ARGENTINA: Crisis Leads to Surge in Mental Health Emergencies

By Marcela Valente Reprint | | Print |

Marcela Valente

BUENOS AIRES, Feb 19 2002 (IPS) - The psychiatrists attending emergencies in the Argentine capital have found themselves overwhelmed by the calls for help, which due to the economic and social crisis have mushroomed to the level of a post-war situation.

“In the past five years, the demand for emergency assistance doubled. But over the last year, and especially since December, the work has surpassed our capacity,” psychiatrist Jorge Cópola, who attends emergencies in the public Alvear Hospital in Buenos Aires and goes out in an ambulance to attend the most severe cases, told IPS.

Eleven years ago, when Cópola began to work in the hospital, there were just two psychiatrists on duty. Five years ago, that number was increased to four.

The mental health professional covering the night shift would usually go out in the ambulance once per shift. But that changed drastically two months ago, when the government of Fernando de la Rúa fell and the country plunged into chaos. Today, the psychiatrists working the night shift know beforehand that they will not get any sleep.

Things have gotten busier and busier for mental health professionals who attend emergencies as Argentina’s economic crisis and four-year recession have deepened and unemployment has continued to climb, leading to an increased incidence of suicide attempts, verbal and physical abuse, self-inflicted wounds, acute stress, depression and hospital admissions for mental health crises.

The number of emergencies rose 30 percent in December and January. But the worst thing is not the sheer quantity of cases, but the gravity and often dramatic nature of the crises, said Gustavo Ligalupi, with Argentina’s Centre for Psychiatric Emergencies.

“I hadn’t seen cases like this since the post-war period” after the Argentine-British war over the Malvinas/Falkland islands in 1982, said Ligalupi, who added that he was seeing patients suffering acute stress that manifested itself as psychotic episodes, but without the underlying pathology.

“It’s like a passing madness, a grave alteration of conduct,” said the psychiatrist.

Cópola and Ligalupi said an enormous majority of adults in this Southern Cone country of 36 million are suffering work-related problems and bankruptcies, while many men are plagued by a sense of guilt because they are unable to support their families, and a large number of people are about to lose their homes because they can’t meet the rent or mortgage payments.

But the severe crisis of the past few months has merely dealt the final blow to a situation of steady deterioration, they added.

“These are people who have suffered many losses, who in the past few years have had to give up their vacation homes, then their vacations, then their cars and their kids’ private school educations, and now they have lost a large portion of everything they owned, due to the crisis in the banks and the devaluation” of the peso, said Ligalupi.

Although women worldwide are the most frequent and regular clients of mental health professionals, their problems are often less acute than those of male patients, who visit psychiatrists less frequently and usually do so only when they are facing a crisis situation. That means they generally require medication, and at times lengthy hospital stays.

“We are used to assisting women who have tried to commit suicide by taking manageable doses of tranquillisers, but now we are seeing many more cases of men who have swallowed entire bottles of pills, who have taken insecticides, or who have stabbed themselves with knives,” said Ligalupi.

At the Alvear Hospital, suicide attempts are the primary case of calls for emergency home visits. “If the attempt was ‘successful’, then we don’t hear about it, because the forensic physician goes,” said Cópola, explaining why he could not answer a question on whether the actual suicide rate had risen.

What is clear is that there are many more cases of attempted suicide, said Ligalupi. Sometimes it is police officers who call, after finding someone wandering along the railroad or trying to tie themselves to the tracks.

One man who tried to kill himself and make it look like an accident told the psychiatrist that he did so in order for his family to get his life insurance, said the doctor.

The Suicide Assistance Service hotline has also seen a sharp increase in the number of calls for help, with 40 percent of callers’ problems related to financial worries arising from the social and employment crisis.

In the best of cases, after getting their problems off their chest, the anguished callers say they have to hang up to keep the phone bill down – taken as an encouraging sign by the mental health professional attending the hotline, but also as a clear indication of the kind of pressures facing the population today.

Unemployment has soared to 22 percent, and the proportion of working poor unable to cover their basic needs is even larger. Over 14 million of the country’s 36 million people have tumbled below the poverty line.

Last year, the Buenos Aires city government set up another 24- hour hotline, “Mental Health Responds”, which refers an average of 40 patients a day to public hospitals and health clinics.

Argentina used to be at the top of the list of countries in terms of the proportion of the population that had received psychoanalysis.

However, private patients are now seeing their therapists for shorter and shorter periods, mainly to address specific symptoms and problems, and many patients have simply stopped going to therapy since December.

“They say they want to wait out January and February to see what happens in March, and we don’t know if they’ll come back. Some of them ask if they can pay reduced fees, but others don’t even ask. They just leave,” psychoanalyst Andrea Sola told IPS.

All of the mental health experts consulted recommended that people avoid isolating themselves in their problems, and that they seek help, or at least try to talk to somebody else about their troubles.

Ligalupi said the pot-and-pan banging demonstrations and grassroots neighbourhood assemblies to protest the partial freeze on bank withdrawals and the conversion of dollar-denominated savings accounts and mortgages to pesos were healthy, because they helped draw people together to weather the crisis.

The mental health services offered by the Alvear Hospital, which treats low-income people, as well as people from the middle- class who have fallen into poverty, are free of charge.

The Centre for Psychiatric Emergencies, where Ligalupi works, attends those who belong to trade union health plans and private health services.

Both experts underlined that in the middle to upper-income sectors, family tension and even domestic violence are accentuated by the fact that many couples have decided to separate but are unable to do so because of financial reasons.

Cópola and Ligalupi also observed that in the middle and lower- income strata, patients in crisis are frequently abandoned. At times, the pyschiatrists on duty attend emergency calls placed by family members, and on arrival they only find an elderly person in need of basic care, which no one is providing. The caller is nowhere to be found.

On other occasions, a patient with a mental health crisis is admitted to the hospital, but no one ever comes to pick them up. Whether or not there is a chronic underlying psychological condition, psychiatric patients can only be discharged if a family member or a judge signs the proper forms.

“Sometimes the family is unable to handle them or just can’t put up with them anymore, and they are left in the hospital, where we have 16 beds for an average of 22 patients,” said Cópola.

Many of the patients end up sleeping on stretchers or mattresses on the floor, waiting for their families to take them home.