The World Health Organization (WHO) and its regional affiliate, the Pan American Health Organization (PAHO)
expressed their rejection
of the modifications to the mental health law proposed by the famous omnibus law of the Government of Javier Milei, in a harsh document released this Friday.
It was in response to a letter from representatives of the Argentine Mental Health Association (AASM) who sought support from the main international health organization to face the changes promoted.
Clarín had recently alluded to them, since, in effect, the proposals detailed on page 167 of the bulky “
Law of bases and starting points for the freedom of Argentines
” divide the waters in the sector.
On the one hand, the Government's text grants central claims from the families of those who have been suffering from the State's neglect in matters of mental health.
At the same time, it revives ideas that, others believe (such as the AASM and, it turns out, the WHO as well), contradict international treaties on the matter and imply a setback with respect to the progress promised in the unfulfilled mental health law enacted in 2010.
The WHO's writing is harsh and emphatic, but not only against mileism.
He also
distributes no small criticism
of previous governments.
The international health organization highlights “the notable delay in the development of community-based second-level mental health services, in their integration into first-level health networks, which should be the basis of the system and with general hospitals , as well as in the
replacement of monovalent ones
.”
Patients within the Borda Hospital.
The Mental Health law sought to eliminate monovalents.
Photo: AFP
As part of this initial criticism that is directed at both the government of Cristina Fernández de Kirchner and that of Mauricio Macri and Alberto Fernández, the WHO highlights that, “currently, there is a significant gap between the contents of the law and its effective implementation, which seems to mark the need to advance in the activation of legal compliance, the strengthening of investment and the health response in mental health.”
Following this comment, the organization acknowledges receipt of the concern conveyed by the president of the AASM, Liliana Verónica Moneta, and the secretary general, Alberto Trímboli, the signatories of a brief letter requesting support that had been sent this Thursday.
Impressive is not only the speed of the WHO's response (the text bears the signature of Eva Jané Llopis, PAHO-WHO representative in Argentina) but also the detail in the evaluations of the various topics.
What the WHO says about Milei's proposals on mental health
Faced with the suggested changes, the organization emphasizes that “certain modifications could
exacerbate already existing difficulties
in effective implementation and contravene international human rights standards.”
They immediately oppose one of the most sensitive issues: the proposal of article 5 of the omnibus law, according to which the judge, without evaluation by an interdisciplinary health team, could
decide the involuntary hospitalization
of a person.
The WHO highlights that this could “facilitate involuntary hospitalizations without scientific/health support.”
The reform proposed by Milei was supported by families who experience mental health problems with some of their members.
Photo: Reuters
They then refer to article 11 of the “bases” law, since it “reduces the focus on the community approach and enables therapeutic communities, limiting the community model of care.”
Also at 20, because “
it expands the causes
for involuntary hospitalization and establishes that the signature of a single professional is required, instead of at least two, as is the current law.”
At this point they propose that such a change could impact “greater medicalization, judicialization and institutionalization.”
They add criticism to article 22, which eliminates "the possibility for the defender to request discharge", which, says the international health organization, "tends to perpetuate prolonged hospitalizations and limits the
right of defense
of users."
They also point out that article 23 “facilitates the extension of involuntary internment and
restricts the freedom of movement
of interned persons”;
and that on the 27th it eliminates the prohibition on creating new monovalents, which slows down “the reform process towards a community model of mental health” and “contradicts the principle of progressivity and non-regression in the International Covenant on Economic, Social and Cultural Rights ( DESC)”.
There is more: they criticize what is proposed in (for many, very controversial) article 28, which “enables hospitalizations
in monovalent
hospitals and displaces those in General Hospitals, recommended by current law.”
Finally, they mention that article 39 “changes the composition of the Review Body, excluding the representation of users, family members and civil society, blurring its function of control and protection of rights.”
In each of the previous items, the WHO highlights the extent to which the changes proposed by the Government contradict specific aspects of the Convention on the Rights of Persons with Disabilities (CRPD).
The gap that the WHO sees in Mental Health
In the letter, which is five pages long, there is a long passage dedicated to explaining the problems that the WHO sees at the regional and local level.
At this point, they recall the suggestion that involuntary hospitalizations be reserved "for exceptional cases of imminent risk in which the person cannot understand the need for the measure", a very controversial issue for relatives of victims of the mental health system. of Argentina, who have been requesting for years that the figure of “potential risk” be included.
Without mentioning that point, the WHO recalls that, as the law stands today, “it seeks to
prevent abuses
and guarantee exceptional and proportionate use of said measure.”
But, although they add that "to comprehensively respond to the problem of mental health, the law orders replacing the old model focused on psychiatric institutions with a
network of community devices
," they warn of the "notable delay in the development of mental health services." ” in accordance with current regulations.
It is not minor (from the point of view of those who ask for changes) that the WHO emphasizes a negative diagnosis.
They say that “the tension in the Argentine health system derives from the fact that while the beds in monovalent centers are decreasing, the alternative devices to address mental health problems and problematic consumption are
insufficient
, and a good part of the resources are restricted to hospitals. monovalent”.
Nor, and this is perhaps essential, do they emphasize that, for a logical transformation, "adequate financing is required, allocating more funds to mental health and reinforcing the outpatient service and reduction of beds in psychiatric hospitals."
P.S.