➡️ This time we would like to introduce you to Gabriela Lago. She is the coordinator of the Benito Menni Rehabilitation Centre of the Sisters Hospitallers, which is located in Montevideo.

What is the work of social reintegration at the Benito Menni Rehabilitation Centre?

The Benito Menni Psychosocial Rehabilitation Centre aims at the rehabilitation and social reintegration of people suffering from severe mental disorders who have been in hospital for long periods of time. A comprehensive approach is carried out, starting from the construction of an individual care guideline, which enables us to begin to identify personal interests, aimed at social and occupational inclusion.
Within the framework of the coexistence program that is being developed, work begins on aspects aimed at re-education and re-acquisition of instrumental skills for daily life, such as: personal hygiene, housekeeping, relearning how to handle money, psychoeducation in the acceptance of pharmacological treatment and its compliance, medical check-ups and acquisition of awareness of the illness.
Reintegration into the social environment is worked on: geographical location and orientation, carrying out simple formalities, inclusion in occupational activities such as: day centers, resuming academic studies, reintegration into the labour market, sports clubs, etc.
The aim is the development of the greatest possible autonomy that each person can achieve, the insertion in external occupational activities, the appropriation of existing community resources, the extension of the network of links and the reconstruction of social-family ties.

What are the objectives and goals of a person arriving at the Centre?

The objectives and goals of most of the people who enter the service are set out in the individual guidelines. They have to do with the recovery of a dignified and inclusive life in all aspects.

What activities and programs are developed, and which are the most valued by the users?

The programs that are developed in the Rehabilitation Centre are:

SHELTERED HOME
This project was created as an alternative care service between the traditional hospital system (institutionalized) and the community, for patients suffering from severe mental disorders.
It aims to cover different needs: permanent housing, food and living together within the framework of a psychosocial rehabilitation program that acts as a bridge between hospitalization and life within a family structure or the start of an independent life project.
The treatment is aimed at complementing pharmacological therapy, placing special emphasis on the stimulation of the healthiest aspects of the personality, taking into account the capacities for autonomy and social integration. We consider that family, social and community support and commitment is necessary, especially from social support networks, psychiatric rehabilitation centers, sports clubs, workshops, etc.
The general objective of the project is to contribute to the improvement of the quality of life of people suffering from PMDD, aiming at their habilitation, rehabilitation and social integration.
The focus of the project is oriented towards mental health work from a psychosocial and community approach. With a double component of intra- and extra-mural work and a strong emphasis on the re-education and re-acquisition of the development of social skills.
The real reintegration takes place in the community, which is why a large part of the program takes place in the community, encouraging participation and inclusion in external activities. And promoting the articulation with other teams, within the framework of the appropriation of existing community resources.
The aim is for users to be able to establish stable links with other institutions and build new social networks, as well as places of reference.
Our care program is based on a working methodology, which is structured in different stages: admission, permanence, pre-release, and discharge, framed in daily coexistence. The delimitation of the intervention in different stages is directly related to the progressive evolution of the users within the project.

ASSISTED RESIDENCES

From the experience of our work in psychosocial rehabilitation, with the Sheltered Home, we began to look for alternative solutions for a dignified discharge.
Faced with the absence of external devices to give continuity to the work carried out, we have developed and generated a new step in psychosocial rehabilitation. We have built our own model that encompasses different levels of intervention and care and guarantees hospitality and quality.
Thus, in 2012, our Assisted Residences program began to operate.
These are facilities that are fully integrated into the community, allowing autonomous living in a group living regime, but with support and supervision. “We speak of an intermediate device, that is to say, ‘between and in between’: between the psychiatric hospital, Halfway House and life within the family or completely autonomous”. At present, we have 3 residential homes in operation.
Psychiatric care in “Assisted Residences” aims at achieving higher degrees of deinstitutionalization, minimizing the process of deterioration and better social reintegration.
The general objective is to contribute to the improvement of personal autonomy, the recovery of social and instrumental functioning of people suffering from PMST, enabling social reintegration and the empowerment of their own lives.
It is worth highlighting the previous knowledge of the users for the conformation of each group that leaves, which simplifies the coexistence and the technical task of approach.
It is a sine qua non condition that the users have undergone the process in the Hogar Protegido project. This makes it possible to put the acquired skills and achievements into practice in the new facility.

The care programs enable the user to have a daily routine, generate a sense of belonging and reacquire habits. The most valued activities are the paid internships. They allow the development of the greatest possible autonomy, on the way to the recovery of a new life.

What are the biggest challenges facing social reintegration in Uruguay?

The greatest challenges facing Uruguay in terms of social reintegration are the construction of social policies that take into account mental suffering.
Programs need to be created, and adequate resources need to be generated to address the different needs, life stages and degree of deterioration of the target population.
Although we are beginning to work with the recovery model in Mental Health, there is a great task ahead due to the state of health of the users who have been and still are going through the old asylum model.
The work of reintegration will be a progressive task. It will be necessary to adapt to the recovery times that people need in order to build a bond that provides security. It is observed that users who are being incorporated into community facilities often need to return to that old structure, presenting psychic instability, in view of the possible gradual reconstruction of a life in society. Due to the strong incidence of isolation in which they have lived.

Can you share with us a successful case of social reintegration?

Clear examples of successful social reintegration are the users who live in the Assisted Living Program, who have developed a level of autonomy that allows them to sustain their lives and fulfil their daily responsibilities such as: housework, shopping, maintaining external activities such as work, studies, etc.
For example, a user of one of the residences works as a receptionist in the Geriatric Home of the Sisters Hospitallers, achieving work effectiveness due to her good performance.
Another example is a user who has been working for two years in an effective position in the departmental government of our city.
Several users have also started a group work project, doing maintenance work and cleaning gardens, which they have been doing for about two years.

How do you see the future of social reintegration in Montevideo?

The Mental Health Law is aligned with the community care model established by the National Integrated Health System (SNIS) based on the paradigm of people’s recovery, which requires the opening, development and diversification of alternative structures that definitively replace the univalent structures.
The current government has drawn up and presented a national plan to address mental health, strengthening existing plans and institutional responses and creating new ones. Emphasis is placed on prevention and promotion, treatment and rehabilitation.
In this context, the Halfway House facilities for people with mental health problems are part of the Comprehensive Care System for the community inclusion of people with mental health problems within the framework of the aforementioned Act.
These devices are specifically aimed at the discharge of people hospitalized in Uruguay’s univalent hospitals and the closure of such hospitals, in a process of transformation of care.
This transition path, while encouraging, makes visible the lack of social policies with regard to chronic mental pathologies; in which the “total institution” has imposed on the patient the quality of “chronic”, producing the appearance of new psychopathological conditions, which are called hospitalist, characterized by social evasion, intransigence, colonization, apathy, inactivity, isolation, etc.

How do users experience hospital values?

They experience it as a form of learning that enables them to integrate into society and relate to other people. It influences the way they act and behave. By acquiring a certain degree of awareness, responsibility for their actions, and generating the capacity to live in solidarity, respect and service towards others.