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41 3 Mental Health Services in Mexico: Challenges and Proposals Benito Estrada Aranda WHY PROVIDE SPECIALIZED MENTAL HEALTH SERVICES TO DEAF PERSONS? In England, collaboration between the National Institute of Mental Health and the Health Department resulted in a publication titled Mental Health and Deafness: Toward Equity and Access: Best Practice Guidance (NIMHE/DH, 2005). Their data show significant relationships between mental disorders and deafness. For example , 40% of deaf children are described as having behavior disorders, compared with 25% of hearing children. Studies carried out in different countries have indicated relatively higher levels of mental disorders and alcohol problems in deaf adults. Hypotheses about these data address the likelihood of brain damage at birth, as well as the effects of social exclusion (Estrada, 2008), including limited opportunities for education and employment. Contributing to this social exclusion is the use of a sign language, which is marginal, visual, and unfamiliar to hearing persons, including those hearing families with deaf children. This situation applies to about 90% of deaf and hard of hearing individuals. In Mexico, with a population of about 112 million (INEGI, 2010), only about 2% of the annual health budget, which itself averages about 6.5% annually, is assigned to public mental health services for the country, according to data compiled by the World Health Organization (WHO), the Pan-American Health Organization , and the Mexico Ministry of Health (IESM-OMS, 2011), working in collaboration . Of that 2%, about 80% is used to cover the expenses of inpatient psychiatric hospitals. No public mental health services for deaf and hard of hearing people (i.e., with sign language accessibility) are either mentioned or currently available. It should be noted that WHO recommends that about 10% of a national health budget should be devoted to mental health, yet the average mental health budget ara86542_03_ch03.indd 41 ara86542_03_ch03.indd 41 12/10/15 6:57 PM 12/10/15 6:57 PM Benito Estrada Aranda 42 for medium- to high-income countries is only about 2% (WHO, 2004), thus putting Mexico below average. In addition to the lack of services for deaf and hard of hearing people in Mexico, there are shortages of these services to the general population as well. According to the report mentioned earlier, the total number of mental health service providers is about 10,000 persons, with approximately 1.6 psychiatrists, 1 physician, 3 nurses, 1 psychologist, 0.5 social workers, 0.19 therapists, and 2 health professionals/ technicians per 100,000 inhabitants, with most inadequately distributed throughout the population and concentrated primarily in psychiatric hospitals. The following discussion reviews the problems and challenges of providing mental health services to Deaf people and then sets out several proposals for establishing such services. In this chapter, “Deaf” (with a capital D) refers to people who are congenitally and/or prelingually deaf and consider themselves part of Deaf culture and the Deaf community, which predominantly uses Mexican Sign Language (MSL). Demographic Issues of the Mexican Deaf Population Approximately 1 or 2 out of 1,000 individuals around the world are born severely or profoundly deaf (ADSS, BDA, LGA, NCB, NDCS, & RNID, 2002). Although in 2001 the World Health Organization estimated that about 250 million people have a hearing disability, it is still difficult to obtain more specific data from most countries. Although Mexico does not have an official or a specific census of deaf individuals , extrapolations from the last two population censuses suggest an increase of nearly double that number. The XII General Census of Population and Dwelling (INEGI, 2000) indicated almost three individuals with a hearing disability for every 1,000 inhabitants in the country, or a total of 281,000, with about 31.2% residing in rural areas. In 2010, the XIII General Census of Population and Dwelling (INEGI, 2010) indicated a total of 498,640 people with a hearing disability (273,216 males and 225,424 females). In 10 years, just about double the number of individuals with a hearing disability were identified, the majority of whom were male (INEGI, 2000). Also noted was considerable variation in the distribution of individuals with a hearing disability throughout the country: 57,792 persons counted in the State of Mexico; 45,429 in the Distrito Federal; 37,662 in the State of Veracruz; 29,960 in the State of Jalisco; 14,192 in Nuevo León; and 2,230 in the State of Baja California Sur (ibid.). It should also be noted that the definition of hearing disability is quite broad...


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