The demand for mental health care is increasing, especially after the pandemic, but there are not enough psychiatrists in public health, nor is there equity in access. The Spanish Society of Psychiatry and Mental Health (SEPSM) urges decisions to be made in the short, medium and long term.
EFE/ Juan Ignacio Roncoroni
This is reflected in the recently published White Paper on Psychiatry in Spain that offers real data on the situation of this medical specialty so that decisions can be made, the main one is to increase the number of psychiatrists in the public mental health care network.
In presenting this document, the former president of the SEPSM, Celso Arangohas affirmed that between 370 and 565 psychiatrists a year are needed in the next five years, a total of 1,850, to reach optimal ratios of between 13 and 15 psychiatrists per 100,000 inhabitants in the next five years.
In Spain there are currently 4,393 psychiatrists in the public mental health care network, which means a ratio of 9.27 psychiatrists per 100,000 inhabitants. This ratio rises to 11.5 if the 1,036 psychiatrists in training are included.
Some figures that distance Spain from the European average: Portugal (14), the Czech Republic (15), Belgium (17), or Denmark, the United Kingdom and Ireland (19); and light years from the reality of other more advanced neighboring countries such as Austria and Sweden (22), France (23), Norway (26) or Germany (28).
And psychiatrists warn that this situation could worsen since it is expected that in the next five years there will be around a thousand retirements given that 20.8% of active professionals are over 60 years of age, while 6.7% have already exceeded the barrier of 65 years.
In addition, the majority of psychiatrists in Spain practice in outpatient settings (61.2%), only 53.6% have a permanent position, 84.8% practice in adults and 92.7% work full time.
Inequity in access to mental health services
The SEPSM also warns of a “serious problem of inequality” in access to public mental health services depending on the autonomous communities.
As reflected in the White Paper, there are regions such as the Basque Country and Catalonia that are already at optimal ratios (15 and 13.3 psychiatrists per 100,000 inhabitants, respectively), while in other areas such as Melilla (4.7) , Ceuta (5.9), Valencian Community (5.9), Andalusia (6.2), Extremadura (6.8) or La Rioja (6.9) the situation is more problematic.
The regional gap in human resources also opens up in care and in the ease and quality of access to the system. At the state level, there is the Mental Health Strategy 2022–2026 and the Mental Health Action Plan 2022–2024, but there is no National Strategy on Suicide or Humanization of care.
While at the regional level all communities have Mental Health Strategies or Plans, 15 of them have addiction strategies or plans, 14 suicide and 7 humanization. Ten have joined the mental health network and the addiction network.
Precisely this lack of integration of both networks is one of the major problems in the care of people with a mental disorder: “A person with a certain disorder receives duplicate and parallel care from two health systems that are not integrated , it is not very efficient”, highlighted Arango.
Good news has been the creation in 2022 of the specialty of child and adolescent psychiatry, although there are still few teaching units in Spain for training.
Proposals to reverse the situation
The White Paper includes a series of proposals for action in the short, medium and long term.
Recommendations on increasing human and care resources:
• Optimize the planning and reinforcement of human, care and technological resourcesfrom a multisector approach, assigning an adequate budget and defining a monitoring system.
• Increase the number of psychiatrists who carry out their professional activity in Spain, as well as ensuring their adequate distribution in the different CCs. AA.
• Increase and strengthen the network of care resources for Mental Health care and its accessibility, addressing the differences between CC. AA. to promote equity and get closer to European ratios.
• Increase the number of hospital beds short, medium and long stay, to meet demand and reduce waiting lists, as well as places in hospitals or day centers.
• Promote initiatives to support Mental Health in the workplace.
• Ipromote the humanization of spaces (hospitalization and outpatient clinics) and care processes.
Care organization and coordination
recommendations to organize psychiatrists in mental health care:
• Coordinate and standardize the portfolios of services in Psychiatry in the CC. AA.
• Strengthen the socio-sanitary and intersectoral coordination.
• Strengthen the digital transformation of Mental Health Servicesinformation systems and patient data recording.
• Design a tiered and collaborative model of care for the organization of the provision of services.
He president of the SEPSMManuel Martin Carrascohas considered that all the measures taken in favor of improving Mental Health care will be, in his opinion, “useless”, if they are not accompanied, in addition, by “a deep reflection on the provision of psychiatric care in a context multiprofessional and a reorganization is carried out with a new model of operation and distribution of tasks”.
Challenges and barriers
The SEPSM thus summarizes the barriers and challenges faced by the specialty, such as a progressive increase in the prevalence of mental disorders; long waiting lists or lack of visibility of psychiatrists in public mental health care.
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