The Unmeasurable Reality of Mental Health
For decades, mental health disorders have existed in a medical limbo: too real to ignore yet impossible to measure. Unlike cancer, diabetes, or autoimmune diseases, there is no biological marker to detect mental illness in a lab. There’s no definitive test for diagnosing depression, anxiety, or post-traumatic stress disorder (PTSD). This scientific, cultural, and economic void has historically been used to deny their existence.
Beyond Neurotransmitter Imbalances
Mental health disorders are not merely neurotransmitter imbalances, as once believed during the era of “miracle” antidepressants (selective serotonin reuptake inhibitors or SSRIs). Today, we understand that behind depression are endocrine, immune, inflammatory, and trauma-related processes interacting with genetics, gut microbiota, chronic stress, violence, and loneliness.
Insurance Models and Mental Health
The business model of both public and private insurance relies on a clear principle: pay only if the damage is measurable and acquired, not if it originates from one’s soul or mind. Consequently, despite clinical diagnoses like depression and PTSD being internationally recognized, they are rarely accepted as causes for work disability or chronic disability.
A Personal Journey: Claudia’s Story
Claudia, a 34-year-old survivor of domestic violence diagnosed with PTSD, struggled to maintain her job and daily life due to the overwhelming physical and mental toll. After various therapeutic attempts, she sought a solution previously unthinkable: work disability due to mental health and a disability credential.
The process was slow, bureaucratic, and filled with forms, medical appointments, and explanations. However, it existed—a public health system finally acknowledging that mental illness can incapacitate.
Changes in Mexico
The Mexican Social Security Institute (IMSS) now recognizes that conditions like depression, anxiety, or PTSD can lead to temporary work disability with a 60% salary subsidy starting the fourth day and for up to 52 weeks, extendable by medical decree.
The CITT (Certificado de Incapacidad Temporal para el Trabajo) document, issued by an IMSS doctor with the corresponding diagnosis according to the CIE-10 classification, supports this.
When workplace-related factors (harassment, overload, violence, harmful shifts) are proven as the trastorno’s origin, one can apply for work-related risk disability through the Coordination of Occupational Health.
This shift is significant in a country where depression was once dismissed as “laziness” and anxiety as “lack of character.”
In parallel, Mexico City has started acknowledging psychosocial disability through the Disability and Functionality Certificate, tramitable at health centers, and the DIF CDMX Inclusive Card, offering mobility benefits and administrative facilitation.
Federally, the National DIF also issues the National Credential for Persons with Disabilities, valid nationwide.
The Issue of Objective Proofs
Although psychiatrists know real alterations exist—in the hypothalamic-pituitary-adrenal axis, inflammatory cytokines, gut microbiota, or brain structure—none serve as stable diagnostic markers yet.
This lack of “objective proofs” perpetuates stigma and delays investment in research. Meanwhile, millions suffer job loss, diminished functionality, and hopelessness without recognition.
Moreover, access to specialized care remains dramatically unequal. Mexico has around 5,000 psychiatrists for 130 million inhabitants—approximately 3.7 per 100,000 people, mostly concentrated in Mexico City, Guadalajara, and Monterrey. Some states have only a handful of specialists, and public health services cover less than 20% of national demand.
Persistent shortages of psychoactive medications in public institutions, documented by both IMSS and patient advocacy groups, exacerbate the situation.
The Cost of Invisibility
Depression, anxiety, and stress-related disorders not only steal life but also productivity, education, relationships, and healthy years.
According to the Organisation for Economic Co-operation and Development (OECD), mental health costs more than 4% of GDP in member countries; in Europe, annual expenditure exceeds €600 billion.
In the US, major depression costs adults over $330 billion annually, while in the UK, mental illnesses cost the state £300 billion yearly—almost double the national health system’s budget.
Investing in mental health is not a luxury; it’s a rational economic decision.
Mexico has only a few specialized psychiatric hospitals: the Fray Bernardino Álvarez Psychiatric Hospital, the National Institute of Psychiatry “Ramón de la Fuente Muñiz,” and the Juan N. Navarro Child Psychiatric Hospital, all in Mexico City.
Outside the capital, mental health care depends on units of mental health and addiction services, many lacking a base psychiatrist. For most patients, reaching a specialist involves waiting months or resorting to private care, which is unaffordable.
Do You Believe You Have an Incapacitating Mental Health Issue?
Remember, you’re not alone. Though the system is still learning to see what the body already knows—that mental health can also suffer, and trauma can incapacitate—there is now a path:
- If you’re IMSS-affiliated, request an evaluation at your family medicine unit. If the treating physician deems it relevant, they can issue a CITT (Certificado de Incapacidad Temporal para el Trabajo) for general illness. If your case relates to the work environment, you can request a review as an occupational risk.
- If you live in Mexico City and your condition is chronic, manage the Disability Certificate at your health center. Access the Uniendo Única with your Llave CDMX and apply for the DIF Inclusive Card.
- Most importantly, seek support. No paperwork replaces the human network sustaining recovery.
For years, we were asked for “evidence” of what our bodies already knew: mental health can suffer, and trauma can incapacitate.
Today, Mexico takes firm steps to acknowledge this, though much remains regarding specialist distribution, medication availability, insurance understanding of mental health, and unbiased research.
Each well-granted disability and each psychosocial disability credential issued is a victory against denial.
Caring for mental health is not a matter of will; it’s a right. I’d love to hear your questions or experiences related to this topic. Let’s keep the conversation going; you can email me at [email protected] or reach out to me on Instagram at @dra.carmenamezcua.
