RIC Query - Honduras (15 November 2002)

Honduras

Query:

What is the current state of mental health services in Honduras, particularly with regard to providing care for young people with mental illness?

Response:

Arthur J. Anderson, a consulting clinical psychologist with experience in Honduras, wrote in 2000 in the INTERNATIONAL JOURNAL OF PSYCHOSOCIAL REHABILITATION that, according to the World Health Organization (WHO), mental illness has risen dramatically in developing countries over the last half century, and that mental health services in these countries are inadequate and often ignored. Taking Honduras as a case in point, Anderson noted that while substantial international aid had been provided for that country¿s health care system, the assistance program:

¿¿ignored the mental health care sector entirely. As a consequence, illness and injury due to family abuse, alcoholism, and major mental illness were virtually ignored and patients were forced to rely on a few understaffed and poorly funded tertiary hospitals that exist in the country. In addition, mental health hospitals received no additional funding and are currently operating at pre-1993 budget levels. This leaves patients in substandard conditions, attended by poorly staffed and in some cases poorly trained clinical support¿ (Anderson 2000).

Honduras, moreover, one of the poorest countries in the Western Hemisphere, was hit by Hurricane Mitch in 1998 and Tropical Storm Michelle in 2001, with not only devastating economic and budgetary but also mental health consequences that have taxed the already inadequate system. Dr. José Miguel Caldas de Almeida, coordinator of the Pan American Health Organization (PAHO) mental health program, said in January 2002:

¿Disasters are very traumatic. We are concluding a study of the populations that suffered the fury of Hurricane Mitch, and the results of the investigation so far indicate a high prevalence of cases of mental illness¿ (PAHO 31 Jan 2002).

Regarding mental health care in Latin America generally, Dr. Caldas de Almeida and Dr. Javier Vásquez have stated: ¿Persons with mental disabilities frequently are victims of cruel, inhuman, and degrading treatment, and in addition are isolated in psychiatric institutions under deplorable conditions that affect negatively their health and at times can even threaten their own life¿In general, the services available in Latin America and the Caribbean are still limited and their orientation is inadequate. Psychiatric care is usually based on hospitals that function with very limited budgets¿ (UN 6 Aug 2002).

In June 2002 the Honduran online magazine REVISTAZO published a special edition on the poor state of mental health care in Honduras entitled "Pacientes Psiquiátricos Viven y Mueren en el Olvido" (Psychiatric Patients Live and Die in Oblivion). For the entire nation of nearly 6.5 million people, there are only two psychiatric hospitals, El Hospital Psiquiátrico ¿Mario Mendoza¿ in the capital, Tegucigalpa, and El Hospital Psiquiátrico ¿Santa Rosita,¿ about 35 kilometers north of Tegucigalpa. Dr. Héctor Murcia, director of the Mario Mendoza facility, said the hospital was very overcrowded and that the great majority of Hondurans suffering from mental illness lacked treatment, particularly those unable or whose families were unable to travel to Tegucigalpa. Dr. Daniel Herrera, a staff psychiatrist at the Mario Mendoza facility, stated: ¿This hospital was built in 1970 and is now totally overwhelmed¿the structure has deteriorated terribly and there is only one psychiatrist per wing¿the hospital has only 50 beds and we are totally saturated¿ (REVISTAZO Jun 2002).

REVISTAZO reported that the Santa Rosita facility was filled beyond capacity with 100 male and 70 female permanent in-patients, 80 to 90 percent of whom had been abandoned by their families, including six children. The Santa Rosita hospital must deal simultaneously with people suffering from mental retardation, people diagnosed with an assortment of mental illnesses, particularly schizophrenia, as well a handful of violence-prone common criminals ordered into psychiatric care by the country¿s judiciary. The facility is so overwhelmed that different kinds of patients are mixed in together, with one report of acute and chronic patients milling together in the hallways. Since the facility opened in 1976, there have been allegations of sexual abuse of patients (REVISTAZO Jun 2002).

Honduran specialists point to poverty and underdevelopment as factors in the continuing increase in mental illness in Honduran society. Psychiatrists estimate that between 8 and 12 percent of the population is now in need of treatment for mental illness, with one percent displaying severe symptoms such as psychosis (REVISTAZO Jun 2002) .

According to Olga Benítez de Portillo, a psychologist with the government¿s División de Salud Mental de la Secretaría de Salud, Mental Health Division of the Health Secretariat, the Mario Mendoza hospital handled up to 34,700 outpatient consultations in 2001 and the Santa Rosita facility 7,000. About 38,000 people came with psychological problems to one of seven regional offices operated by the Health Secretariat (Inforpress 15 Oct 2002).

A critical aspect of mental illness among younger people is the sharp increase in the number of street children. Many are on the streets due to poverty and abandonment, while some have been deported from the U.S. There are now an estimated 20,000, most of them in Tegucigalpa and San Pedro Sula, the country¿s two main cities. Many have become mentally ill or have suffered brain damage from inhaling the fumes from glue and industrial solvents. According to a government mental health worker interviewed by Inforpress Centroamericana, street children are a ¿grave problem¿ but there are no public programs designed to address it (Inforpress 15 Oct 2002; REVISTAZO Jun 2002).

The private Casa Alianza continues to offer alternatives to street children through both residential and non-residential programs. However, a decline in donations has forced the agency to substantially reduce its outreach. Casa Alianza also has a family reintegration team that tries to locate families of street children, as well as children arriving after being deported from the U.S., and explore the possibilities for reintegration. If families cannot be found or reincorporation is not feasible, Casa Alianza tries to house them in its own facilities until they reach the age of 18. But three homes have been closed due to cutbacks, leaving only the agency¿s center in Tegucigalpa, with 110 places, which was filled to capacity as of fall 2002. Casa Alianza did manage in October to open a new residence specifically for children addicted to sniffing glue. However, the agency¿s Dr. Irma Benavides emphasized to Inforpress Centroamericana that the situation Casa Alianza faced in Honduras was ¿critical¿ due to budget cuts and the mounting demand for its services, and that its capability to attend to deported children and others in need remained limited (Inforpress 15 Oct 2002 and 31 Oct 2002).

This response was prepared after researching publicly accessible information currently available to the RIC within time constraints. This response is not, and does not purport to be, conclusive as to the merit of any particular claim to refugee status or asylum.

References:

Anderson, Arthur J. INTERNATIONAL JOURNAL OF PSYCHOSOCIAL REHABILITATION. ¿Sectorization and Sub-sectorization of Mental Health Services in Developing Countries¿ (2000, Vol. 4), p. 107-109. URL: www.psychosocial.com/policy/sector.html.

Inforpress Centroamericana. Email communication, 15 October 2002.

Inforpress Centroamericana. Email communication, 31 October 2002.

PAHO. ¿Mental Health. A Serious Problem, but One with a Solution.¿ (Washington: 31 Jan 2002). URL: www. Paho.org/English/DPI/100/100feature05.htm.

REVISTAZO. "Pacientes Psiquiatricos Viven Y Mueren En El Olvido" (Edición VI, Jun 2002). URL: www.revistazo.com/jun/principal.html.

UN. Caldas de Almeida, José Miguel and Vásquez, Javier. ¿The Pan American Health Organization¿s Advocacy Strategies for the Promotion and Protection of the Human Rights of Persons with Mental Disabilities and Their Family Members¿ (New York: 6 Aug 2002). URL: www.un.org/esa/socdev/enable/rights/adhocunbrief6.htm.