Mexico tunes in to needs of drug war survivors
After nearly six years of drug war violence in Mexico some 55,000 people have been killed. Mexico is attempting new ways to reach survivors who may not have considered mental health options.
Jose Luis Gonzalez/Reuters/File
Plagued by insomnia and nightmares, and increasingly isolated from friends and family, Juan Carlos signed up to participate in a pilot mental health treatment program in Ciudad JuĂˇrez last year that usesÂ virtual reality-based psychotherapy.
â€śAt first I thought going to a psychologist was for crazy people,â€ť says Juan CarlosÂ who requested his last name be withheld for safety. â€śBut â€¦ later you realize that you donâ€™t need to be crazy. I really believe that for what has happened in the city, the majority of us need therapy.â€ť
After nearly six years of violence ignited by the federal governmentâ€™s assault on organized crime and fighting between rival gangs â€“ in which more than 55,000 people have been killed â€“ Mexico is waking up to the needs of survivors. A handful of promising mental health treatment and crisis intervention initiatives have been launched, notably in Ciudad JuĂˇrez and Monterrey, two cities most besieged by cartel violence.
One in four Mexicans over the age of 18 report having experienced theft, threats, extortion, or assault, according to Mexicoâ€™s statistics agency, INEGI. The percentage increases to 35 percent in Chihuahua state and 27 percent in Nuevo Leon, which contain Ciudad JuĂˇrez and Monterrey, respectively.
Dr. CĂˇrdenas led the pilot program in JuĂˇrez, which doubled as a controlled study for the use of â€śvirtual reality exposureâ€ť to treat Post-Traumatic Stress Disorder (PTSD) in survivors of drug war violence.
During treatment, a patient navigates a virtual world that resembles the place where the violence occurred â€“ for example, Juan Carlos confronted the scene of a homicide on a dusty street that mimicked Ciudad JuĂˇrez â€“ while a psychologist sits alongside, guiding the experience. Afterward, the psychologist discusses techniques for relaxation and reducing anxiety.
â€śItâ€™s not about forgetting,â€ť CĂˇrdenas says. â€śItâ€™s about reducing the pain.â€ť
Psychologists first employed virtual reality to treat veterans of the Vietnam War, 25 years after the fact. The technique has been used most recently to treat survivors of the Sept. 11 terrorist attacks as well as US soldiers returning from Iraq and Afghanistan. But virtual reality treatment is not well known in Mexico, and, according to CĂˇrdenas, this is the first study testing its ability to help victims of drug war-related violence.
The pilot program involved 51 participants in the study, and 25 completed the entire program. Those who finished all reported a reduction or elimination of the symptoms they initially reported (measured at one, three, and 12 months after the study's completion). Those who did not complete the program cited a variety of reasons, often relating to security or their inability to get to the clinic.Â
â€śIn JuĂˇrez, the people showed symptoms similar to those seen in ex-war combatants and women who have been raped â€“ violent events that are considered to generate the greatest psychological impact,â€ť says Anabel De la Rosa, a psychologist and doctoral student who worked with CĂˇrdenas on the study.
Juan Carlos counts himself among the successes.
â€śRight now I have a photo of him by my side,â€ť he says of his brother, noting a photograph he keeps in his home office in JuĂˇrez. â€śThe loss is still painful â€“ but not at the level of before.â€ť
At least nine students have been killed in the past two years in Monterrey, a prosperous city in Mexicoâ€™s north known for its prestigious universities. This has made the need to treat survivors something of a personal matter for psychologists at the Autonomous University of Nuevo Leon.
In conjunction with state health authorities, the university has increased the operating hours of its in-house clinic, which treats students and the greater community. Some 55 therapists work in the clinicâ€™s department focused exclusively on victims of violence. The clinic has beefed up its emergency program and runs an online portal to answer the publicâ€™s questions about mental health services.
â€śPost-traumatic stress wasnâ€™t common here,â€ť says MarĂa Elena Urdiales Ibarra, who directs the universityâ€™s clinic. â€śUnfortunately, now it is. By now, many families have lived something [violent] like this.â€ť
The state health department launched a pilot program two years ago to treat people who have experienced â€śsocial violence.â€ť Meanwhile, the university and local health authorities have also teamed up two years in a row on a crisis intervention diploma, in which 315 students and specialists have participated. The university estimates that, as part of the fieldwork involved, graduates have attended to more than 4,000 people affected by violence in the state.
Yet Dr. Urdiales Ibarra says she worries that while authorities in some states like Nuevo Leon have become increasingly aware of the need to treat mental health, many victims are not. Itâ€™s not until they become overwhelmed by symptoms â€“ they lose sleep, lose weight, lose their job â€“ that they seek therapy.
â€śThe reality is that they come to us after theyâ€™ve been to a doctor, after theyâ€™ve been to a lawyer,â€ť Â Urdiales Ibarra says. â€śThere is not enough awareness in the population.â€ť
A question of access
The lack of awareness may be a function of the lack of public mental health infrastructure in many regions. People in Monterrey, not far from the border with Texas, have more awareness and more options than most.
Obstacles to broad-based treatment remain, says CĂˇrdenas, including a lack of infrastructure, affordable access, and highly trained therapists, as well as public acceptance of therapy as part of the healing process. On a national level, for every 10 people who need attention, Mexico has the mental health infrastructure to attend to one, she says.
â€śIn Mexico and Latin America, there hasnâ€™t been greater acceptance [of therapy] for lack of infrastructure,â€ť she says, adding that most people canâ€™t afford to pay the 600 to 1,500 pesos ($46 to $114) hourly rate for private therapy.
Other countries in Latin America are watching Mexicoâ€™s approach. Next month, CĂˇrdenas will present the results of the virtual reality study in Colombia and Peru, two countries that have faced their own internal conflicts and high rates of violence.
In Mexico, CĂˇrdenas and a team of 12 psychologists are working to overcome barriers to access with a Mexico City-based clinic that serves patients long-distance through a secure, proprietary platform for online therapy sessions â€“ a potential bridge to close the access gap.
Because, ultimately, CĂˇrdenas says, â€śWhen threats of violence are constant, there are problems with anxiety, substance abuse, post-traumatic stress. It has to be treated.â€ť
The JuĂˇrez study revealed the troubling risks of letting such symptoms go untreated, Ms. De la Rosa says.
â€śIn daily life, these [violent] acts become normal,â€ť she says. â€śThere are three homicides around you, and you see it as something normal. The violence becomes something that isnâ€™t inhuman, terrifying, and horrific but something habitual.â€ť
Juan Carlos puts it another way: â€śThe value of life has been lost.â€ť