Nov. 30, 2010 -- They are known in Mexico as "abandanodos," or abandoned ones. They are patients locked inside Mexico's psychiatric institutions, lost in a system that seems only to know how to sweep them away to a place like Samuel Ramirez Hospital.
The 200-bed psychiatric facility is in the heart of Mexico City. Its own director, Dr. César Bañuelos, calls it "hell."
Most patients walk around shoeless, some with badly swollen and bleeding feet. Their sleeping areas are sparse, there are no activities and there's little interaction between the patients and the staff. There is nothing for patients to do except lie there. Some rock back and forth endlessly.
"We are trying to do the best that we really can do without knowledge and experience right now, but it is not enough, as you can see," Bañuelos said.
Most of the patients appear to be profoundly disabled, but the reality is that they arrived with a variety of disabilities. Some came as children with no disabilities at all, and all are worse than when they arrived. San Francisco-based psychiatrist Dr. Robert Okin has traveled the world examining conditions in mental hospitals as an investigator with the advocacy group, Disability Rights International. He calls the human rights violations taking place at Mexican mental facilities "among the worst ... anyplace in the world." He visited Samuel Ramirez hospital at the same time as ABC News.
One patient at the facility hasn't gotten out of bed for 15 years. Another patient wears urine-soaked pants because the staff doesn't have enough clean clothes. Perhaps no single person better represents the agony of institutionalization than Juan Carlos, who lives in a helmet with his arms tied behind his back -- measures taken to keep him from constantly hitting his head.
During the visit, Dr. Okin said the staff at the hospital has to chose "between hurting him by restraining him and letting him hurt himself."
Bañuelos admitted it is not a good solution for Juan Carlos but said it's all they can do. In fact, he said Juan Carlos is so used to life this way that he becomes agitated when the restraints are off. After the staff took off Juan Carlos' helmet and untied the rope to clean a head wound, we saw this for ourselves. Juan Carlos started moaning.
ABC News' investigation started 10 years ago at another facility outside of Mexico City called Ocaranza. It was a notorious place. Patients could be found outside without clothes in the freezing cold. The floors were littered with feces and urine and the stench was unbearable.
After the last investigation, Mexico publicly pledged to clean up its act. It signed a new United Nations convention protecting the rights of persons with disabilities and closed Orcaranza.
Children Still 'Moaning, Crying'
Sixty Orcaranza patients ended up at Samuel Ramirez Hospital.
"They just put them in different facilities in order to appear like the transformed institution," Bañuelos said.
Despite the promises made 10 years ago, the system hasn't been cleaned up, said Eric Rosenthal, the director of Disability Rights International.
"What is shocking is that it's as if time stood still," Rosenthal said.
Disability Rights International today released "Abandoned and Disappeared," its report on Mexican psychiatric facilities. Over the past year, Rosenthal and his team have visited 20 institutions across the country.
In a quarter of the facilities, investigators discovered patients in restraints. Staff said that many of them were kept that way over long periods of time -- that, Rosenthal said, constitutes a violation of Article 1 of the United Nations convention against torture.
"It's torture to tie a person down and leave them strapped to a wheelchair for a lifetime," he said.
DRI's Okin said life in the institution has led patients to become more dysfunctional than they were when they first arrived.
To better understand the effect of institutionalization, "Nightline" travelled 330 miles northwest of Mexico City to Guadalajara. We had visited the Caisame mental facility ten years earlier to see how institutionalized children lived -- at that time, we found them tied and bound, even leashed to a window grate.
Ten years later, those same children are now young adults, but they are still living in the facility and little has changed. Many of the young adults are heavily medicated.
"It broke my heart to come back 10 years later and find the same kids are now young adults sitting in the same room, on the same mats, rocking back and forth moaning, crying," he said. "Nothing has happened in 10 years."
In other facilities that DRI visited, investigators found children all jumbled together, some with disabilities, but others with no apparent infirmities, including some lively toddlers.
"There is no oversight, there is no monitoring, there's no quality control," Rosenthal said. "It's a black hole."
Made Worse by Institutionalization?
At Samuel Ramirez hospital in Mexico City, Bañuelos said all the patients had been made worse by institutionalization. Bañuelos, who came to the hospital three years ago, said he's taking risks by conceding this publicly but added that he just wanted to be honest.
"If somebody in the government gets angry or mad or something, I'm really sorry, it is a reality right now," he said.
Dr. Carlos Campillo, who is in charge of psychiatric facilities for the Mexican Health Ministry, acknowledges there are problems.
"You have to train people, you have to open new services, to open new facilities, and this is a very tough job to do," he said.
Mexico spends 2.5 percent of its health budget on mental health -- far less than the World Health Organization's recommendation of 10 percent. Campillo said that, amid many competing government priorities, the budget for psychiatric facilities is increasing 0.5 percent per year.
The government has allocated 100 million pesos, nearly $8 million dollars, to spend on Samuel Ramirez Hospital and community services in the area surrounding the hospital starting in January, 2011.
Okin said improving the bleak condition of Mexico's psychiatric system is about putting limited resources into community services that help people before they wind up in an institution.
"There is no poverty that could explain this degree of abandonment," Okin said.
There are small signs of humanity. One patient gives Dr. Okin a gift of twig and grass.
But many of these patients, like Juan Carlos in the helmet, will likely never know another life. Looking into his eyes, Okin said, you can tell he's "frightened to death."
For more information on Disability Rights International, go to www.disabilityrightsintl.org.