Caracas Chronicles

In preparation for a course on clinical community psychology at my home university in Caracas, Venezuela, I stumbled upon a May 2022 tweet from an anonymous student complaining about a family of pigs that had occupied the psychiatric hospitalization ward where he was supposed to develop his clinical training. The tweet seemed preposterous, until you consider the degree of deterioration of the public health system and that the tweet included pictures and a video of a group of pigs roaming carelessly through the hospital.

I shared it with the class to stress the need to rethink the ethical grounds of our profession and attempt to resolve this huge crisis, and a student told me in private that it was another classmate who posted (and later deleted) the tweet, and he was threatened for exposing the situation. I asked my student to speak to him directly and he welcomed the invitation. 

The directors of the hospital, considering the empty spaces provided by its lack of services, decided to allow a family of homeless milicianos to move in, and they were raising pigs for their personal consumption, seeing that the hospital was pretty much abandoned. The student explained to me that his supervisors were worried that the military personnel managing the hospital were going to react angrily over feeling exposed about the dysfunction of the institution. That they might prohibit the university, which has a tense relationship with the government, from continuing to develop its academic practice on these grounds. Actually they accused the student of betraying the professional confidentiality that clinical practice requires.

I have followed the continuous deterioration of the mental health system for years, collaborating with the development of alternative networks and treatment options to try to buffer consequences. A few years back, I hesitated before publicly denouncing the deterioration of another psychiatric center, the El Peñón psychiatric hospital in Caracas, after hearing the pleas of various colleagues who argued that public outcry would only worsen the government’s persecution of the medical professionals that were struggling to continue to offer assistance in dire circumstances. 

In Venezuela, access to decent medical attention is in crisis in general but, as tends to be the case, attention to psychological suffering is even worse. The national and international press have been calling attention to the gravity of the situation for almost ten years now. As far back as 2014, for example, an article reported that workers of the Psychiatric Hospital of Caracas at Lídice, which had one of the main public psychiatric hospitalization wards in Caracas, held a protest complaining over patient’s conditions that included lack of food; while another report denounced that in El Peñón, windows had been closed with cement to avoid patients from escaping and that corruption ran rampant. 

The general landscape of the psychiatric system was reported as grossly lacking in relation to the demands of the population, with 11 psychiatric centers and 78 out-patient centers having an average of a five month waiting list to provide attention. Health professionals avoid reporters for fear of being persecuted.

By 2016, international press reports had picked up on the situation. The New York Times titled a piece “Inside Venezuela’s Crumbling Mental Hospitals,” describing the Pampero hospital where patients complained of being hungry. By 2020 a local newspaper reported that ten patients had died from hunger at that same hospital in Lara state. In 2019, a Washington Post’s headline speaks for itself: “Locked up naked on a soiled mattress: Venezuela’s mental health nightmare.” In it, the downfall that was apparent in 2014 had taken a huge toll, as the previously mentioned El Peñón Hospital, reported having had fourteen patients die because of lack of resources. 

In 2022, we developed a nation-wide survey on the impact of Covid-19 on psychological suffering in Venezuela and the availability of attention. A team of newspaper reporters called the 264 public centers listed by the health ministry during three months, only eleven of these answered the calls, but out of this meager 4% of listed services, only half had an operative psychological service.

Interviews with colleagues that continue to work in the public health sector report having received unofficial orders to avoid all hospitalizations. This means there are no public places to treat a person in crisis. For example, the Hospital Universitario de Caracas, one of the most progressive services in the past, recently had only one hospitalized patient. She remained in the center since she had no family or home to be sent back to. 

Enduring the same challenges that the struggle that psychiatric users have had in the rest of the world, and having many transformations still waiting to happen, this collapse points to another level of human rights abuse.

Venezuela not only has a huge pending agenda regarding the incorporation of the many new developments in relation to patient led policies for mental health services, it has also regressed to the horrors of nineteenth century psychiatric wards that includes gross dehumanization.

The collapse of the traditional system could, from an optimistic standpoint, be an opportunity to develop and strengthen alternative, community and patient led approaches to mental health. But such a dire situation demands previous actions that include rendering visible the plight of many that, at this point, have very little voice in the midst of an economic, social and political crisis that pushes mental patient’s struggles to invisibility. We first need to raise awareness and counter the fears that political persecution over denouncing this situation has engulfed the mental health community.