In Mexico, a therapeutic community dedicated to treating mental health and addiction problems in adolescents in conflict with the law
By Simón Tavera – As a public health problem, the treatment of mental health and addiction among adolescents in conflict with the law should meet a set of technical and regulatory requirements that fall within the remit of the Mexican state, according to the country’s constitution.
Promoting the right to health
Being a delinquent does not mean losing one’s right to health. When an adolescent with an addiction problem enters the criminal justice system after committing an offence, they retain the right to receive comprehensive, professional and science-based treatment services, providing their informed consent.
It should be noted that Mexico’s national law on criminal justice for adolescents considers the restoration of human rights to be the main objective of treatment measures. The aim is to act on the causes that led to their committing an offence and to promote the adolescent’s integral development, taking into account their living conditions, in order to avoid recidivism and implement a social reintegration process.
This approach is grounded in a complex perspective according to which the causes for the offence go beyond one’s personal motivations, while promoting a holistic approach in which individual, family, community and social factors come into play.
Emotional problems, drug use, lack of parenting skills, the vulnerability of certain communities where violence and delinquency are normalized, and situations of social exclusion are all interdependent factors that lie at the root of crime and largely determine adolescent behaviour.
In this sense, the law proposes a set of provisions relating to criminal responsibility for criminal acts and related sanctions, but also to the restoration of rights that are the foundation of citizenship healthy social co-existence.
In this sense, sanctions are not only linked to repressive measures involving freedom deprivation as a condition of public safety, but also to a principle of safe citizenship in which one seek collective participation with a view to building security and social well-being. From this perspective, freedom deprivation is seen as a formative process in terms of fundamental freedoms, the promotion of positive social ties and personality development. It must also aim for social reintegration, through the full development of people’s abilities and their sense of responsibility in the family, school, work and community areas, thereby reducing the risk of re-offending and enabling them to play a constructive social role.
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A participatory process involving adolescents
If such a socio-educational process is to function properly, two important prerequisites should be met: the methodology should be participatory, and the adolescent be involved as the driver of their own development. In order to do so, the adolescent should be aware of their situation as offender, recognize the consequences their actions and the damage caused to others, and be prepared to repair this damage or harm as far as possible. A substantial part of this restorative approach involves recognizing one’s fault, admitting one’s lifestyle as an offender, and being ready to adopt a new life project in which health, individual and collective development and peaceful living play the greatest role.
To this purpose, an individualized plan is jointly drawn up by the teenager, their families and the staff in specialized centres. The adolescent has to give their informed consent before the plan is submitted to the judge. The plan is oftentimes a complex one; it should cover all of the adolescent’s needs and development issues, which is why it should identify the situations that need to be addressed by the specialized services. The essential components of this formative process include medical and mental health care, family therapy, school reintegration, and reintegration-oriented job training and social skills, including art, culture and sport.
The individualized plan uses a holistic, socio-educational approach with interventions contributing to the training and acquisition of social tools and skills, a culture of respect for the law, education for peace, human rights, the gender perspective, and environmental protection, in order to facilitate reintegration in the family, school, social and employment areas.
The therapeutic community
The treatment of mental health issues and addictions is part of this operational framework, in accordance with the law. These services should complement the socio-educational activities carried out in specialized centres and promote social reintegration. The additional component of such specialized treatment is the therapeutic community.
The therapeutic community model is based on the premise that substance dependence is always linked to an emotional problem. As a result, treatment should aim not only to control substance use, but also to resolve the emotional problems underlying a person’s addictive behaviour. The therapeutic community therefore complements the individualized mental health plan with psychotherapeutic interventions.
The intervention is based on the assumption that these emotional problems manifest themselves in everyday interpersonal relationships and during the various activities of the individualized treatment programme. Experience shows that such problems result in difficulties with relationships and adapting to the community, a loss of sense of the reason for treatment, difficulties in understanding the aims of the programme, and conflicts with peers and staff.
Objectives: mental health and addiction treatment
The model promotes intervention techniques to help resolve relational conflicts that arise in the community on a daily basis. These problems are then the subject of group analysis and reflections on impulse control and violence, the corollaries of mental health problems. The analysis is also geared towards a better understanding of the links between current relationship problems and the situations that led them to delinquency and addiction. In practice, as soon as a conflict arises, a staff member is present to contain the situation and guide the intervention approach in the spaces provided for this purpose, such as reflection, confrontation, psychodrama or discussion groups. The aim is to move from the world of conflict to that of the spoken word, based on psychotherapeutic learning criteria.
On this basis, we can define the therapeutic community as a treatment facility dedicated to addressing mental health and addiction issues among adolescents in conflict with the law. The treatment process takes place within a highly structured framework where the pressure of the programme leads the adolescent to ‘act out’ their relational and legal problems in front of their peers. For the teen, peers act as a mirror, showing the social consequences of their actions, which are then subjected to analysis and reflection by the community so that they can be understood and assimilated, in a context of restraint and emotional security.
Finally, we should mention the conditions or prerequisites necessary for such a process, namely: voluntary admission, a certain degree of awareness of one’s problems, the involvement of the family, commitment to the programme of activities and community work, and lastly, respect for the rules prohibiting violence, theft and substance use.
For the past eight years, this has been the mission of the ‘Nelson Mandela’ therapeutic community at the Specialized Centre for Preventive Detention attached to the under-secretariat of the Mexico City prison system.
This text is dedicated to this community of adolescents.