• A health in crisis (V) "We have public funding in Health that is 25% lower than that of other EU countries"
  • A health in crisis (IV) "It is key that in the faculties of Medicine an area of knowledge of primary care is generated"
  • A health in crisis (III) "We are facing the worst health crisis that the system has experienced in 40 years"
  • A health in crisis (II) "The Ministry of Health must also assume its responsibility for not having done the duties of planning professionals"
  • A health in crisis (I) Carlos Rus: "Health in Spain is a social achievement and private a choice of the health model, both at the level of management and users"

The Mental Health Confederation Spain celebrates this 2023 40 years defending the rights of people with mental health problems and claiming an increase in resources so that the public system can offer them adequate care. Its president, Nel González, talks to EL MUNDO about the main shortcomings of the system, the mental health of children and adolescents, and controversial issues such as the Trans Law.

How do patient associations see the crisis in the health system? We have been seeing it for a long time, at first I had a hope of positive progression and from the crisis of 2008 everything fell apart and that never improved. Our health system, being a public health system that we defend tooth and nail, has very serious deficiencies of lack of resources that becomes a lack of human resources. In the case of mental health, which was always the 'poor sister' within public health, and although the pandemic made us topical, that endemic evil and that lack of resources is very noticeable. The view we have at the moment is that it needs to be addressed urgently because it needs to be improved. If not, not only will we not move forward, but we will also cause much more suffering to emerge in the population. Since the pandemic, there was talk of an increase in anxiety and depression, especially in children and young people. But apart from these increases, what are the key mental health problems that dominate the consultations? Indeed, there is talk of anxiety and depression and everything that generates uncertainty, lack of horizons or not reaching the end of the month, the shopping basket, the high cost of living, unemployment ... Fundamentally it is because the lack of well-being is what generates many mental health problems. The most disadvantaged population that has less income, fewer economic resources, and of course the most disoriented population that is our youth, our adolescents who do not see certainty about the future, are curiously the two segments of the population that are suffering the most at this time from this lack of resources or lack of adequate attention. And this is a source where the mental disorder can be born, first it will start being mild and it can end up being serious.

The dependence or influence of social networks influences to put a distorted image of reality in the heads of people who are not mature enough. Eating disorders abound, which increase; Self-harm and a whole series of pathologies that can have a fatal consequence also increase. The most important thing in our youth is the issue of suicide, the lack of certainty and ignorance of life lead to suffering and sometimes to see no way out and to think about disappearing. Primary is the first filter to detect mental health problems, but is it possible to detect them when you have just over three minutes per patient? We have immense gratitude to these professionals who do what they can with their best wisdom and their best will, and that is very commendable, but you can't, people have to have means. Unless it is something very evident, such as a desperate person who is about to throw himself out of the window, which is an extreme case, it is very difficult to detect or accompany or be able to practice active listening that focuses on what you think can be done as a professional with so little time. Not only is it the short time for consultation, listening and conversation between the professional and the person who demands help, but also the lack of appointments: generating an appointment for the psychologist or psychiatrist takes a few months, unless it is an emergency that is done more quickly, in other cases the deadlines are absolutely devastating and people feel helpless, disoriented and see how their lives are deteriorating.What do we do with all those patients who can not afford private health and who have no choice but to go to the public where they have an appointment with the psychologist every month and a half? Are they really being helped? In our country, fortunately, we also have a complexity in care. They do not have to be psychologists always those who attend, since it almost always has to do with well-being and economic or orientation deficiencies. We have, for example, town halls, whose social workers can guide, listen and help people who are currently waiting to be attended by a professional. Without forgetting the work we also do in the associations, which also have psychologists, social workers, social educators and counselors, free, and our mission as an organized civil society movement is to listen, welcome, guide and support people who need it. We must not forget those resources either, there are not many, but if we have 346 associations throughout Spain they are points where, if you are close, you can resort to seeking that guidance and this is what saves us. But those who already have a diagnosed problem, depression, for example, and they quote you to the psychologist every month and a half or every two months, is that really helping that person? Isn't equity between patients broken by the fact that some can access an alternative and others only the public one, which does not have sufficient resources? Sure enough, you are right. We have made a calculation through experts in public management who say that the lack from 2008 until now in mental health has an amount of 4,000 million euros. It is an absolutely brutal volume, and if public health is not provided in the State budgets progressively with economic resources we will end up without it because it will be totally useless. Of course we must be grateful that there are private resources because some people need them, but we must bear in mind that the majority of the population does not have access, does not have economic resources to access a private consultation. That is why we must demand political action, managers, political leaders and the administration that must gradually provide, I do not say suddenly that this is impossible, with the economic resources to compensate for that huge gap that there is 4,000 million since 2008. Does this coordination between primary and hospital work worse in mental health issues than in other specialties? In mental health, as in the others, a health emergency of someone who goes to the emergency room enters the system in a much more accurate and faster way. If it is not an emergency, it must go through the different steps and it is slower, but above all because our primary care doctors sometimes do not have the necessary training and of course they never have the necessary time. In addition, the resources in primary care in psychology are absolutely precarious. For example, the usual data: Spain has six psychology professionals per 100,000 inhabitants, when the countries of our environment reach 18. That is the gap we have to bridge. There is a lot of talk about the amount of anxiolytics and benzodiazepines that are taken in Spain and that the patient is medicalized, but perhaps there are no resources to do anything else ... Is the system so collapsed as to not be able to reorganize and have to medicalize? That's the key. The doctor wants to help and does what he can and the resources he has in his hand are drugs, but it is the fish that bites its tail: drugs can make people chronic, they do not solve the problem because they palliate only the symptoms, and what is being achieved is a revolving door where people end up being victims of a chronification that is not desirable. . How is it supplied? Providing the necessary human resources, starting with the economic ones that make humans come behind. There are indeed steps at the regional level. The other day in La Rioja they approved a mental health plan with 30 million euros for the period and 56 million euros in the Principality of Asturias, but that is still very little. I hope not. I hope there is sincerity and less hypocrisy because the lack of mental health affects us all, it is everyone's co-responsibility. That's why I don't think they dare to use it as a throwing weapon because who against whom? Now there are some political managers, previously there were others and all since 2008 have continued with the same ship, in the same direction. No one raised the alarm. It is true that since the famous 'go to the doctor' it seems that at the political level a window was opened, but that can be a fashion and we must bear in mind that mental health should never be a fashion. It has been demonstrated that everything that is invested in mental health has a return that quadruples it, the euro that is invested, it has a profitability that quadruples over time. He mentioned the famous 'go to the doctor' and that mental health finally came to Congress, but has it translated into something palpable? What was the National Plan for Mental Health, the National Plan for Suicide?... Progress is scarce, but it is real. For example, the National Mental Health Plan the Ministry is taking it punctually, it is developing it in the territories and there is also a co-responsibility in the autonomies, with the investments that I mentioned in La Rioja and Asturias, for example, with which they try to shoulder the shoulder to try to fill these deficiencies and that is a reality. Another very important thing also that has to do with that plan, the 024 telephone number for attention to suicidal behavior is a reality and that is a powerful psychological resource of proven immediate attention: from May 10 of last year until now the demand of the population to this telephone remains sustained. Therefore, there are resources that did not exist and now exist and that are being implemented and progressing. But for us to be able to update the needs it will take a long time. Returning to children and the youngest, why are there more and more mental health problems at those ages? What are we doing wrong? In the little ones it happens as it happened in our age, but in our times it was not spoken and it was not known so much. The elderly do not know the new times qThey run, although we are even professionals, because there are many variables that must be added to the attention, care and analysis of what is happening. Young people have a society that goes much faster. I think the important thing is to reflect and put enough technical and economic means to try to know what is happening, because although we do not remember we were all adolescents and adolescence is an age of change where the family, which for the child was the sustenance, sometimes becomes an important blockage.

The main parts to try to address these issues, which are the family environment, the parents themselves, and in the school environment teachers and school boards, have neither the training nor enough information to monitor a changing society at a dizzying pace and that seems to escape our hands. There would be several things to be done: the first would be to try to train and inform and support the school boards so that they can intervene at the slightest sign of bullying or school abuse. And we must talk about emotional education in schools, participation and education or information to parents' associations. By depathologizing transsexuality, the will of the person is enough to change the sex and name in the Civil Registry. If we need a specialist to assess the prescription of treatments and drugs, why in this case should not be assessed by a specialist to see if there are no other underlying problems, especially in minors? What do patient associations think? There will always be an orthodoxy that has a lot to say and has a lot of wisdom, but I insist that the individuality of people as subjects of rights must also be incorporated. I know that what many professionals want is that there are no false steps that are later irreversible, and that has its reasons, but that is a later process. I don't think anyone will say 'tomorrow I'm going to the registry and change my sex', it's not frivolous so much. There are people who are having a hard time and these people have the right that after making their decision and starting the process a team of professionals guide them, but in the meantime people have the right to be them and they have the right to be happy and they also have the right to make mistakes.
When children have this problem they already know it since they are very young and what we have to do is accompany, listen to these creatures and when the time comes to take the step that has no turning back, then there will also have to intervene the scientists who say 'it must be done like this, in the least burdensome or least onerous way', but always respecting the will and rights of people. Of course respecting the will of people, but just as if we talk about suicide we resort to professionals, why not in this case and especially when we talk about minors? There is some study that even points out the pressure of social networks and how it pushes the most vulnerable who are not satisfied with their body to transsexualityThis leads us to the ideological debate, but it is something that is already much debated and analyzed. I insist on the right of people even to be wrong and people have to feel well. If after Change is bad, so let him go back to doing what he needs to to feel good again. The data you mention from the very interesting study of whether it will not be a fashion that has to do with social networks, I ask the question in another way: will it not have to see that society is changing very fast and we are learning to see that a different way of understanding the things that surpass us is coming? It may be and I sincerely believe that all this must be settled with the wisdom of those who know, but not with the orthodoxy of those who believe that the lives of others or the happiness of others depend on them. The decision and the rights of the person are above those they want to impose, even if it is with scientific arguments.

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