Interview Magda Casamitjana, director of the National Plan for Mental Health of Catalonia

2023-12-31 12:14:34

BarcelonaMagda Casamitjana has been at the head of the National Pact for Mental Health for two years, an assignment from the president of the Generalitat to make a diagnosis that will allow for the reorganization of a system that, despite the resources invested, does not end up satisfying anyone. Casamitjana, former mayor of Roses and ex-deputy, had previously worked with a program for people with highly complex disorders. He says that the idea of ​​leading this project, supervised by the World Health Organization, excites him. The Pact must be approved next year, which is defined with all the modern rhetoric of public management: transversal, comprehensive approach and change of perspective.

What is the objective of the Plan?

— The task given to me by the president of the Generalitat was to draw up a country strategy to design the system to guarantee that a person with a mental health problem is treated like a citizen from the moment they wake up until they leave he goes to sleep. The pandemic brought emotional distress to unprecedented levels and strained the system as everyone went to the CAPs. In addition, in Catalonia it is estimated that between 1 and 1.2 million citizens have a mental disorder. The number has not increased, but in some cases it has worsened.

In this working time what have they found?

— We have talked to absolutely everyone, but especially to the departments and, therefore, we have done a situation analysis and we have realized that there are many services, resources, entities and professionals specifically aimed at mental health. A budget of at least 550 million euros is allocated to mental health. We have social clubs, pre-employment, home support programs, supported homes, family care services… But it is true that we also lack specific professionals, psychiatrists, clinical psychologists, psychologists, nurses, and now we have hired for the field of health occupational therapists, social educators, social workers to provide other accompaniments. The figure of the referents for emotional well-being are working very well, listening to people who are very overwhelmed by the social problems that arise in mental.

And why do families and affected people find it so difficult to access a service?

— Because the services do not know each other, they are not connected. There is a lack of coordination between departments of their own services. In addition, there are the services of the town councils. That’s a lot of resources, really. Health makes its programs and Labor makes theirs, but then there are no channels to coordinate and people don’t know which door to knock on when they have a child with fetal alcohol syndrome who punctures car wheels, but who is not bad and that the parents are afraid that the police will arrest him and lock him up. We have to be able to change that and we are working on it.

How is it done?

— Making the coordination land in a territory, knowing how to offer resources that are often not specialized, but ordinary. If the CAP or social services know that there is a person with a disorder who likes to read, they can refer him to a library, which has previously been notified to accompany him, since, if not, it may be that he distress the gain and do not enter. We miss the cases of people who are undocumented and unregistered and what do we do with the children of single mothers who have a psychotic episode and have to be admitted. It can’t be that people have to fend for themselves, we have to put the person at the center of the system and, if they go to the doctor, have a referrer and manager to set up the help circuit.

It can’t be that people have to look for their lives, we have to put the person at the center of the system”

Magda Casamitjana Director of the National Pact for Mental Health of Catalonia

There is a complaint of violations of rights, of restraints or involuntary income. What does the Pact say?

— Although we do not have definitive data on rights violations, we could accept what the first people say [les persones afectades] which forces us to act quickly. We have committed through an agreement with the World Health Organization to implement what they call Quality Rights, quality rights, which imply a change of paradigm, a total change of outlook, of culture, because it implies accepting that people with a mental health problem have personality, identity and the right to be heard. Professionals and people first need to be very clear that we are talking about human rights, of course, but also about added rights because, unfortunately, the rights of those who cannot defend themselves tend to be violated. We are finalizing PDA, Advance Decision Planning, so that anyone with a mental health problem can write into their medical history how they want to be treated.

Are there still people admitted to mental institutions for years? Until when?

— No one has been living in hospitals for some time now, but even now there are 2,400 people living there: they are people with very serious disorders, elderly people with comorbidities. There are those who have no family. What we will do is look at each case exactly because there are a few that we know we won’t be able to move, there are others who could already start to be in other spaces and others who could already be if they have them with their family . We will deinstitutionalize as fast as we can.

We want a housing reserve for people with mental health so they can live in community wherever they want”

Magda Casamitjana Director of the National Plan for Mental Health of Catalonia

Housing, like work, are the two big problems?

— These are common problems for citizens, but in the case of mental health everything is aggravated. Emergency boards for housing are overwhelmed, but just as there is now a model for homelessness, we need to make one for mental health, which has a different demand than the rest . Our claim is to have flats to make the transition from income to return home or to supervised flats or other spaces. We also want a reserve of housing for people with mental health so they can live in community wherever they want.

People with mental problems have come out of the closet to break stigmas.

— We have made an agreement with Obertament to run a campaign against stigma at work, at school, on the street, what families should do, what you should do yourself. Therefore, this has helped us a lot and also to visualize the problem. Now they are activists, now they are no longer silent. They work with me because without them we can’t do anything. All this empowerment work is beastly. They are empowered, they organize, they break the image that a person with mental health problems is violent and problematic.