Allow me to present a historical journey through the development of mental health services in Panama, shedding light on its evolution and current state. This exploration unveils the efforts to provide comprehensive mental health care, highlighting achievements and aspirations.

Several years ago, while being a part of the medical staff of specialists at St. Thomas Hospital, which served as my home for over a decade, I created a presentation I now wish to share with you.

It’s important to emphasize that data on the care of mentally ill individuals in our country is scarce before the 20th century. In 1883, the Ancon Hospital was inaugurated in France. Coinciding with the commencement of the Panama Canal construction, undertaken by La Compagnie Universelle du Canal Interocéanique de Panama, deadly yellow fever thwarted these efforts. Over two years, this disease claimed 1,200 lives in the hospital.

Following the demise of the French Canal venture, the United States acquired assets from the French Canal Company, heralding a new era in the Canal’s construction.

In November 1903, the Hay-Bunau-Varilla Treaties were signed, granting the United States perpetual use of the Canal. The treaty authorized the United States to conduct environmental cleanup work in the canal area and its associated cities. The Taff Agreement of June 1904 granted the United States the responsibility to establish and manage a hospital for mentally ill, leprosy patients, and charitable individuals within the Panama Canal Zone.

The esteemed William Gorgas became the inaugural Chief Health Officer in the American-occupied territory. The Miraflores Hospital in Colozal was constructed, offering care to nearly 125 mental health patients.

In 1905, by the Hay-Bunau-Varilla Treaties and the Taff Agreement, 18 Panamanian patients were admitted to the Miraflores Hospital. By 1907, those with psychiatric disorders were being treated at the Ancon Hospital in a complex comprising 12 buildings. This complex housed men’s and women’s wards, administrative buildings, and specialized “cells” for aggressive patients, equipped with secure windows.

However, in 1928, by order of President Calvin Coolidge, mental health patient care at the Ancon Hospital ceased. Subsequently, all patients were transferred to the newly established Colozal Hospital, which is solely dedicated to mental illnesses, thereby recognizing the significance of addressing these conditions.

What began as a response to the surge in psychiatric cases linked to tropical diseases and the strenuous labor during canal construction evolved into pioneering approaches in mental health treatment in our nation.

Notably, during the French Canal construction period, it’s been remarked, perhaps exaggeratedly, that among the first 500 engineers who arrived in Panama from France and other European nations, none survived long enough to collect their initial salary. It’s also estimated that around twenty thousand individuals, a third of the European workforce that came to the isthmus for canal work, succumbed to tropical diseases. The Isthmus of Panama had a longstanding reputation as one of the world’s most unhealthy locales due to endemic malaria, yellow fever, typhoid, dysentery, and other tropical ailments.

Recognizing the substantial financial burden on the national government regarding the care of Panamanian mentally ill patients by the United States, the first law was enacted in 1924, allocating funds for the construction of a psychiatric care institution—the future Matias Hernandez Retreat.

Established on June 26, 1933, this esteemed institution emerged. In response to the pressing demand to transfer mentally ill Panamanian patients from the Colozal Hospital in the Canal Zone, the Panamanian government rapidly converted structures initially intended for an agronomy school into a suitable treatment facility.

Six hundred Panamanians and a few foreigners were hospitalized based on Panamanian authorities’ orders. These individuals sought mental health care within this unique center, necessitating transportation from various regions to Panama City.

We now explore the eminent figures who played pivotal roles in shaping the emergence of psychiatry as a medical science in Panama.

In the early 1950s, Dr. Octavio Méndez Pereira founded the Faculty of Medicine at the University of Panama. Dr. Mariano Gorriz, a Spanish psychiatrist, was a valuable team member during this endeavor. As a professor and collaborator with the Ministry of Labor and Social Security, Dr. Gorriz contributed significantly to mitigating the stigma associated with mental illnesses.

This era saw the formulation of the first National Mental Health Plan, which prioritized humanizing care for individuals with mental health disorders.

One notable achievement stemming from the First National Mental Health Plan was the establishment of psychiatric outpatient clinics across provinces, including Colon, Cocle, Chiriqui, Herrera, Los Santos, and Veraguas in 1962.

Simultaneously, health issues were gaining prominence within our country. A significant stride was made with the creation of the Ministry of Health in 1969. This institution was mandated to promote, prevent, repair, and rehabilitate health through Cabinet Decree No. 1 of January 15, 1969. The inaugural director of this entity was Dr. Jose Ramon Esquivel.

During the same year, the National Mental Health Program was established, acknowledging the imperative to address the escalating population of individuals with psychiatric conditions.

Enter the Chapter of the Social Security Fund (CSS):

The CSS established polyclinics across the nation. In 1955, it inaugurated psychiatric care services with a solitary clinic. This clinic evolved into the Neuropsychiatry Unit by 1959—a precursor to the subsequent Psychiatry Service at the General Hospital of the Social Security.

When the General Hospital was inaugurated in May 1962, this service occupied the west wing of the third floor for a mere three months, closing due to a patient’s tragic suicide.

Nonetheless, the service was resurrected on September 1, 1969, under Dr. Hernán Higuero’s leadership after Dr. Mariano Gorriz’s retirement.

The Psychiatry department within the Social Security Fund marked the first instance of a general hospital in our country housing a psychiatric ward. This initiative also featured a liaison psychiatry program, a day hospital, and a psychiatry residency program.

Moving on to the St. Thomas Hospital Chapter:

The origins of St. Thomas Hospital date back to the early 18th century.

Named by King Philip V of Bourbon, the hospital was founded by Fray Juan Argüelles a year earlier to care for impoverished women from the Santa Ana neighborhood. Named Santo Tomas de Villanueva, it opened its doors on September 22, 1703, in honor of this saint’s feast day.

1819 construction commenced on a new building for Santo Tomas Hospital on Avenue B.

In December 1919, during Belisario Porras’ presidency, a new Santo Tomas Hospital was constructed. Nearly five years later, on September 1, 1924, a new complex spanning five hectares was inaugurated on Balboa Avenue. This facility was intended to care for the sick from all walks of society.

Referred to as the “Hospital del Pueblo,” the hospital acknowledged the need to address psychiatric conditions. To offer solutions for the mentally ill, steps were taken to establish the future Psychiatry Service of the hospital.

Eminent psychiatrists played vital roles in the nascent Psychiatry Service of St. Thomas Hospital. Among them, Dr. Luis Picard Ami was instrumental. In the late 1960s, he initiated psychiatric care in the outpatient clinic without inpatient services.

Amid shifting societal values during the late 1960s, young psychiatrists dissatisfied with prevailing mental health care practices spearheaded significant changes, fostering the development of innovative psychiatric care models.

On July 21, 1971, the Santo Tomas Hospital psychiatric ward was officially established, known after that as Ward 25. Architect Blanca Escala designed the ward’s structure.

The establishment of the psychiatric ward faced opposition from influential medical leaders within the institution. However, their concerns were mitigated by the Ministry of Health. Accepting a psychiatric ward within a general hospital took a lot of work.

What was described above marked the first instance of an “open-door” psychiatric ward within a general hospital in Latin America? Initially, it was staffed by personnel from the National Psychiatric Hospital. Six patients were also transferred from the latter institution to this new ward.

The medical team included individuals like Dr. Jean Delenze and Dr. Juan Kravcio. Lic. Exley Reid served as a clinical psychologist, Lic. Nubia de Flores in social work, and Nurse Delfina de Jácome, who specialized in psychiatry in the United States, previously held a Head Nurse position at the National Psychiatric Hospital.

Initially, the ward offered both outpatient and inpatient services, with a capacity for 12 beds each for men and women, as well as an isolation bed. Admission was voluntary, and the ward operated with an open-door policy. Various programs addressed specific patient needs.

Further contributions to the psychiatry service at St. Thomas Hospital were made by Dr. Ovidio de Leon, who joined in 1974. He introduced new concepts like the Crisis Intervention Program, Liaison Psychiatry, and the Lithium Clinic.

Dr. Jaime Arroyo also significantly contributed to the service, providing care to oncology patients and later organizing the Mental Health Service at the National Oncology Institute.

National Institute of Mental Health Chapter:

There are scant records concerning the initial stages of what is now known as the National Institute of Mental Health (INSAM) in the Republic of Panama.

As previously mentioned, it was established in 1933 as the Retiro Matias Hernandez to address the urgent need for care of the mentally ill from Colozal Hospital.

In the 1950s, it was renamed the National Psychiatric Hospital, and in 2004, its services were reorganized, adopting the name National Institute of Mental Health.

As a specialized institute, its mission has been to offer hospital care for acute psychiatric cases with diagnostic and treatment challenges. Today, it functions as a Center for Teaching and Research in Mental Health, benefiting patients, families, and the community.

The Azuero Regional Hospital Chapter:

Anita Moreno Hospital became operational in March 1972. On May 22, 1972, it welcomed the first 25 psychiatric patients from central provinces.

Over the past four decades, the hospital has evolved from a regional concentration facility for central provinces to an institution focusing on women’s and men’s wards, accommodating 100 beds each. During the 1970s, 1980s, and 1990s, the hospital adopted a custodial care approach, leading to chronic overcrowding.

Treatment primarily revolved around psychotropic drugs, electroconvulsive therapy, and occupational therapy. The Caracas Declaration of 1990 and subsequent declarations, like the one signed in Brasilia, underscored the need to modernize the mental health sector in the Americas.

International reports highlighted human rights violations against patients with mental illnesses, including conditions at the Anita Moreno Hospital in Panama in 1997, describing the infrastructure as deplorable and care quality as poor.

Psychiatric reformation began in Azuero in 1995, with the support of PAHO and Italy’s Regio Emilia Mental Health Institute.

In 2019, the ongoing remodeling of the hospital, which commenced years prior, will culminate in the provision of new, modern facilities to serve patients in the Azuero region.

Panama Consensus Chapter:

The Pan American Health Organization/World Health Organization (PAHO/WHO), with the co-sponsorship of the Government of Panama, convened the Regional Mental Health Conference in Panama City in October 2010 to urge governments and other national actors to:

• Promote the implementation of the Mental Health Strategy and Action Plan, adapting it to each country’s specific conditions to effectively address current and future mental health needs.
• Strengthen the community mental health care model in all countries of the Region, aiming to phase out the mental health care system within the next decade.
• Recognize the essential objective of safeguarding the human rights of mental health service users, particularly their right to independent living and inclusion in the community.
• Identify the current and emerging challenges in national contexts that require an appropriate response from mental health services, especially addressing psychosocial issues among children, adolescents, women, and special and vulnerable populations.
• Increase resource allocation to mental health programs and services and ensure equitable and appropriate distribution of these resources, considering the growing burden of mental and substance use disorders. Recognize that investing in mental health contributes to overall well-being and nations’ social and economic development.

Where Are We Now?

After this historical journey through Panamanian psychiatry, it is only fair to discuss the current reality briefly.

Mental health services are now accessible to the entire insured and uninsured population. The Social Security Fund, Santo Tomás Hospital, the National Institute of Mental Health, and San Miguel Arcángel Hospital, along with all health centers and polyclinics in the country, offer outpatient and inpatient care to patients with psychiatric conditions.

We have come a long way in mental health care, and although there is still much work to be done in terms of raising awareness and educating our population and health authorities, the truth is that we see a promising future on the horizon.

Sources:

• Development of Mental Health in Panama, History and Actuality, Mental Health Series No. 1.
• Dr. Ovidio De Leon.
• Dr. Luis Picard-Ami.