Nacional de Psiquiatría Ramón de la Fuente – Maria Elena Median Mora,General Director – Mexico
The general director of the National Institute for Psychiatry discusses the Institute’s commitment to translating clinical research into better care for patients, the social stigma patients with mental disorders still face in Mexico and the increasing importance of mental health on productivity and the country’s economic development.
You have been general director of the institute since 2008. What have been your key priorities and the most important achievements since then?
By the time I was appointed, I already had many years of epidemiological and community research at the institute behind me. One great advantage of having such a practical background was that I knew the areas of opportunity of the system to progress on closing the treatment gap as well as meeting the needs of our community. The key priorities I undertook were to join forces with other government entities to improve the framework of mental healthcare in Mexico – for us the most important variable to consider – as well as to foster clinical research in the field, as we need more practical outcomes.
At the institute in the past we have done great developments in the field of neurosciences, epidemiology and social sciences, under the lead of Dr. de la Fuente, which implied a hard and extensive training for our psychiatrists and researchers. This eventually developed in the growth and expansion of specialty clinics and the improvement of the quality of medical care for mental disorders in Mexico. Indeed many achievements were accomplished before my arrival, so my current role is to keep research as a vital and important field. Gaining new knowledge and closing the research gap will translate into discoveries to improve clinical practices and, eventually, into overall better care for the Mexican population.
What are the main challenges you face at the institute and how are you tackling them?
Psychiatry has many challenges, the most important being how to find a converging point for social, clinical and neuroscientific research to meet. We need to monitor our patients and their symptoms carefully, and take advantage of the great technologies that have been developed for the study and monitoring of the human brain. However, we should also ask ourselves questions such as: Why do people get this kind of illnesses? What are the origins of these pathologies? What is the relationship between genetics and the environment? How can we create better models for the treatment of brain-related diseases? And should also consider and understand influences such as aging and violence on internal processes and changes in the brain.
Another big challenge we face is how to translate the knowledge and evidence collected through research into practical and measurable results, such as better treatment for patients, decrease in hospitalization time, prevention of hospitalization and faster diagnosis process, community interventions for groups in condition of vulnerability, adapted to their cultural background and considering their felt needs, just to mention a few. In other words, how to make the experiments done on animal models useful for human beings and to close – or at least shorten – the distance between the different disciplines cultivated at the institute. To fill this gap, after my appointment as director, we have started a network among the different specialties where everyone is able to have access to information provided by other departments and enter a positive feedback loop that can help us obtain better results.
Last but not least, as a public institution and even if we handle as many patients as other institutes, we currently receive very limited funding. Mental illnesses represent 7 percent of the total diseases treated in Mexico but only 2 percent of the health budget is dedicated to the treatment of these disorders. Also, we need more psychiatrists since, as we speak, we only have 102 in the entire country.
What do you think could be done to improve the importance given to mental disorders here in Mexico?
The methods used so far to educate our community about mental health issues have not been very successful. I think we should create effective social programs to make people more aware of problems such as depression, violence, teenage pregnancy and abuse of drugs. Innovation is not only about new scientific developments and technological advancements, but also about the generation of new models of social attention and awareness raising. Unfortunately all these issues have a common denominator: the lack of financing.
Recent data tells us that one out of every four Mexicans aged 18 to 65 has experienced a psychiatric condition, but only a small percentage is diagnosed and treated adequately. Why is this the case?
It is the sum of many factors that come into play and, when combined, make things harder for our patients and for us as caregivers. In many cases, common people simply ignore they have a disorder; many teenagers and their parents, for instance, don’t give mental health issues an important role and think these are just temporary problems. Also, the social stigma surrounding mental illness represents a great barrier. People with schizophrenia represent one percent of the total population in Mexico, but most of them live their life without receiving any treatment because of social and cultural barriers that make them afraid of being harshly judged by society. The same happens with depression and other disorders: we estimate that 75 percent of people with mental disorders will never receive treatment or, sometimes, they just wait too long to be treated bringing unnecessary suffering and loss of opportunities for development.
Social stigma acts as a major barrier that keeps people from looking for a solution. We want them to acknowledge that they have a condition like any other and that it can be controlled, without being afraid of stigmas.
What kind of mental disorders and cases do you usually treat at the institute?
The main vocation of the institution is to help patients with serious diseases, which cannot be treated somewhere else. Patients with minor disorders are automatically sent to regular or specialized primary care centers and usually do not get pharmacological ailment. We provide a combined treatment of pharmacological and psychological support to patients with severe illnesses.
I’m proud to say that today we treat more than 18,000 patients per year, which represent more than 100,000 medical consultations. Over time the institute created eleven clinics focused on different issues related to mental health, such as a clinic for teenagers, psycho-geriatrics, addictions, gender and violence, schizophrenia, depression, anxiety, compulsive behaviors, eating disorders, personality disorders, sleeping disorders and genetics. It is also important to highlight that public healthcare providers have included mental disorders in their list of illnesses covered by the national insurance scheme Seguro Popular, and this is something that we all should be proud of; we now have to work to make sure all affiliated can gain access to the treatment they need.
However, our approach is very human. As a matter of fact, one of the most effective methods to help our patients and their families is to teach them how to “help themselves” through psycho-educational methods and how to have control over their illnesses by understanding and identifying their symptoms.
In recent times we are witnessing a trend towards an increased cooperation between private and public organisms in the medical and healthcare sectors to share knowledge and develop innovation. Can you talk about your experience?
We had a couple of experiences in the past, but – to be honest – they weren’t enough to fulfill our needs and expectations. We would like to have more participation of the private sector in the elaboration of new drugs that might benefit people with mental disorders. In recent years, we have worked along with private parties in the development of anti-addiction vaccines with a lot of success: today we have more than 70 patents associated with our medical and clinical investigation. We have years of constant testing of many successful vaccines on animals and the results have been astounding, as our vaccines have created high levels of long-term immunization and have proven to fulfill the security requirements to give the next step. However, if we want to keep this research going we need to enter a new phase where we will definitively need the aid of the private industry. We place high hopes in partnering with the private industry, as this will help us give the giant leap of going from animal to human tests. It is crucial to create new links with the pharmaceutical industry to have access to high-risk investments that can help us speed up the development process and provide us with faster and more efficient diagnosis and treatment methods.
Do you have any exciting new projects in the pipeline?
In recent times we received a grant by the US government and with this help, we were able to move on some projects we had in our pipeline, as for a example the establishment of a clinical trial unit. As we speak we are researching non-opioid pathways for the treatment of pain: we’ve come a long way with animal models and, so far, we have experienced excellent results. We have other great projects involving the quest for finding new biological markers: our researchers have found out that the nasal epithelium allows us to differentiate patients with specific disorders trough a low-risk and safe procedure.
What changes would you like to see in the coming years with regard to treatment of mental health in Mexico?
We should all join forces to create integration between mental disorders and other health-related issues. For example, we can’t just keep treating diabetes without considering the depression behind an important proportion of persons with this disorder. We should create bridges between different institutions to treat depression and other mental disorders from all sides until we find the primary cause. We should educate ourselves, our society as well as the private industry to recognize symptoms and foster treatment. Hiding and ignoring issues such as addictions or alcohol dependence only make things worse. We must think about economic development based on a better lifestyle in which mental health plays a much more important role than it does today.