A conversation with...
Dr. Hugo Cohen
Sub-regional Advisor on Mental Health for South America
Pan American Health Organization (PAHO)
(Based in Buenos Aires, Argentina)
Challenges to mental health reform in South America:
"It is easier to disintegrate an atom than to break a prejudice"
Dr. Hugo Cohen
Dr. Hugo Cohen was born in Argentina and did part of his studies in Granada, Spain. After many years of professional practice in the Argentinean Patagonia region, he worked for the Pan American Health Organization (PAHO) in El Salvador, Mexico, and the United States. Since returning to Argentina, Dr. Cohen has served as Sub-regional Advisor on Mental Health at the PAHO Representative Office in Buenos Aires.
Dr. Cohen believes that progress is still inadequate in the Region towards giving real and practical meaning to the 1990 Mental Health Caracas Declaration. He acknowledges, however, that a process of change has begun: "Another type of discourse can be heard, a discourse grounded in innovative practices."
Caracas, he explained, was a critical turning point. "In the mental health field, we can in fact say that Caracas in mental health is what Alma-Ata was for primary care in health," he said. "Caracas was something akin to a new national constitution, and I believe that we must thank and express our gratitude to the two principal architects of the consensus reached in 1990, Dr. Itzhak Levav and Dr. Benedetto Saraceno."
The Key Role of Training
Many years of striving to promote and implement all the details required for mental health reform in Latin America have given Dr. Cohen an intimate knowledge of successful developments and practices in several countries such as Chile, Brazil, and Argentina, to name a few. However, Dr. Cohen has also seen that these reforms, specifically mental health reform, have encountered heavy resistance, often -he noted- from health professionals and health workers themselves.
"It is easier to disintegrate an atom than to break a prejudice," said Dr. Cohen, just as Albert Einstein once said. "Our field [mental health] is permeated by a high degree of fear [and] misinformation, rooted in scientific and technical ignorance," he noted. "We still have a long way to go in professional training in an area of education whose curricula, not even at the graduate level but in medicine and psychology, does not cover current either scientific and technical advances or social and legislative reforms."
Dr. Cohen noted that a very large segment of people with severe mental illness in South America have not received care or drugs or seen a doctor in the past 12 months.
"Our field [mental health] is permeated by a high degree of fear [and] misinformation, rooted in scientific and technical ignorance."
"Our challenge is to bridge this gap with a comprehensive reform to decentralize services and integrate them into health systems, providing beds in general hospitals and personnel trained in primary care, assisting families, involving intermediate structures in community networks, and educating the population."
He believes it is "essential to give effective access to people who need it and to ensure continuity in care." In conclusion, Dr. Cohen expressed guarded optimism regarding achievements in the Region, especially in light of the Caracas Declaration of 1990.
"Initiatives advocating the traditional system of hospitalization in asylums for the insane no longer carry weight in the countries, but ideas and efforts to promote decentralization, proposals for integration into primary health networks, and programs based on inter-sectoral approaches, along with the active incorporation of other actors that are directly involved, such as justice, law-enforcement, labor, housing, education, and social-development authorities, patients and their family members, and churches and religious organizations."
"We now have a foundation," he said.