This is an audiotape of the tour by health care professionals from the USA of the Psychiatric Hospital of Havana, November 1999. In which Laws Educational Academy for Professionals, Inc., conducted, "A study of the holistic health care delivery in Cuba as compared to that in the United States."

The first disposition regarding mentally ill care began in the 19th century, while Cuba was still a Spanish colony. This was initiated by gathering Negro senile slaves abandoned by their owners in hospices and religious establishments.
In the presence of these needs the Madhouse of Cuba, known as Mazorra, was founded in 1857, and in 1864, ill and marginal people with heterogeneous problems were admitted there. There was not any legal disposition to favor the admission of these people other than the administrative decrees or circulars from those whom governed representing Spain.
At that time the difficulties for the admission of a mentally ill who could not be supported and cared for by his family were practically insurmountable.

With the establishment of the Republic of Cuba in 1902, laws to favor and rule mentally ill care were not issued and the only requirement for the admission to the Madhouse was a declaration of a Municipal Judge allowing the cohabitation of the mentally ill, criminals, antisocial, vagrants and handicapped.

We can say that with this administrative modality the Madhouse of Cuba became the only legal madhouse of the country until 1959. The therapeutic outcome for many patients was practically solved with their death.
With the triumph of the revolution in 1959 a real humanitarian spirit reached those poor individuals and began, within the great transformations and reformation of that national shame converted since then in the Psychiatric Hospital of Havana, the elaboration of new laws with the necessary rules for the admission of mentally ill patients taking into account those cases where "public order and people security" are involved in all their individuality.

Thus appears our Public health Law or Law 41 defining in its Article 37 that "only those mentally ill who constitute challenges or danger for themselves or the community with their pre-criminal behavior could be admitted by disposition or order from the competent court." As we can see it is first of all an assistance law which foresees the need the patient has to be treated and the public need of setting him/her aside for a period of time.


Footnote:
Dr. Eduardo B. Ordaz Ducunge-Director, Psychiatric Hospital of Havana
Dr. Alexis Alonso Rodriguez-Consultant of Forensic Psychiatry, Psychiatric Hospital of Havana
Dr. Noemi Perez Valdes-Full Professor, Higher Institute of Medical Sciences, Havana