up in the stipulated time, their licence will be revoked and the mental health facility will be shut down. The matter is also under the purview of human rights commission. If they are found guilty of violation of the act, as per IPC they can face imprisonment up to five years and cancellation of licence,” said Kumavat.

“Ours is the only psychiatric ward in the city. We cannot close down because of such minor drawbacks,” said a belligerent Dr. Matcheswala.

What’s ailing Masina hospital

♦ Detaining patients without consent: “Ideally a patient can come voluntarily or following a court order. However, patients here were brought in a van at relatives’ request. There are cases of relatives sending patients away due to vested interest,” said Kumavat, and consent taken later.

♦ Unqualified staff, inadequate facilities: The report says the hospital has few psychiatric nurses and other professionals. Despite a 40-bed licence, some 100 patients are kept without permission.

♦ Forcing unnecessary therapies, including shock therapy: Patients are administered treatment banned long ago.  Shock treatment is often used despite use of tranquillisers. One patient is given 35 sessions of Transcranial Magnetic Stimulation, which is unnecessary.  “As patients are unaware, the hospital administers almost all non required treatment and makes money for itself and pharma firms, by extending their stay,” said Dr Vinayak Mahajan, committee member. “We have prescriptions of unwanted medicines,” he said.

♦ Patients seldom rehabilitated: Hardly any patients are being rehabilitated. The hospital only concentrates on active psychiatric cases. They are not maintaining patient records and case papers.

Source: Sobiya Moghul and Jyoti Shelar, “City’s foremost mental hospital uses banned therapies, detains patients illegally,” Ahmedabad Mirror, January 4, 2011.