When there is a sufficient, robust and effective healthcare network to address the mental health needs of the population, we can move on to a second phase in which complementary and innovative resources are offered. Unfortunately, The National Health System (SNS) network has too big holes that cannot be covered with ideology.
In our country, where it is estimated that the 34% of the population currently suffers from some type of mental disorder (43% in people over 50 years old and more than 50% in people over 85 years old), the Average waiting time to be seen for the first time by a psychologist or psychiatrist in public health is around 14 weeks (almost 3 months), according to the most recent data from the Ministry of Health. However, waits may be longer, since it is estimated that 40% of patients wait more than 3 months and 20% wait 6 months or more.
The main cause of these delays and deficits in care is the lack of mental health professionals (psychiatrists, child neuropsychiatrists, clinical psychologists and specialized nurses). Spain is at the bottom of Europe in the number of mental health specialists per 100,000 inhabitants, 30, compared to the average of 50 in the states that are part of the EU.
Priority: increase ratios
Increasing these ratios has been, for years, the priority for medical societies of psychiatry and clinical psychology, for patient and family associations, and for the majority of autonomous communities, but the responsibility lies with the department headed by Mónica García.
In the Mental Health Action Plan 2025-27, recently approved in the Plenary Session of the Interterritorial Council of the SNS, The ministry committed to creating a working group dedicated to analyzing how the accreditation of teaching units could be expanded and the number of places already accredited could be increased to train more residents in psychiatry and clinical psychology.. At the moment, the minister has not made public any progress in this regard.
What it has done has been announce, on October 10, World Mental Health Day, an initiative to integrate “cultural prescription from primary care.” Together with the Ministry of Culture, led by his colleague in Sumar, Ernest Urtasun, Health has signed an agreement that, among other lines of action, includes a tool, “Localiza Salud”, that allows the user to search for cultural spaces and activities such as exhibitions, visits to museums, plays, among others, anywhere in Spain. Presumably, this is the portal that will be used by family doctors to “prescribe” culture in their consultations.
It should be noted that the initiative was presented with the endorsement of “scientific evidence and broad international consensus” which, in the opinion of both ministries, supports the project. A project that, far from being defined as a complementary activity to adequate health care and limited to the general population that presents what they define as “discomforts of daily life”, has the ambition to help “people with mental disorders, with special attention to the serious ones.”
At this point is where psychiatrists put their hands on their heads. “These types of initiatives could help in the context of a comprehensive and multidisciplinary approach that includes treatments based on scientific evidence with psychiatric and psychotherapeutic support. But only as something complementary. “There is no scientific evidence that this can help people with mental disorders, let alone serious ones.”explains Marina Díaz Marsá, president of the Spanish Society of Psychiatry and Mental Health (Sepsm) and director of the Eating Disorders Unit of the San Carlos Clinical Hospital, in Madrid.
“The question here is not whether or not this can be useful for a certain type of people with a temporary discomfort situation – which it is not, in the long term, if there are no other resources -, it is that these measures They are not nuclear,They should not even be the responsibility of the Ministry of Health, which does have the obligation to focus its efforts on increasing the ratio of mental health professionals to be able to offer quality care to the population that needs it,” he highlights. “Perhaps these measures may be acceptable to cope with the discomfort of daily life; who doesn’t feel better after having visited a good exhibition? But they are not enough for people with mental disorders. Furthermore, I do not know whether or not they will be the responsibility of the Ministry of Health, which does have the obligation to focus its efforts on what it is: increasing the ratio of mental health professionals in public health to be able to offer quality health care to the population that needs it,” he highlights.
But this is not happening. “As an example, in some hospitals in Madrid they have only provided us with an occupational therapist and a social worker,” says the psychiatrist.
Delete psychiatry
In this ideological line of erase psychiatry from the equation in mental health care, It is worth highlighting the words of the Commissioner of Mental Health, Belen Gonzalez who, also on the occasion of World Day, on October 10, wrote an editorial in a specialized media in which he boasted that his department was implementing some of the lines of action of the aforementioned plan and the Action Plan for the Prevention of Suicide. He cited the “crisis houses” as “non-coercive alternatives to psychiatric hospitalization, putting autonomy and trust at the center”, and assured that “mental health emergencies are being reformed so that they stop functioning as devices focused on containment and become places capable of offering responses that are respectful of the rights of people in crisis.”
Words that are carried with the wind since, for example, in the case of the Community of Madrid, with the 3.9 million euros that Health allocated to develop the Mental Health Plan, it is difficult to implement any reform of the emergencies in the more than 40 hospitals of the public network. As the president of the scientific society points out, “In addition to the fact that the budget is completely insufficient to cover any structural reform, what good is it if the services are not provided with more personnel?”