Psychiatric patients are often considered among the most vulnerable populations, largely as a result of a psychiatric patient’s powerlessness once placed under the control of another person. This vulnerability can be illustrated through a recent investigation of a Guatemalan psychiatric facility that produced alarming results. Human rights groups—including Disability Rights International—conducted a month-long study of psychiatric hospital conditions across Latin America in November 2012. Conclusions indicated that, of a dozen hospitals examined, the Federico Mora Hospital in Guatemala City exhibited the most deplorable conditions. The Federico Mora Hospital is the only national, public psychiatric hospital in Guatemala. The investigation revealed incidents of severe neglect, abuse, and outright denial of medical treatment for many patients. Moreover, approximately 300 children were held in solitary confinement, a practice the international community condemns, especially when used for young children. Patients also reported incidents of sexual and physical abuse, identifying that the perpetrators include hospital staff and inmates from an adjacent prison. Although some hospital staff members are aware of the abuse committed against patients, the perpetuated climate of fear has resulted in unreported crimes that inevitably encourage further abuse.
The Guatemalan government ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) in 2009. Article 15 of the CRPD provides that persons with disabilities shall not be subjected to torture or cruel, inhuman, or degrading treatment or punishment. Furthermore, Article 16 states that persons with disabilities shall be free from exploitation, violence, and abuse. As a State Party to the CRPD, the Guatemalan government’s adherence to both of these provisions is suspect, especially in light of the reported grave conditions at Federico Mora hospital.
The Guatemalan government has also ratified the UN Convention Against Torture (CAT). The treaty enforcement body of the CAT, the UN Committee Against Torture, has established that “each State party should prohibit, prevent and redress torture and ill-treatment in all contexts of custody or control, for example, in prisons, hospitals, schools, [and] institutions that engage in the care of children, the aged, the mentally ill or disabled.” The obligation to prevent torture extends to doctors, health-care professionals, and social workers, including those working in private hospitals, detention centers, and other institutions. The UN Special Rapporteur on Torture, Juan E. Méndez, concluded in a recent report on abuses in health-care settings that “[m]edical care that causes severe suffering for no justifiable reason can be considered cruel, inhuman or degrading treatment or punishment, and if there is State involvement and specific intent, it is torture.” Furthermore, the Special Rapporteur determined that prolonged seclusion may constitute torture and ill-treatment.
In response to the allegations of rampant human rights violations in Federico Mora Hospital, the Inter-American Commission on Human Rights (IACHR, Commission) requested precautionary measures for the patients of the Federico Mora hospital in November 2009. The Commission urged the Guatemalan government to take “[i]mmediate preventive measures aimed at protecting all patients, particularly women and children, from physical, psychological and sexual violence by other inmates, guards and hospital staff.” Further, the Commission called on the government to relocate patients to community-based facilities in hopes that such facilities will respect disabled persons’ right to physical and mental integrity. Community-based alternatives also prevent segregation and exclusion from society, decreasing the likelihood of the vulnerability experienced in psychiatric hospitals like Federico Mora.
Dr. Miguel Alejandro De León, Federico Mora’s Head of Forensic Psychiatry, acknowledged some of the hospital’s problems, yet denied the extensive findings of the human rights groups. According to Dr. De León, a proposed solution is to create a separate facility for patients who have been criminally charged and who allegedly commit most of the abuses. However, such a solution inadequately addresses the deplorable conditions and practices employed by hospital staff.
As a State Party to both the CRPD and the CAT, the Guatemalan government is legally obligated to ensure the mental and physical integrity of all its citizens, including the patients of Federico Mora Hospital. The Commission has requested that the government take several immediate steps to address the situation, including providing appropriate medical care, adopting measures to prevent abuse against patients, and separating children from adults. A failure to address known abuse and neglect may be further evidence of abuse that amounts to torture, thus placing the government at even greater risk of falling short of its international obligations.