Addressing collective mental health care in the Dominican Republic

Although depression is primarily a state of anguish that can affect the ability of many Dominicans to perform daily tasks, it also appears as one of the probable causes of social violence and conflicts with the law. It is doubtful whether what the State is currently doing against the worst manifestations of this condition, which to varying degrees could advance to 20% to 30% of the population, is sufficient according to the assessments of at least one long-standing master of psychiatry in private practice.

Months ago, at a weekly meeting of the Corripio Communication Group, Dr. José Miguel Gómez, author of several works on psychiatry, which is his forte, was asked to summarize the reality of the mental health care system in the country. He said that there was a deficit “at all levels,” starting with a low public investment located at approximately 1% of the national budget of the health line when it should be between 2% and 3%.

Insufficient is reflected in the very low availability of beds in crisis intervention units, including provinces without these services, such as Independencia and Bahoruco. The contingency unit of the Padre Billini hospital had just been closed, while of the 40 beds promised to be available in the Luis Eduardo Aybar Health City, only 10 appeared. “There was also a deficit to attend to child and adolescent cases for which there were not 15 beds.” There has been no area to treat alcohol and drug abuse or for long-term psychosocial rehabilitation for mentally ill people who wander the streets and have no families, he added.

The government responded to these descriptions at some point by stating that mental health programs and services are being developed in the country that may be sufficient, at least for people to cope with depression. He mentioned a contact center called “Take care of your mental health” set up to offer free psychological support through line 809-200-1400. There was talk of a “National Mental Health Plan that seeks to reduce morbidity, disability, and mortality associated with mental disorders.

He considered it appropriate for the country’s reality that the Promesa/Cal entity provides medicines through a network of popular pharmacies. People with mental health conditions demand these medicines, and the Public Health Services Network has crisis intervention units in hospitals in Santo Domingo and other cities. However, professionals in that branch do not believe that it proportionally corresponds to the community’s needs. The Ministry of Health updates and develops specific protocols for managing adult depressive disorders.

The vulnerability of the Dominican population is seen as growing by more than one behavioral professional who, based on the arrival at offices of people trapped in depression, takes into account the suicide rate and the alarm expressed by society for the high registration of femicides to the point that recently three occurred on the same day and in different parts of the geography. Specialists associate depression and other disorders with the violence triggered by drug addiction, addiction to gambling, chronic stress, and the many Dominicans who turn to psychiatrists and psychologists affected by signs of emotional deterioration.

MINDS IN CRISIS

For the Spanish professor of psychology, Paula Atienza, it is not strange that young people from any country who are brought before prosecutors and courts are more chronically affected by anxiety and depression than those who do not commit crimes. According to their studies, “The rate of anxiety and depression in the population in trouble with the law indicates that almost half experience mental health disorders while serving time and even while at large.”

“In addition, mental health problems go hand in hand with criminological problems; people who continue to offend after adolescence are almost three times more likely to experience emotional health problems,” he added. According to other scientific evidence, there is a close link between the inclination to misconduct and post-traumatic stress disorders, personality limits, anxiety, substance abuse, sleep disorders, eating disorders,s, and suicidal tendencies.

In the same order, and as if the State understood that the health of those deprived of liberty deserves greater attention, some prisons have pavilions to care for inmates with mental disorders. At least this has been reported by the General Directorate of Penitentiary and Correctional Services in apparent reaction to complaints of overcrowding and humiliating treatment behind the bars of the system that accentuate emotional affection.

He also indicated that the transfer of inmates to the Padre Billini Psychosocial Rehabilitation Center is routinely arranged. He reported that the National Office of Public Defense has managed to transfer inmates with mental health disorders to that place urgently. The authorities admit that Dominican penitentiaries have cases that are considered standard in the general population: “mood disorders, abuse of illicit substances (narcotic portions are discovered in cells all the time) and schizophrenia.

NOTORIOUS FAILURES

Specialists convened by the Corripio Communications Group recently concluded something that does not seem to be enough: “Medications for mental illnesses must be integrated into the High-Cost Medication Program because any patient requires around 50,000 pesos per month in addition to paying for private consultations that on average cost between RD$3,500 and RD$6,000. With a tendency to become more expensive after the country has crossed the pandemic”. For a bipolar or schizophrenic patient, the cost of every 30 days of their medications rises to RD$40,000 and RD$50,000 when the attacks are acute.

The Health Risk Administrators usually cover only the first two consultations, but these conditions require continuous attention. Another conclusion from the meeting was: “When there is a patient of these characteristics, the family economy is greatly affected.” Some patients must be taken twice a month to specialists who feel free to raise their fees from RD$7,000 to RD$12,000.

Even though public hospitals have no costs in the Dominican Republic, they barely had 467 psychologists, at least until a year ago. This implies less than one for every 100,000 inhabitants when there should be at least five. In the case of psychiatrists, there were 356 nationwide at public and private care levels.

KEY FACTS

Among mental illnesses that affect the population, it has been reiterated that there are depression, anxiety, personality, affective, emotional, bipolar disorders, psychosis, alcoholism, and abuse of legal and illegal drugs. A country nestled in the heart of a continent where, according to figures from the Pan-American Health Organization, at least 75% of affected people do not receive treatments recognized as effective. 75% of people with schizophrenia in this country, who tend not to think or feel, have never been seen by a professional.

Alcohol consumption is predominant in 8.2% of the population over fifteen years of age. Still, consumption among minors is not quantified because policies to remove them from such contact are not directed at them either. Ordinarily, at Easter and Christmas, many children are rushed to hospitals and clinics with overindulgence, with or without the consent of parents and guardians, many of them unable to recognize the risks of premature ingestion of spirits.

Every year, and in circumstances that often involve drinking beverages that the states themselves proclaim as very harmful, in the region of the world to which the Dominican Republic belongs, 93,337 deaths by suicide are registered. The rate of decisions to end one’s life has been increasing by 17% since the year 2,000. The average public expenditure on mental health in this entire hemisphere region is only 3%. We have already seen that it barely represents 1% in the Dominican Republic, probably one of the most painfully low in Latin America.