Teaching Essential Life Skills

By Fernando Ravsberg*

The residents of Old Havana, one of the humbler neighborhoods of the Cuban capital, have access to preventive and curative mental health treatments without the need to leave their community. Photo: Raquel Perez
The residents of Old Havana, one of the humbler neighborhoods of the Cuban capital, have access to preventive and curative mental health treatments without the need to leave their community. Photo: Raquel Perez

HAVANA TIMES — “I’m on medical leave for three months. I’m being treated at my neighborhood’s mental health center,” a good friend of mine who has just gotten a divorce tells me. This immediately raised my curiosity and I managed to go into the facility with her.

What I ran into was the interior of a gigantic, colonial house in Old Havana, recently restored by the Office of the Historian, where a group of psychiatrists, psychologists, medical doctors, occupational therapists and social workers endeavor to prevent and cure the mental illnesses of community members.

About twenty people were waiting to start a group therapy session, where each can speak about their problems. I asked them whether they find it hard to “get things off their chest” in front of so many people. A young woman replies: “their opinions help me heal and mine helps them heal.”

Among the patients was a young journalist who has trouble relating to people. “This was so frustrating it plunged me into a deep depression,” she tells me, adding that “here; I’ve discovered the mechanisms and complexes that set off my fears.”

Maria Teresa Gonzalez came to this hospital because of the intense stress her work at the bank was causing her. She tells us she “would not have been able to move forward alone. Here, I learned to like myself, to feel good about myself, not to stress out over external things. I came to understand the importance I alone have.”

“The pills were a temporary solution, but they were no guarantee I wouldn’t fall into a depression again,” Luis Muñoz says. The 30-year-old man adds that “in the day hospital, I came to understand that I was the only one responsible for my depression and, therefore, the only one that could overcome it.”

Dr. Isidoro Bali applies different techniques to treat his patients without sticking to any one specific pschiatric school, broadening the spectrum of therapeutic options. Photo: Raquel Perez.

Anything Detrimental to Health

The clinic treats patients suffering from depression, stress or mental illnesses and employs specialists in child psychology, sexology, alcoholism and drug addiction. Those in the day shift work from 8:30 in the morning until 4 in the afternoon, eating their breakfast, a snack and lunch at the hospital.

Dr. Ana Julia Clemente, the director of the mental health center, explains to me that the facility is designed to provide service to a population of more than 100 thousand inhabitants of Old Havana and states that “we are responsible for treating anything that could be detrimental to the mental health of this community.”

In addition, there is a psychiatrist and a nurse from the institution in each of the 5 polyclinics located in the municipality and they will soon be opening a stress clinic, where patients will be taught techniques to cope with the hectic pace of everyday life.

Dr. Clemente explains that, “being located within the community allows the center to respond to its specific needs. All services are entirely free of charge and open to everyone, from those receiving social aid (who don’t even get charged for their medication) to workers and company managers.”

The institution’s greatest achievement has been the reduction of hospital admittances in the municipality stemming from mental health issues. The aim of the center is to keep the patient within their family and community (save in those cases where the diagnosis calls for institutionalization).

The psychiatrist at the center is Dr. Isidoro Bali, and the most common cases he treats have to do with “stress, the empty nest syndrome, neurotic traumas, depressions, schizophrenia, alcoholism and nicotine addiction. We have patients who have drug addictions, but they are very few in number.”

Luis learned that he has the power to overcome his depression. Photo: Raquel Perez.
Luis learned that he has the power to overcome his depression. Photo: Raquel Perez.

Dr. Bali uses many different techniques. In addition to group, couple and psychotherapy, patients also become involved in art classes, film critiquing, museum visits and physical education. Once a week, they participate together in recreational activities that include everything from going to a disco to a day at the beach.

The psychiatrist tells me that the center works to open patients up to the world, “get them out of their houses and away from the TV, to enjoy a sunset, a concert or an art gallery, taking advantage of the fact that going to the ballet is cheaper than having a beer in Cuba.”

The aim of the center is for the patient to re-structure their personality as quickly as possible. Following the first three months of daily treatment at the clinic, patients return once a week to receive assistance in terms of their re-incorporation in society, until they are discharged.

“In Cuba, those 5 to 10-year psychoanalytic treatments aren’t common,” Dr. Bali explains to me, adding that “the clinic is not a place to come to rest for a while and then go back to the same old routines. On the contrary, it is designed to teach patients the skills needed for a healthy life.”
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(*) A HT translation of the original published in Spanish by BBC Mundo.


4 thoughts on “Old Havana’s Mental Health Center

  • There are hospitals as you describe in the US, but there are also some many good clinics similar to the one described by Fernando. The range of care available ranges from excellent to appalling.

    Similarly, the range of psychiatric care in Cuba runs the full range too. Treating depression, anxiety, or various adjustment disorders in an out-patient clinic is a relatively easy and low cost practice, provided one has good quality staff who know what they’re doing. But treating more profound mental illnesses, such as schizophrenia, is a far more challenging job. The abused and neglected patients at Havana’s Mazorra Hospital saw the worse end of the Cuban healthcare system.

    An out-patient clinic is one thing. But any inpatient psychiatric clinic is going to be very different, and given the worsening condition of Cuba’s hospitals, I don’t imagine it would be very pleasant as a patient in one.

  • What a contrast the typical situation up here! When many of the large residential psychiatric institutions were closed in the 1970’s and early 1980’s, they were supposed to be replaced by an adequate network of community mental health centers (like the one depicted here, in Habana Vieja). Instead, such a network was never fully implemented. Many of the community mental health centers here are totally overwhelmed, and the conditions are so apalling that there is a constant “revolving door” of therapists and staff (but not, of course, the bureaucrats who run these centers)! There is an overemphasis on medicating patients, and major pharmacological companies have come up with all sorts of psuedo-disorders which need–what else, but–particular medications or, better yet, a whole series of medications, in order to treat these questionable diagnoses (check with the next edition of the DSM-5 to see how many of these diagnoses have fallen into disfavor, been completely eliminated, or updated into new diagnoses described by yet new jargon). Many of these patients are “zombified” by these medications, the major goal seeming to be masking/surpressing any behaviors which are threatening–or even unpleasant–for the community. A friend who was a patient of one of these mental health centers, after being seen for almost a year, while he was the waiting room one day the therapist forgot his name–or that he was even his patient! The clinic in Habana Vieja is a far more humane and caring facility than most clinics I know of here (the exception being a local pastoral counselling center)

  • A very interesting report. This kind of community based clinic, free from stigma, is the key to a effective mental health treatment. As the old saying goes, and ounce of prevention is worth a pound of cure. Medication to treat depression or anxiety are helpful, but they work much better when combined with appropriate talk therapy.

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