In 2007 the Comprehensive Addiction Act was passed in the City of Buenos Aires (number 2318), which sought to establish a systematic policy against the use of psychoactive substances. However, a report by the City Audit (AGCBA, for its acronym in Spanish) found that the ministries that should intervene in the matter were not acting together; each area has limitations inherent to them, sometimes caused by these scenarios, among other things, that register abandonment of treatment and patient outbreaks.
The 2318 Act arises from the initiative of Escuela de Vecinos program for students in public and private schools, who participated in the preparation of the project starting with the diagnosis of the issue. The legislation was written with a plan with four areas: 'Prevention', 'care and social reintegration', 'Centre' and 'Tracking legal substances'. These actions must be carried forward jointly by the Ministries of Health and Social Development.
However, the City Watchdog took data from the Ministry of Public Care (an entity of the Judicial Branch of the City) to state that there is "almost" no interaction between the portfolios, and they exemplified: "The treatments (therapeutic communities) are provided by the Ministry of Social Development without intervention or coordination with the enforcement authority on Mental Health."
According to the report, approved this year, the "lack of intervention by the Ministry of Health in Social Policy addiction" becomes relevant if one considers that 76% of treatments to minors requires patients to be admitted, that 95% of the institutions that house them recognize that children receive psychiatric medication, and that 63% of the medicated cases are monitored "exclusively by psychiatrists of the entities, which are mostly private." In fact, they add that "of the 21 therapeutic communities the Directorate General of Political Addictions has; only two are of the City Government."
Thus, AGCBA concludes: "The areas of 'prevention' and 'assistance and reintegration'- the first two points contemplated by the norm- are not integrated so as to enable the implementation of (joint) actions in the treatment of addictions."
To complete the picture, the auditors noted that "the Ministry of Health does not have institutions to accommodate people with diseases by the use of psychoactive substances, and there are difficulties in the Hospital systems" to incorporate patients, whether they are in psychiatric centers or in the mental health services in acute care hospitals.
Ministry of Social Development
The third element provided by the 2318 Act is the Centre for Social Policy Addiction which has been active since 2008. This area generates data on the problem of drug use and drug trafficking, but "does not receive information in a systematic manner from the effectors of the Ministry of Health. Nor are they related to the Metropolitan Addictions Network which is under the aegis of the Department of Mental Health”.
Also in this Ministry operates the Social Policy Directorate in Addictions, which the centers of admission and referral of patients work under. Here, the Audit found "architectural deficit limitations for vacancies during weekdays, lack of schedules so the youth meetings could complete their requirements (i.e. medical clearance prior to a public hospital) and subsequent transfer to the therapeutic community.”
The issue of "medical discharge orders," was also highlighted by the AGCBA. The prosecution had already pointed out that in this area a "deficit in the inner workings of the Hospital; lack of unanimity on the evaluation criteria, which seem to be left to conscience of each (health center), as well as the will, or not to have them in the hospital, and lack of a unified approach to the realization of medical discharge orders for admission to Therapeutic Communities".
Ministry of Health
According to the report, to work on this problem, the health portfolio has the Care Coordination Department of Addictive Risky Behaviors that at the time of the investigation was pending the designation of positions in bids.
In parallel, there is the Metropolitan Network Addiction Service in the orbit of the Department of Mental Health. The Network was created by a decree of 1990 (1757) which provided for the allocation of resources "that were never taken into effect," the auditors stated. They added that the area "is not defined and a schedule of meetings are recorded in the Minute books."
The health ministry also runs the Program for Research and Epidemiological Surveillance in Mental Health, which makes diagnoses of behavioral disorders of referral patients. The idea is to "provide elements to make decisions and design strategies of promotion, prevention, and care of mental health in the City of Buenos Aires".
The problem says the report, is that the information obtained by the professionals in the first query, which are then processed to the development of indicators and conclusions, "are not done in a systematic manner, nor is everyone involved, this favors underreporting and prevents having updated and centralized data." The investigation adds that "no statistics were published in 2010 because of changes in the structure of the program."
The AGCBA detected that a "failure to monitor patients in partner institutions" and that "although the prevalence of substance use in children was detected, no actions were defined or anticipated to articulate the available resources to different areas (Education, Social Development, and Health)." Also, "the existing units of toxicology resolve acute situations, but there are no specific devices for monitoring and counseling, with a high dropout rate and patient breakout treatments."
As if all this were not enough, the watchdog noted the "lack of human resources allocated to the care of addictions, in the following health effectors: Argerich Hospital, Mental Health Center No. 3, Elizalde Hospital, Hospital Gutierrez, Center No. 1 Mental Health Center Carlos Gardel".
For the City Audit, the need to develop combined actions on this issue, "contrasts with the fragmented implementation of proposals and programs of difficult evaluation and monitoring. The lack of centralized statistics prevents the development of an epidemiological analysis to facilitate decision-making regarding the allocation of resources and changes in the organizational and functional dynamics of the system. "The report argues that "the integration of interdisciplinary teams acting in the context of protection for patients and professionals is hampered by the lack of nominations, and physical space and security."
The researchers conclude that, despite being contemplated in the legislation, "these aspects have limitations and delays in its implementation in the health system of the City of Buenos Aires".
The watchdog states that "the existence of a metropolitan network in the context of mental health was not unable to secure the joint operation of the effectors, nor do they reproduce the efforts of those who integrate them to achieve bigger and better results”.