"We focus on young people, but an old person, alone and with a mental illness is the most vulnerable being in the world"

• Psychiatry The footprint of the pandemic on children's mental health

• Policy Twelve years for a Mental Health Strategy criticized by experts

In 2022, mental health has left the strictly medical realm to take center stage in the social conversation.

However, at times it may have seemed that this talk was carried out in a somewhat simplistic way, with the risk of equating emotional discomfort with mental disorders and pathologies.

On other occasions, the much-needed focus on acute illness and childhood and adolescence has

: long-term disorders and the elderly.

The current president of the Spanish Society of Psychiatry and Mental Health,

, slips that "an old person, alone and with a mental illness is the most vulnerable being in the world."

This is how he puts it in this interview, where the medical director of the Sisters Hospitaller Centers in Navarra and the Basque Country, reviews, among other topics, the need for a generational replacement of professionals, as well as an organizational transformation in the care of Mental health.

It may be that by jumping into the media this phenomenon has produced a blurring of the limits: it seems that they are all health problems mental and it is not true.

There is an emotional discomfort, something completely natural in adverse situations and that

, as well as joy, when something satisfactory happens.

A topic of extensive debate would be to determine to what extent it is advisable or not to

those problems, and what kind of answer would be best.

These issues aside, the truth is that the number of people with psychiatric, mental health disorders has increased during the pandemic.

On the one hand, people who were already undergoing treatment could not follow it for a while, and in other people the pandemic has been a

mental disorders.

This has been added to the fact that for a long time there have been reports of a

, specifically psychiatrists, among other needs;

.

The creation of the specialty is a hopeful milestone for which we have fought for years.

But the fruits are not seen immediately.

This year, in the MIR call, the first posts in child psychiatry will be generated, so the first generation of trained professionals will be ready in 2028. The news is good, but for now it will not produce a direct impact .

That does not mean that you have to stand idly by until then: it would be desirable if there were

to provide this training, and since we know that there is going to be a

, the necessary changes will have to be initiated to deal with this situation.

It is not just about increasing the number of professionals, but

redefining the care tasks that the psychiatrist and the rest of the professionals who work in mental health will provide;

Let's not forget that we have always defended that

, on the contrary, and some of these other groups also suffer similar shortages.

These are issues that cannot be deferred, because decisions take time to take effect and the needs are already here.

We adhere to the position of the Spanish Association of Child Psychiatry, which indicates that very serious decisions should not be taken lightly, which condition the rest of a person's life, and without taking into account that there are psychiatric disorders that give rise to to identity problems.

Based on the recognition of the right of people to opt for this type of intervention, since we

following the indications of the World Health Organization, it does seem to us that the fact has

who are still in a maturation process.

Disorders can occur that generate identity problems, not only in terms of sexuality, but in many other areas.

In short, it is a call to good sense and prudence.

Yes, it seems to us that unfortunate situations are going to occur.

There have already been cases of people who have made decisions that they have later regretted and we fear that by allowing the law that more people have access to this type of intervention, obviously the cases could multiply.

Yes, in a very striking way and, of course, without paying attention to the proposals that the Sepsm made at the time, it has not considered attention to the psychiatric problems of the elderly as a strategic line, being the

due to population aging.

In this sense, our approach is not to create a geriatric psychiatry specialty -which, by the way, exists in some countries-, but to define a

and a

.

And that there be a number of professionals who have preferential dedication to care for the elderly.

also be reviewed

, since it is expected that a person aged 65 be functional, even continue working, and possibly maintain that good level of functionality and health until 70 and many years.

But, evidently,

appears with age , which is why an important area of ​​work is attention to neurodegenerative problems.

_

They are located within the chapter of neurological diseases, but their psychiatric nature is also recognized in the international classifications themselves.

More than 90% of people with dementia have a psychiatric disorder, which requires specific attention, which is also needed by family members and carers.

There is also a need for greater coordination with other specialties.

It happens that there is less referral to specialized care.

The stigmatization of psychiatric problems is also more present than in younger people;

it is more difficult for them to recognize that they have a problem of this type and therefore the request for help is less.

For example, depression in the elderly often tends to present as a somatic complaint rather than a sadness complaint.

The changes that would have to take place in the

, not only in the face of the elderly, but in the entire population, but certainly in the elderly in a very, very specific way, because primary care physicians treat a large number of the problems of this population group.

Prevention, indeed, is an area pending development, which can be deployed in

labor -a great pending subject-, school and primary care.

In turn, preventive measures have different levels: general, with measures aimed at the entire population (avoid consumption of toxic substances, promote a healthy diet and exercise. In the same way, certain social protection measures can also have a preventive nature; For example, during the economic crisis of 2008, there was evidence of a lower impact of unemployment on mental health in countries with better social protection systems.There are also measures aimed specifically at

, such as people who may have a family burden. sick, or who have been subjected to abuse.

Other types of measures are those that affect early detection, so that when the disorder begins, they prevent care from being delayed;

that, as with many other diseases, reduces the risk of disorders becoming severe, chronic, and more difficult to treat.

A good example is the

, but they could also be extended to other illnesses.

And in people diagnosed there are also measures to ensure that they receive the treatment properly, so that relapses do not occur.

In all these areas and levels you can continue to deepen.

Actually, the preventive approach in the field of mental health is a pending task.

The

emphasizes the situation of psychiatrists, but in effect, as I commented before, the response to this type of situation is not only a matter of number, of encouraging more psychiatrists to delay retirement or recruit more.

One of the problems that causes this shortage in Spain is that

.

It's a kind of chain: they form here, they leave, and here they come from other countries.

That is not a solution at all, but a way to alleviate our problem by generating another one in another place.

The ideal would be

.

Surely, a reorganization of assistance will be necessary, to determine what are the specific tasks that the psychiatrist and professionals from other disciplines, such as psychology, nursing, social work and occupational therapy, can carry out.

It would be important to review the role of each discipline.

Well, if we look around, the situation could be worse, obviously.

In general, there is satisfaction among young psychiatrists, but

.

In my opinion, there is a change in mentality in what each person asks of their work today in 2022 compared to the 1990s. The importance given to money, free time, personal life, and In this sense, private companies adapt very quickly to these changes, but the vast majority of the assistance provided in our country is public.

It would also have to have that responsiveness so that attractive positions are configured.

Of course, the salary is very important, but it is not the only thing: there are a whole series of aspects, for example,

, who are now poorly incentivized, rely too much on personal initiative.

They are meant for a professional who doesn't mind putting in hours outside of their job, and that has changed radically, training is now seen more and more as an integral part of the job.

It is just an example, there are many things to harmonize.

Mental health problems are very complex, they affect the most superior functions of the organization of the human being.

Bearing this in mind and if we see how things were 30 or 40 years ago and how they are now, it must be said that great progress has been made in all areas (treatment, diagnosis, etiological knowledge, genetics).

On the whole,

Part of the stigma of mental illness is thinking that there is no cure, when in fact even the most serious disorders such as psychotic disorders have a very high remission rate: more than 30% of people who have a psychotic episode are cured.

An aspect that is not sufficiently attended to and that will generate problems in the coming years is

.

It is an issue that, from my point of view, is not adequately addressed in the Strategy either.

Many of these people develop such a dependency that it forces them to take special measures, with coordination with social care that is not well resolved;

There are very important gaps there.

There continues to be a tendency to focus more on acute problems, which are better solved, and on younger populations, while the elderly, long-term patients and those in need of support and social care remain in the background.

We must also focus on these people:

and it is very easy to forget about these people, because they themselves are not aware of it.

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