Introduction
In the intricate web of Mexican public policies, few issues reveal the internal contradictions of a political project as clearly as the implementation of the new mental health paradigm. Mexico faces a paradox that demands deep reflection: while a groundbreaking reform to the General Law of Health in 2022 explicitly prohibited the construction of new specialized mental health hospitals, President Claudia Sheinbaum inaugurated with fanfare on November 30, 2023, the “Dr. Victor Manuel Concha Vazquez” Mental Health Hospital in Orizaba, Veracruz. The hospital’s construction began just a year after the law prohibited such practices, leaving it under the responsibility of OPD-IMSS-Bienestar.
The Legislative Paradox
This incongruity is not merely administrative or technical; it reflects a structural problem that plagues Mexican government planning and exposes the gap between legislative intentions and the operational reality of the national health system. Moreover, it highlights the fragility of a model that, while conceptually correct, lacks the necessary resources and infrastructure for effective implementation.
As we argued in Congress, the reform published on May 16, 2022, in the Federal Official Gazette marked a historic milestone in mental health treatment in Mexico – at least on paper. Article 74 of the General Health Law states categorically that “to eliminate the psychiatric asylum model, no new specialized hospitals for psychiatry should be built; and existing psychiatric hospitals must progressively convert into outpatient centers or general hospitals within the integrated network of health services.”
This legislative transformation represented a paradigmatic shift towards a community-centered model focused on human rights, aiming to eliminate forced institutionalization practices and promote comprehensive attention from the first level of care. The new legal framework prioritizes informed consent, prohibits involuntary admissions except in extreme cases, and establishes a preventive and community approach that, in theory, should revolutionize national psychiatric care.
Underfunding and Resource Shortages
However, as pointed out by the Center for Economic Research and Budget Studies (CIEP), Mexico allocates only 1.3% of its total health budget to mental health issues, while the World Health Organization recommends at least 5%. This chronic underfunding means that Mexico would need to triple its current investment to meet minimum international standards.
The Orizaba case perfectly illustrates the contradictions of the Fourth Transformation government. While the 2022 reform explicitly prohibited building new specialized mental health hospitals, the Veracruz state government advertised for the “Replacement of the Orizaba Mental Health Hospital ‘Dr. Victor M. Concha Vazquez'” in November 2023, with an investment reportedly reaching 99% completion by August 2024.
President Sheinbaum, upon inaugurating this facility, described it as “an example of mental health care and prevention throughout the Republic,” highlighting its services for minors and 120 beds, including 105 reimbursable and 15 non-reimbursable. This installation, equipped with specialized medical equipment in psychology and psychiatry, embodies the very type of infrastructure the legal reform aimed to eliminate.
The paradox deepens when considering that this hospital, in addition to violating the spirit of the reform, was built without an integral implementation plan for the new community model. Experts have pointed out that transitioning to a primary care model requires not only closing or converting psychiatric hospitals but also creating a robust network of Community Mental Health Centers and mass training of first-level personnel.
The shortage of human and financial resources contradicts the Fourth Transformation’s discourse. Data on mental health human resources in Mexico reveals the magnitude of the challenge. The country has only 0.36 psychiatrists per 10,000 inhabitants, far below the WHO recommendation of one psychiatrist per 10,000 inhabitants. For other professionals, Mexico has 0.67 psychiatrists, 2.8 psychologists, 0.52 social workers, and 0.18 occupational therapists per 100,000 inhabitants – figures that demonstrate a severe structural deficit.
This scarcity is exacerbated by the uneven geographical distribution of specialists, concentrated mainly in large cities, while rural and marginalized populations lack access to specialized services. The 2022 reform, though well-intentioned, did not include specific mechanisms to address this gap nor allocate additional resources for accelerated training of specialized personnel.
Presupuestary Concerns
The budgetary outlook is equally discouraging. By 2025, the National Commission on Mental Health and Addictions will exercise a budget 15.2% lower than in 2024, dropping from 2,466.5 million pesos to 2,146.1 million pesos. This reduction occurs amidst a growing demand for mental health services: from January to May 2024, 158,814 people were attended for various mental health conditions, with anxiety (51.5%) and depression (25.9%) being the most prevalent.
Economic Consequences of Neglecting Mental Health
The neglect of mental health has devastating economic consequences that extend far beyond the direct cost of treatments. International studies demonstrate that mental disorders account for between 2.5% and 4.5% of the annual GDP in various countries, while in Mexico, chronic work-related stress is estimated to generate over 100,000 million pesos annually in indirect costs.
Absenteeism related to mental disorders reduces corporate productivity by 23.8%, and companies that ignore their employees’ mental health needs face fifteen times more absenteeism and six times higher staff turnover. With approximately 15 million Mexicans living with mental disorders but only one in ten receiving timely treatment, the cost of inaction multiplies exponentially.
This reality becomes even more dramatic when considering that Mexico ranks first worldwide in work-related stress, with 75% of the working population affected, surpassing China (73%) and the United States (59%). The implications for national productivity, economic competitiveness, and human development are evident.
Questions for the Fourth Transformation
The Orizaba hospital’s inauguration raises fundamental questions about the coherence and responsibility of the Fourth Transformation’s project. If the federal government understood the need to transition towards a community model, why did it allow and celebrated the construction of an installation that directly contradicts its own legal guidelines?
The answer seems to lie in the lack of coordination between government levels, the absence of an integral implementation plan, and prioritizing physical construction over conceptual transformation. The Orizaba hospital thus becomes a symbol of the internal contradictions of a government that, while proclaiming its commitment to transformation, maintains practices that contradict its own principles.
This situation worsens when considering that Mexico currently has 341 Community Mental Health and Addiction Centers and only 241 hospitalization beds for individuals with mental disorders across 115 general hospitals. These figures clearly show that existing community infrastructure is insufficient to meet national demand, making the decision to build a specialized hospital even more problematic.
The Path Forward
The Orizaba paradox should not be interpreted solely as criticism of government management but as an opportunity to reflect on the inherent challenges of any structural transformation of the health system. Transitioning to a community-based mental health model requires not only political will but also meticulous planning, sufficient resources, and most importantly, time for specialized human resource development.
The “Mexican model of mental health” must reconcile the aspiration for a human rights-centered system with the reality of budgetary and human resource limitations. This involves acknowledging that while conceptually problematic, the Orizaba hospital could serve as a laboratory for implementing innovative practices that eventually allow its conversion into a more community-based model.
The current government’s responsibility is to ensure that facilities like Orizaba operate under community care principles, respect for human rights, and a preventive approach while rapidly developing the necessary community infrastructure to make the desired transition viable.
Ultimately, the mental health of Mexicans cannot wait for political or budgetary contradictions to be resolved. Each day without adequate attention affects human lives, shattered families, and accumulating economic and social costs exponentially. The Fourth Transformation has the opportunity to demonstrate its effectiveness in implementing reforms as it did promulgating them, but this will require the coherence and budgetary commitment that has been notably absent so far.
True mental health transformation will be measured not by the construction or closure of hospitals but by the state’s ability to guarantee that every person requiring psychiatric care has timely, dignified, and effective access to necessary services, regardless of their socioeconomic condition or geographical location. The Fourth Transformation still has a long way to go in this regard.
*The author (www.ectorjaime.mx) is a general surgery specialist, certified in public health, and holds doctorates in health sciences and public administration. He is a legislator and advocate for Mexico’s public health, a reelected PAN group member in the LXVI Legislature.
