2024-03-02 09:05:24
The highest authorities of the City of Buenos Aires presented this week a new mental health protocolespecially designed for to meet the emergency of people in street situation who are suffering from a violent outbreak, whether psychiatric or addiction-related. The recently published action plan will be used to address a long-standing social problem that has been worsening in recent years.
The new document summarizes the instructions for manage and care for people in this situation who require psychiatric care. Until now there was no official procedure to act, and it depended on the will and experience of the operators on duty.
In CABA there are (as of November 2023) about 3,500 homeless people.
The problem is pressing because, according to recent data collected by the staff of the Ministry of Human Development, in CABA there are (as of November 2023) around 3,500 homeless people. And to this another element is added: 60% of these people are involved in some specific or prolonged situation of mental disorder or addictions.
To address this situation, the City designed a plan that began by strengthening and train SAME staff so that you can work better in these situations. This also included adapting four City ambulances to eventually be able to safely transport the people involved. And it is now completed with the protocol that tells all actors – social workers, doctors, rescuers, police, etc. – how to act in each case.
Protocol details
At the press presentation attended by PROFILE, the Head of Government, Jorge Macri, clarified: “We designed a specific protocol, with the objective that our teams can act and help homeless people with a mental health problem or problematic substance use.” And he clarified: “Until now, in a situation of these characteristics, people looked the other way.”
On the other hand, the official explained that “It is a global problemwhich is growing in the big cities of the world, along with an increase in people living on the streets, an increase in addictions and high situations of violence.”
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Macri assured that the protocol is correctly framed in the current Mental Health Law, especially in his controversial article which indicates that the ‘involuntary hospitalization of a person must be conceived as a therapeutic resource exceptional and it can only be carried out when, at the discretion of the health team, situation of certain and imminent risk for oneself or for third parties‘. According to experts, in a situation of poisoning or outbreak it is almost impossible for the person to decide to be admitted voluntarily, and it is usually complex for decision-makers and witnesses in these situations to take any concrete action.
The new procedure presented by the head of Government together with his Minister of Health, Fernan Quirosand that of Human Development, Gabriel Mraida, seeks to order these procedures. Thus, after calls to telephone numbers 107, 108, 911 or 147, the protocol is activated that facilitates the identification of the person to know if they are being searched by a family member. Then, depending on the situation, the SAMEthe Comprehensive Directorate of Immediate Care or the Police, and it is determined if it is necessary to make a referral to one of the five general acute hospitals in the City that have experts in psychiatric issues on permanent duty.
These hospitals are the Durand, Pirovan, Alvarez, Piñeiro and Rivadavia. And the authorities announced that they will soon add others to this group.
In these units it will be an interdisciplinary mental health team that can complete an in-depth evaluation and propose treatment or the possible consequences of not doing so.
For this reason, the determination will be made there. If hospitalization of the patient is necessary or if you are at certain and imminent risk to yourself or third parties. This usually occurs within a period that can extend up to 72 hours after admission. And the hospitalization will end when the cessation of risk is confirmed.
A particular detail of protocol is that it states that, if there are minors involved, the Council of Children and Adolescents will be convened to act according to current regulations.
What is seen most in this space are chronic pathologies
C.C.
Maximiliano Cesoni, secretary of the Association of Psychiatrists of Argentina (APSA), explains: “I think it is notable that an attempt is made to protocolize how official actions should be in an emergency of this type,” he told PROFILE. “But it is wrong to think that mental health is only attention to a particular crisis of a homeless person. Seeing it like this can generate a stigmatizing situation and the truth is that the situation does not end up being addressed comprehensively.”
According to this psychiatrist who works in the Borda hospital“if someone decompensates and has a crisis, but is not technically homeless, it would be out of this protocol. And this is something we see more and more frequently due to recurring crises.” On the other hand, it is important to remember that with the current economic situation, practically all health providers (social works, prepaid, public sector) face a shortage of professionals and resources. And what is there is usually saturated or overflowing. “So I have some doubts about how the protocol will end up working. I am concerned that it is something done with good intentions, but does not have the necessary resources.”
For her part, Verónica Mora Dubuc, psychiatrist and member of APSA, commented: “The intervention paradigm is changing on mental health problems, and now respect for human rights is included as a priority. That is why before we talked about “dangerousness” and now it is explained in terms of “risk situations.” The expert clarifies that these changes in vision are sometimes complex when it comes to applying them specifically: especially when there are serious crises, in emergencies, where it is difficult to discriminate “risk” from “danger.” In that sense, it is correct that the new legislation has framed the possibilities of intervention differently, even to decide on involuntary hospitalization.
On the other hand, the psychiatrist stated: “basically It is a protocol for urgency. And that causes us some discomfort, because what you see most on the street are chronic situations. There are people who have lived on the streets for decades and require specialized intervention, in accordance with the law and specific treatments, that address the vulnerability that arises from having a mental disorder.
In many of these cases, it is neither indicated nor appropriate to intervene urgently. “In short, it seems that there are situations in which “This protocol is too small for us.”.
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