Foto: Regulación Legal.
    Comunidad

    Reforma en la Ley de Salud Mental: cambios en las internaciones involuntarias y la vuelta de los manicomios

    Updated:776 comentariosLectura de 7 min

    La Ley “Ómnibus” de Javier Milei entre otras cosas plantea modificaciones a la actual Ley de Salud Mental dando lugar al reclamo de profesionales y familiares de pacientes.

    El proyecto de ley “Fundamentos y Bases para la Libertad de los Ciudadanos Argentinos”, conocida como Ley Ómnibus, enviado al Congreso por el Poder Ejecutivo Nacional (PEN) prevé modificar 8 artículos de la actual  Ley N° 26.657 de Salud Mental y Adicciones promulgada en diciembre de 2010.

    De esta manera, se busca dar lugar y respuesta al reclamo de profesionales de la salud y también al de los familiares de pacientes con enfermedades mentales y adicciones.

    Entre los puntos en discusión están las internaciones involuntarias de los pacientes y la idea de crear hospitales psiquiátricos (especializados) o la actuación del Órgano de Revisión (OR).

    En este último caso, y si se aprueba el documento, el OR pasará a estar integrado por un equipo multidisciplinario. Así el proyecto prevé la modificación del artículo 39 que propone que dicho cuerpo esté integrado por un médico psiquiatra, un psicólogo, un técnico especialista en adicciones, un técnico especialista en cuestiones de niñez y adolescencia. y un abogado especialista en la materia.

    La reforma, en el artículo 5, señala que el diagnóstico de salud mental “no habilita la presunción de riesgo de daño o incapacidad, lo que debe responder a una evaluación interdisciplinaria”. 

    De esta manera, faculta al juez a “adoptar medidas de atención urgentes y deberá posteriormente realizar la correspondiente evaluación interdisciplinaria, cuando así corresponda en situaciones particulares”.

    Foto: Infobae.

    En su artículo 11 la normativa propone que el Ministerio de Salud de la Nación, que es la autoridad de aplicación, debe “promover con sus pares de las provincias servicios de rehabilitación a nivel comunitario, además de las actividades de inclusión social, laboral y de atención que ya preveía la norma”.

    El artículo 20, que plantea las condiciones para que se dé la internación involuntaria, de la ley actual prevé que sea “excepcional” para el momento en que no sea posible “el tratamiento ambulatorio y profesionales de la salud adviertan una situación de riesgo cierto e inminente para la persona o terceros”. 

    Pero sí es necesario que dos médicos de distintas especialidades, si o si un psicólogo o psiquiatra, sin relación previa con la persona a internar tengan que firmar un dictamen profesional.

    La modificación propuesta por el proyecto del PEN mantiene la excepcionalidad de la internación “como recurso terapéutico”, pero aclara que se procede, previa evaluación médica y del equipo interdisciplinario, en cuatro casos:

    • No logre adherencia a los abordajes ambulatorios y presente una falta de conciencia de enfermedad que afecte su capacidad de discernimiento y que implique una grave vulneración a su salud integral
    • Se encuentre en situación de riesgo cierto e inminente para sí o para terceros
    • Con posterioridad a la internación bajo el supuesto del punto anterior, no entrañe riesgo cierto e inminente para sí o para terceros, pero no hayan cesado las causas que generaron tal situación
    • Se trate de un menor de edad que padece adicción a sustancias psicoactivas que comprometa gravemente su salud integral o desarrollo psicofísico. En este caso, es a pedido de ambos padres o de quien/es ejerzan la responsabilidad parental, tutor o a requerimiento del juez, previa solicitud del órgano administrativo competente.

    En estos casos, se mantiene la necesidad de contar con un dictamen profesional del equipo interdisciplinario, pero bastará con “al menos la firma de un médico psiquiatra o un psicólogo”.

    Emilio Ruchansky.

    El documento enviado por el Ejecutivo obliga al equipo de salud a externar al paciente o tener en cuenta su voluntad para la internación apenas cesa la situación de riesgo pero aclara que “esa decisión depende de aquello que motivó la internación”.

    El integrante del Centro de Estudios de la Cultura Cannábica (CECCA) y también coordinador del Acuerdo por la Regulación Legal del Cannabis, Emilio Ruchansky, dialogó con Cannabica Argentina sobre las modificaciones propuestas y dio su punto de vista al respecto.

    Ruchansky señaló que uno de los problemas que se plantean en la modificación de la Ley actual de Salud Mental es la de volver a las internaciones judiciales, es decir que un juez o una jueza, a pedido de familiares, pueda internar a una persona sin ningún tipo de consideración médica.

    “Hay que aclarar que la internación involuntaria en Argentina existe, la diferencia es que actualmente hay un control, la persona que es internada tiene derecho a la defensa y la internación la define el equipo interdisciplinario”, explicó el trabajador de prensa.

    Según indicó Emilio, se trata de un “excelente piso de derecho” para una persona que tiene un problema de salud mental. “Una internación involuntaria es una privación de la libertad, no es una pavada”, aseguró.

    Por otro lado, el integrante de CECCA afirmó que el hecho de que se plantee la posibilidad de volver a crear manicomios “es tal vez lo más peligroso”. “Los pacientes que tengan un problema de salud mental, incluidos los que tienen consumos problemáticos, deben ser atendidos en hospitales generales, no hay que esconderlos”, señaló.

    Ruchansky defendió la actual Ley de Salud Mental por restituir derechos a quienes tienen padecimiento mental o consumos problemáticos. “En algún punto la Ley de Salud Mental discute la Ley de Drogas y, en muchos sentidos, despenaliza”, agregó.

    Gustavo Zbuczynski.

    A su turno, el presidente de la Asociación de Reducción de Daños de Argentina (ARDA) y Licenciado en Psicología de la UBA, Gustavo Zbuczynski, afirmó que los cambios planteados en materia de salud mental no escapan a lo propuesto en general en la Ley Ómnibus. 

    “La podemos llamar el colectivo antiderechos, todas las modificaciones que propone este proyecto, casi sin discriminación, apuntan a una mirada de quitar derechos concedidos”, aseguró el psicologo.

    Para Zbuczynski las medidas prevén facilitar y ampliar las internaciones involuntarias y generar un colectivo de personas cada vez mayor susceptibles a ser internadas contra su voluntad.

    De esta manera, explicó el titular de ARDA, se facilita el negocio de las corporaciones médicas, clínicas privadas y comunidades terapéuticas que se venían transformando o reduciendo desde 2010 con la Ley de Salud Mental.

    Gustavo criticó particularmente uno de los cambios planteados en el documento enviado para que el abogado defensor del paciente se pueda oponer a un alta terapéutica.

    “Es una locura total porque si el equipo interdisciplinario propone un alta es porque considera que la persona está en condiciones de externarse”, señaló el profesional de la salud y agregó que se trata de una reivindicación del ámbito del derecho por encima de la salud mental.

    Entre otras modificaciones figura también el hecho de poder evitar la participación de representantes de organizaciones de usuarios de drogas, como lo es ARDA, y otros de derechos humanos en los órganos de control.

    En lo que respecta a consumos o adicciones, el documento incluye a las comunidades terapéuticas y las reconoce como un dispositivo para tratar a los pacientes.

    “Además, se reivindica a los técnicos en adicciones, formados por el movimiento de comunidades terapéuticas, que son ex usuarios que pasaron por las comunidades y se formaron ahí y son equiparados con profesionales de la salud”, señaló Zbuczynski.

    Según indicó el presidente de ARDA, los técnicos en adicciones han sido denunciados, por parte de su propia organización, por violación a los Derechos Humanos y que con la “oleada antiderechos” vuelven a tener preponderancia.

    Creación de centros especializados para la internación

    La iniciativa del PEN dejaría sin efecto el artículo 27 de la normativa actual que plantea la prohibición de la creación de nuevos “manicomios, neuropsiquiátricos o instituciones de internación monovalentes, públicos o privados».

    De esta manera, el nuevo texto señala que: “Los hospitales o centros médicos, neuropsiquiátricos o instituciones de internación monovalentes, públicos o privados deberán funcionar conforme a los objetivos y principios expuestos, y de acuerdo a las reglamentaciones que establezca la autoridad de aplicación”.

    Además, se hace hincapié en que las internaciones de salud mental no deben llevarse a cabo en hospitales generales, sino que deben hacerse en “instituciones adecuadas”.

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