The Mental Health Law, passed in 2010, could never be applied well and there are
problems that until now no one could or wanted to solve
.
As a counterpart, Javier Milei's ill-fated Omnibus Law had a chapter that attempted to reform the original law.
While that initiative was deactivated, the City of Buenos Aires decided to make the application of the rule effective.
In the last few hours, the Buenos Aires Government released
a protocol
to care for people who live on the streets and may represent
“a real and imminent risk”
for neighbors.
According to sources from Jorge Macri's administration, their objective is to overcome the challenges presented by the aforementioned law 26,657, in particular article
20
, which stipulates a series of requirements so that a person can be involuntarily interned.
This article generated controversy over the years and even earned criticism from families who have a member with mental health problems.
They argue that the rule is cumbersome and creates obstacles when it comes to
hospitalizing, without their will, a patient
in a situation of consumption of psychoactive substances or with some other type of psychiatric pathology.
According to the City, what the district has done now was follow the requirements of Article 20 to the letter in order to put it into practice.
“It is expensive, it is complex, but we can make the law work and
reduce the problem
,” they say in the Uspallata building at 3100, headquarters of the Buenos Aires Executive.
One of the motivations for the initiative, they argue, is that “many residents have the feeling that they have asked for the neighborhood.”
How will what a "real and imminent risk" means on public roads be evaluated?
Clarín
asked those responsible for the initiative.
In the Buenos Aires Government they admitted that this concept
"is totally open to opinion"
, but that there enters the scene an
interdisciplinary team
from the ministries of Human Development and Habitat, Health and Safety, plus the Council of Children and Adolescents, to evaluate the path that each case will take.
One of the SAME ambulances equipped for psychiatric emergencies.
The universe of application will be, for now, people who
live on the street
, under conditions of "housing vulnerability", or who for some reason eventually find themselves in that situation and their actions on public roads represent
a danger
to themselves or for other neighbors.
The prelude to the publication of this protocol was the recent presentation of the psychiatric SAME, with
ambulances specially equipped
to transport patients suffering from a mental health problem.
Now, the new protocol already finalized will be the script on which social workers, the Police and medical professionals from public hospitals will rely so that the objective of
preventing situations of violence
on the street is achieved.
That is, act before these situations escalate and end in worse dramas.
"Until now, when there was a situation of these characteristics ,
we looked the other way
. Article 20 of the Mental Health Law
does not work
. The logic of thinking that a person with addiction is going to raise their hand and ask for help does not happen" Macri declared when confirming that the protocol now applies in the City.
What the protocol says for mental health emergencies
Specifically, the protocol is a step by step ("an orderly tube", they say in Macri's environment) so that the team involved
knows what to do at all times
.
For example, its activation can occur from the moment a neighbor calls 911 to warn about a situation of these characteristics.
Durand, one of the five hospitals with a psychiatric ward, along with Pirovano, Alvarez, Piñero and Rivadavia.
“The Buenos Aires Government can become aware of people in a situation of housing vulnerability through
telephone channels
(107, 108, 147 or 911) or by direct contact, through the teams of the Buenos Aires Presente (BAP) program or members of the City Police,” they explained.
The sources continued: "In any of the cases, and if the person shows signs of having a mental health condition or problematic consumption, immediate intervention will be given to the
SAME Mental Health
emergency unit ."
They explained that “the mobile phones are in charge of emergency doctors trained to quickly contain patients in crisis.
These transfer units are completely
padded inside and without sharp elements
so that the patient cannot hurt themselves or others.”
At that point, the SAME team, if it considers it necessary, “will transfer the person to an Acute Hospital for the relevant evaluation by the
interdisciplinary mental health team
, which will provide the patient with information in clear terms about their condition.” of health, the treatments that are proposed, the therapeutic alternatives and the possible consequences of not being treated," explained Fernán Quirós, Minister of Health of the district.
Likewise, the Buenos Aires sources consulted added that the interdisciplinary team
may order the involuntary hospitalization
of the patient "as long as the existence of a certain and imminent risk for himself or third parties is determined, within a period that can be extended up to 72 hours after the income".
When would the hospitalization end?
“At the moment the cessation of the risk is confirmed,” they responded.
The Council for Children and Adolescents would come into play when the person approached is in charge of or is a minor.
City officers during an operation in February 2023, when a policewoman was murdered on the subway by a person with mental health problems who took her weapon.
Photo: Juano Tesone
If hospitalization is ordered, the destination will be any of the
14 General Acute Hospitals
for adults in the City.
Of that number of health centers,
five
have psychiatric wards: Durand, Pirovano, Alvarez, Piñero and Rivadavia.
"This protocol helps us give a better response to situations that
exceed the social intervention
that we do from the BAP. The tools we had until today
were not enough
to solve this problem that affects 3 million Argentines," Gabriel justified when asked. Mraida, Minister of Human Development.
According to City data, there are currently
3,500 people homeless
, of which 2,300 sleep in official shelters and 1,200 sleep outdoors.
According to statistics provided by Human Development, “
six out of every ten people
who live in these conditions suffer from a mental health situation.”
Against the backdrop of the law and the questions it generates, a sensitive discussion arises.
The Buenos Aires Ministry of Health puts it this way: “When can the State withdraw
a citizen's
autonomy .
And if that citizen gives up his autonomy, who takes it.
And what does the State do with that autonomy?
Trying to find a balance between the obstacles posed by the Mental Health Law and the opposite reaction that the Omnibus Law project meant, the City proposes that “it is necessary to
lower the barrier
of autonomy.”
And specifically - as a new, more comprehensive step after this exclusive protocol for homeless people - they propose
modifying article 20
so that any individual can
designate
who will govern their autonomy for the moment when, eventually, they are not in a position to do so. itself".
The head of Government, Jorge Macri, during an eviction operation in Retiro.
Photo: Luciano Thieberger
They warn about "stigmatization"
Alberto Trímboli, coordinator of the Addictions area of the Álvarez Hospital and honorary president of the Argentine Mental Health Association, told Clarín
that
he met with Macri and had a dialogue on this issue.
The expert raised two issues.
The first is what he evaluates as “a
contradiction
by Macri for saying that the law is useless and that it is not being complied with, that it must be modified and he is campaigning against the law, but now with this protocol
he is admitting that it is possible to intern
.
Because the protocol does not say anything that is outside the law.”
On the other hand, he considered that the protocol “is
stigmatizing people who are homeless
and with problematic consumption problems,” by associating them with mental health conditions.
“It seems that the message is: why do neighbors have to put up with a person on the street.
"They target a group that is already stigmatized and this makes it even more so."
Furthermore, Trímboli added that “all this has to have a vision of continuity of care.
And emphasis should be placed on
primary health care
.
Territorial teams that account for the difficulties that people in a neighborhood are having to cover them from the first moment, which is what the Mental Health Law establishes."
And he explained that "mental health
is not only problems in the brain
, but is
intersectoral
: problems with housing, work, social life. If we start with primary care, these types of cases will decrease. That is, it is fine "That we intervene in these types of situations but also in
the conditions
that lead to this. That it is not just about beautifying the neighborhood by removing the people who are ugly, as if they were flower pots."
Regarding the City's idea of delegating the decision of hospitalization to a third party, Trímboli said that “delegating is wrong, it is going backwards, it is not necessary.
It is the health team that decides whether to hospitalize
voluntarily or involuntarily
.
If there is a risk to oneself or to third parties, one must be admitted and there is no need for a judge or anything to order it.
Within 10 hours, the health team has to notify the judge and the review body (an interdisciplinary team) so that they can verify that the hospitalization was carried out correctly and corroborate that the person is not deprived of his or her freedom.”
P.S.