Open-Regime Policy of Our Lady of Fuentecilla Psychiatric Hospital

The Open-Regime Policy of Our Lady of Fuentecilla Psychiatric Hospital made mobility a defining feature of institutional life without making the hospital an unregulated space. Described as the first psychiatric hospital in Spain to inaugurate such a regime, it allowed patients judged non-dangerous to move beyond the walls and visit nearby towns. The policy’s promise of ordinary life—work, recreation, walks, and excursions—was real, but qualified by clinical decisions, practical safeguards, and the legal circumstances of each patient’s admission.

Definition and Scope

Montserrat Castell explains the regime to Alice Gould as a comparatively recent change at the hospital. Patients had relative freedom to move through the building and park. They could gather in the bar for dominoes, brisca, or parchis, walk and talk in the garden, or explore a large wooded area. They could also attend occupational-therapy sessions or work in the hospital’s workshops. This was a substantial shift in daily experience: movement and activity were not limited to the treatment room or ward, and patients could spend time in shared social and working spaces.

The policy extended beyond the hospital grounds. Patients could take a bus to nearby towns, especially for local celebrations, where activities included dancing, fireworks, and events with young bulls. The freedom could reach further still: patients might spend periods in their own homes. Yet the account stresses that this was the general rule, not a universal entitlement. Exceptions were numerous, and the stated freedom applied to patients considered non-dangerous. Open management therefore described a conditional institutional arrangement, not the disappearance of distinctions between patients or of clinical authority.

Work, Recreation, and the Orange Pass

The workshops gave the regime an economic as well as therapeutic dimension. They functioned as small-scale industries, producing objects for sale; patients received wages that varied according to their aptitudes and performance. Work could therefore connect treatment with skill, production, and payment, rather than treating patients solely as passive recipients of care. The policy also made room for leisure and social contact, from games in the bar to unstructured walks through the grounds.

The Orange Pass Card made freedom beyond the walls concrete and administratively visible. During Alice’s stay, César Arellano gives her the card she has long wanted; it permits her to leave the hospital accompanied. He couples it with an invitation to dine with him in the neighboring town of La Fuentecilla. The episode shows both the scope and the limits of the privilege: the pass enables an actual outing, but Alice’s departure is accompanied rather than simply unrestricted. Mobility is granted through a recognized procedure and remains subject to conditions.

Reform and Its Risks

The novel presents the policy as part of a broader effort to change how the hospital operated. Its director established workshops, introduced orange cards for walks outside the walls, and removed window bars so the institution would not resemble a prison. But a later criticism links these reforms to concrete dangers. Workshop tools were not adequately secured; a patient took a rod from the umbrella workshop and stabbed another patient. After the orange cards were introduced, escapes increased. The account thus refuses to treat a liberal intention as proof that a measure was safely implemented: access to tools and movement beyond the walls created responsibilities that the institution also had to meet.

Arellano’s discussion of antipsychiatry sharpens this distinction. He regards the criticism of old hospital systems as constructive and describes removing bars as an excellent measure, while arguing that the infrastructure needed to support such a reform must come first. His point is not that openness itself is mistaken, but that a humane change in the built environment cannot be separated from the arrangements that make it workable. The policy’s central tension lies between reducing the experience of imprisonment and managing risks that do not disappear when barriers are removed.

Boundaries of Freedom

Open management did not erase the hospital’s internal divisions or the need for intensive care. The narrative distinguishes ordinary movement through the grounds from crisis measures: patients could be placed in the Saco during episodes, while those in the Lion Cage required extensive staff assistance with dressing, eating, going to bed, and basic bodily care. These descriptions mark the limits of a single, uniform model of freedom. The ability to participate in the open regime depended in practice on a patient’s condition and on the level of support or supervision required.

Nor did freedom to walk outside settle the separate question of whether a patient could leave the hospital altogether. Alice initially insists that she entered of her own will as a professional detective. The director counters that her file records the procedures for involuntary admission: a medical certificate and a request from her husband, Heliodoro Almenara. Alice later reasons that voluntary admission and involuntary confinement have sharply different consequences: a voluntary patient can leave with relative ease, whereas an involuntarily admitted patient cannot simply decide to go. The distinction exposes an important limit of the open regime. A patient might receive permission to move around or take an escorted trip while remaining subject to an involuntary commitment.

Narrative Significance

The policy serves as both a practical reform and a test of what institutional freedom means. Its everyday details—games, paid workshop labor, bus trips, and a coveted pass—show that openness can restore forms of movement and participation. At the same time, the stabbed patient, increased escapes, crisis units, and Alice’s contested admission reveal how quickly that freedom meets the limits of safety, care, and legal power. The hospital is neither simply a prison nor a place where the walls have ceased to matter: it is an institution attempting to make movement possible while retaining the authority to classify, supervise, and detain.