Mental Health Care Delivery in Cuba
Best standards of care in national mental health systems include access to modern psychotropic medications. In poorer countries, however, access to drugs is often restricted for various reasons. Certain countries have responded by incorporating alternative therapies into the system. This is the case in Cuba, where alternative medicine has been integrated into the medical school curriculum and the national health service to a striking degree.
Patt Franciosi, President Elect of WFMH, led a delegation including a number of Federation members to Cuba on 15-23 November 2002. The purpose of the visit, arranged by the American People Ambassador Program (founded by President Eisenhower in 1956), was to allow participants to learn about the Cuban mental health system, observe the mode of health care delivery, and meet professionals working in it. The program offered opportunities to view the provision of services from the entry point at the level of a primary health care center (the neighborhood “consultorio”) to a community mental health center (the “polyclinic”), and at a central inpatient facility, the Psychiatric Hospital of Havana.
Site Visits
Local mental health care is provided in community health centers (polyclinics). The group visited a mental health center in Havana which was staffed by 90 workers (including 6 physicians), and served a community with 70,000 residents. The staff appeared well trained and highly motivated, but the effect of limited resources was visible in the equipment and the range of medications available. There was a strong emphasis on promoting wellness; on family support in caring for those with chronic illness; and on various alternative approaches including acupuncture, hypnosis, yoga and herbal therapies.
Despite the network of community clinics there are no goals to close psychiatric hospitals, which currently have more than 7,000 beds, though there is a move to relocate some services to general hospitals. The group visited the Psychiatric Hospital of Havana, which has improved considerably over the years since the time in 1948-58 when it was considered the worst in all of Latin America. It is situated on a 160-hectare site, with a capacity of 4,100 beds, and currently has 3,400 patients. About 60%-80% of these receive medication, but doses are small. Alternative therapies are also used, including acupuncture, aromatherapy and herbal medicines.
Pat Franciosi, WFMH President Elect (extreme left, facing the camera)
and members of the visiting group at a health care facility in Havana.
Rehabilitation
The rehabilitation program is divided into 6 levels, the first three of which are hospital-based. Activities in the hospital program include raising livestock (chickens, lambs and rabbits), and flower cultivation. Occupational therapy includes art, crafts, dance (ballet), drama, sports and special education. People in levels 3-5 reside at the hospital but spend the day at workshops in the community (people in level 5 receive half of the going wage). Those in level 6 are fully integrated into the community and earn a full wage.
In addition to clinic and hospital visits, the group learned about prevention activities, and visited an anti-stress program located in a general medical rehabilitation hospital. It accepts 40-50 patients at a time for a three-week program which provides training in relaxation techniques, supplemented with biofeedback and acupuncture; group and individual therapy; exercise; and music therapy, hydrotherapy and herbal therapy.
For a group whose members were almost all from the United States, it was particularly interesting to visit a country where very good benchmarks in general health have been achieved despite limited economic resources, and which offers universal free medical care. (There is a small charge for outpatient medications; drugs provided in hospital are free.) Patt Franciosi commented after the trip that Cuba’s strategy of training a high number of medical professionals and other staff relative to the size of the population was visible at the facilities the group visited. Although the impact of scarce resources and difficulties in obtaining medications was easy to see, the high level of staffing was also impressive.