IT would seem sensible that a hospitalshould ban smoking within its buildings.The dangers posed by cigarette smoke bothto smokers and other patients in delicatestates of health are well documented.But to a schizophrenic, a cigarette canmean the difference between a tensemoment and a psychotic episode, accordingto doctors.Small details like this underline theimportance of the new psychiatric wardscheduled to be inaugurated next Tuesdayat CIMA Hospital in Escazú, southwest ofSan José.It will be the first of its kind on the isthmus,according to hospital representatives.“IN Central America, we are the firstprivate hospital to open an inpatient unitthat specializes in psychiatry,” said Dr.Cristian Lachner, a psychiatrist who willbe working at the new facility. “Before thisunit, when we had a patient that neededinternment, they would go to a generalmedical ward,” where, according toLachner, the very specialized needs of psychiatricpatients are not accommodated.Smoking, for example, is prohibited inevery other hospital, points out Lachner.But in the new unit at CIMA, there is anopen-air area for smoking.“I’m not advising that people smoke,”he added. “But in an acute setting, bringingsomeone in and adding another stressantagonizes the relationship.”DR. Luis Diego Herrera is the head ofthe new facility – the fruition of a year’sworth of planning and work.“It is a psychiatric unit for the short-termtreatment of patients in an acute situation,or crisis,” he explained. This caninclude patients who are severely depressedto the point where they are in danger of suicide,or who are not sleeping or eating,patients whose health is in danger because ofeating disorders such as anorexia or bulimia,patients severely intoxicated on alcohol orillegal drugs, or undergoing acute withdrawal,and patients in delicate situations becauseof mental illnesses such as schizophreniaand bipolar disorder.WHILE there are other psychiatricwards in Costa Rica and Central America,the unit at CIMA has several important distinctions.First, it is the only one that is ina private, general hospital, meaning thatdoctors have access to all the resources ofa regular hospital, while still being able toprovide the very specific care needed inhandling psychiatric patients, Herrera said.“This is very important,” he said,“because we have all the services necessaryfor an interdisciplinary treatment. Forexample, if I get an emergency patient whois severely intoxicated with alcohol, and hehas an injury to his head, I can get a CATscan done. I can call the neurologist immediately.”ANOTHER important distinction is thelevel of care the new unit provides. Locatedin a secure wing on the second floor ofCIMA Hospital, the new ward has four privatebeds, a central recreational room with aTV and DVD player, and is run by a team ofseven psychiatrists, seven psychologists, andfour psychiatric nurses. Staff members areavailable 24 hours a day, seven days a week,every day of the year.The staff has a wide range of specializations,from adolescent and child psychiatryto geriatric psychiatry, to sexual dysfunctionsand family therapy to art andrelaxation therapy.Before this new wing, Herreraexplained, the options for treating a patientin a mental-health crisis in Costa Rica werelimited. They could be put in a generalmedical hospital bed, or, if the patient wasnot stable enough, they could be sent to astate psychiatric hospital, where resourcesare very limited.“For example, a severely depressedpatient, a suicidal patient, who is not safein a medical bed, would be put in a roomwith 40-80 other patients,” Herrera said.THE other option has been to send thepatient home for treatment, which is bothstressful for the family and risks the healthof the patient.“First, it is very difficult for a family tomanage a psychiatric treatment,” Herreraexplained. “Then there are health risks.These patients are often given high dosesof medication to calm them, because theyare not in a secure facility. This can lead tomedical complications. So, it isn’t adequateto have a patient in a home.”Herrera said he expects the new facilityto experience a high level of demand,stating that at any moment, 10% of thepopulation of Costa Rica is in a crisis ofmental health.“Two percent of the population hasbipolar disorder,” Herrera told The TicoTimes. “1-2% of the population has schizophrenia.Approximately 14% of the populationhas clinical depression.”He also pointed out that eating disorders,which he rarely used to see, are risingdramatically.“Fifteen years ago, I would maybe seeone patient a month with an eating disorder.Now I could see one every day,” he said.A press release from CIMA reportedthat 4% of girls and women between theages of 14 and 25 suffer from anorexia, and20% have had symptoms of bulimia. It alsoreported that 14% of school-aged childrenhave a psychiatric or psychological disorderrequiring specialized attention.THE new facility will serve not onlyCIMApatients, but also offer its services todoctors in any hospital in the country orregion.If a physician decides a patient needs tobe interned in CIMA’s psychiatric ward, heor she can have the patient transferred, andthen have the option to continue to participatein the treatment to the degree of theirchoosing.This could mean daily visits andupdates from the floor nurses, or it couldmean totally turning the case over to theCIMA staff. In this way, Herrera said,CIMA is amplifying the services of thenation’s entire medical system.For patients requiring long-term care,the options are much more limited, Herreraexplained. Either the person continues toreceive treatment as an outpatient living intheir own home, or, if that is not possible,they are interned in the state-run NationalPsychiatric Hospital, as no private serviceexists for long-term inpatient care.THE cost of internment in the newpsychiatric unit at CIMA varies dependingon the medications and other services, suchas CAT scans, that a patient might require.Basic treatment, including a bed, food,daily attention from the nurses and a psychiatrist,and group therapy, runs $250-300, according to Herrera.The same services in the United Stateswould cost $600-1,000, Herrera said, quotinghis colleague Dr. Richard Kadison,Chief of Mental Health Services atHarvard University.For more information about the newward and its services, contact CIMAHospital’s call center at 208-1000 or callthe psychiatric unit directly at 208-1750.