Spain's investment in mental health assistance 'below EU average'

Today (Monday, October 10) is International Mental Health Day, which has thrown into the spotlight the fact that although the average spending in this area for the European Union is 7% of the health budget, or €7 in every €100, Spain's own investment comes to just 5.5%, or €5.50 per €100.

Considered one of the top causes of temporary and permanent disability in the western world, a typical one in four people in Spain will suffer mental health problems at some point in their lives – a figure which exactly mirrors the global average.

In the main, these tend to be the less serious but equally debilitating conditions such as panic attacks, phobias, depression and OCD, or personality disorders (narcissistic, histrionic, paranoic, avoidant, and so on) although in many cases these can equally be life-threatening.

And certain brands of personality disorders, such as sociopathy and psychopathy can potentially lead to others being placed in danger.

The one in four, however, also covers very life-limiting conditions such as schizophrenia, bipolar disorder – once known as 'manic depression' – attention deficit disorder and autism spectrum disorders, all of which need constant medication and monitoring.

Anecdotal evidence of insufficient mental healthcare resources include long waiting lists, lack of day centres and other physical facilities, and an absence of any 'active' therapy besides medication for those which are more subjective than purely biological and would benefit from counselling and cognitive or dialectic behavioural therapy.

Head of psychiatry at Madrid's Gregorio Marañón hospital, Dr Celso Arango – also chairman of the ministry of health's psychiatry commission – recalls that according to the World Health Organisation (WHO), 'without mental health, there is no health'.

Effectively, this does not only mean that a person cannot be healthy unless he or she has no mental illness, but goes a step further and suggests personal and social wellbeing is completely necessary for an individual to be in full physical health.

Dr Arango says some of the problems arising through lack of investment include a shortage or near-absence of preventive measures, scarce resources for early intervention appropriate to each patient's age, limited or no research or development into child and teenage mental health care, and a lack of 'intermediary' facilities such as day centres and day hospitals.

General public attitude holds back some of the progress Spain could otherwise make, but which may be possible to change with more financial investment, Dr Arango reveals.

“For example, Spain is a country where it is believed that, either a person can work like anyone else, or they can't work at all – there's no middle ground – and the consequences of either can be nefarious for people with mental illness,” he explains.

“With the right support and supervision, a person with a mental illness would be able to access the job market in a 'protected' format.

“The number of people with severe mental disorders in Spain who are actually working is vastly lower than in other countries, and this erodes patients' self-esteem, a situation which feeds their disorder.”

Chairman of the National Mental Health Confederation, Dr Nel A. González, says the 'lack of resources' is 'very noticeable' in the 'extraordinarily long' waiting lists for patients to be attended to.

And even once patients are able to be seen, the amount of time professionals are able to spend on them is 'very limited indeed', unless they pay to go to a private consultant.

“Cases which, a priori, appear less serious are the ones that suffer from the most critical deficiencies, because patients are not given the amount of time they need and their situation can get out of hand, meaning their recovery is far more difficult and a much slower process,” Dr González explains.

Spain does indeed have a Mental Health Strategy in place, but according to Dr Arango, it is 'out of date'.

A new one has been drawn up, but has not been signed off because the various regional governments are unable to agree over its content.

Dr González adds that new approaches need to be incorporated into the Strategy, such as the issue of mental health patients' rights and their participation in society.

The first of these 'frankly, has room for improvement', and the second 'should be complied with by all regions as an obligation' in order to 'end the unfairness and inequality' in this area.