Mercedes Navío: "Mental health has come out of the darkness, but it must be addressed rigorously"

• Research "Now we talk more about mental health but not necessarily better"
• 40% of Spaniards believe their mental health is not good

Mercedes Navío has been managing Madrid's mental health actions since 2017, which has allowed it to ratify the importance of investment and the provision of resources in this area. Her 'other face', that of a clinical vocational psychiatrist, the one she never forgets and that, at some point, she will resume, keeps her close to the patient, whom she places at the center of all activity.

What does a care psychiatrist, who has experienced first-hand the problems of patients contribute to management? In m

In this case, it has allowed me never to forget what the objective of management is, which is none other than

who have a mental health problem, who are suffering, in the best possible way, and

. Moreover, facilitate my

that at this moment they perform clinical care, that this assistance is done in the best conditions. Those are the two

, the two responsibilities of a manager. I have never left mental health management because I consider myself a

And I have tried to improve it to the maximum, to the extent of my possibilities, from this responsibility that we call mesomanagement.

Globally, is mental health precarious?

One of the priority objectives that I have set myself when working in management has been to put on the table the

of attention to mental health and valuing the fact that there is much room for improvement. Sometimes, the

whereas accompanying these diseases also has repercussions on management; It can be mistakenly believed, by those who do not know this specific area, that there are fewer real opportunities for

. This is not the case at all; The field of mental health has many treatment opportunities for people, in every way and with all the different therapeutic variants. In addition, and contrary to what could sometimes be raised, we can say that the

intended for mental health has a

Very important. In management language, we know that many actions in mental health

. Preventive measures, such as suicide prevention, are absolutely necessary, but they are also cost-effective. It is very important to share knowledge and

to be able to reflect that this area of attention is prioritized in management. That has been my priority objective and I know that not only in Madrid, but also in other autonomous communities, this priority has been put more in focus.

Since his arrival at the Office, several plans have been launched: Strategic Plan in Mental Health and Addictions, Suicide Prevention Plan, Covid-19 Mental Health Specific Plan. What are the preliminary or consolidated data of these actions in Madrid?

The 2018-2020 Mental Health Plan, which is fully evaluated and which, in fact, was

of the elaboration of the current current plan of the Community of Madrid 2022/2024, executed the

of the planned funding and professional recruitment, which exceeded 200 professionals. In terms of organizational actions, the degree of implementation, despite the fact that it was a plan that in the last year coincided with the entire management of the Covid-19 pandemic, also exceeded around the

and what we call

. The margins for improvement that the evaluation of this plan showed, which were carried out and have been the starting point of the elaboration of the

, maintains as priority lines the attention to people with

and attention to

; add a specific line of

, which we consider very important, and another on attention in

, another area in which further progress was noteworthy. In addition, it is accompanied by its own specific plan on the prevention of

.

Do these lines include both chronic and acute care?

The Mental Health Plan addresses the entire process; from the most acute needs to those that require rehabilitation and intensive treatments for longer periods of time. Sometimes, indeed, there is a

which is precisely a situation we are trying to avoid. In any case, the current plan, like the previous one, contemplates an endowment for the creation of

and intensive treatment and

; units of medium and long stay and that between the two exceed 140 beds. However, the priority is to carry out an assertive community treatment. Therefore, although the needs are observed in all care contexts, the

It's him

of this model, which does not mean that it is not necessary to reinforce and develop other types of resources. In fact, and for this reason, new day hospitals for adolescents and children have been created and existing ones will be reinforced, emphasis has been placed on the extension of the

. Other types of initiatives have also been launched, such as the

in the Gregorio Marañón Hospital, in Madrid, the

of comprehensive medical care of autism spectrum disorder (ASD) to the Hospital of Getafe in collaboration with the already established in the Gregorio Marañón through what we call a strategic alliance. To meet all needs, the

-which have been evaluated in the hospitals 12 de Octubre, La Paz, Gregorio Marañón and Fundación Jiménez Díaz and that have shown that they reduced the risk- to

and with

, among other actions.

¿Se persigue ir disminuyendo la necesidad de la urgencia aguda hospitalaria en favor de una asistencia más continuada que consolide la prevención y el seguimiento?

Ese es, precisamente, el modelo comunitario en salud mental: reforzar el tratamiento en la comunidad para

, en la medida de lo posible, que sea necesaria la atención hospitalaria y, desde luego, la

. Sin embargo, está claro que no podemos dejar de prestar atención aguda. Por ello, hemos crecido en camas de hospitalización para adolescentes, por ejemplo, porque hubo un

de esta necesidad a la que se tuvo que dar respuesta. Pero el

es que la atención hospitalaria urgente o aguda termine siendo lo menos necesaria posible.

¿Cómo es la 'salud' de la salud mental madrileña en comparación con la de las otras comunidades autónomas? ¿Es favorable? ¿Es mejorable?

La salud mental está saliendo de un escenario pandémico en el conjunto de las comunidades autónomas. En

en concreto, la

o en los últimos cinco años, con la ampliación de dotación de profesionales y de creación de recursos, está permitiendo colocarnos en una situación de poder

, priorizando, por supuesto, aquellos casos de mayor complejidad y gravedad. Tenemos

que, desde luego, vamos a abordar. Siempre hay márgenes de mejora que hay que acometer. Ese es el esfuerzo de los planes de salud mental: elaborarlos, ejecutarlos, evaluarlos y ver hasta dónde hemos llegado en la

. En aquellos en los que la culminación no haya sido total, perseguirlos hasta que se cumplan.

Según los últimos datos, País Vasco -seguido de Cataluña, Baleares, Asturias, Navarra, Murcia y Madrid-, es la que tiene una mayor ratio de psiquiatras por cien mil habitantes. Este puesto coloca a la comunidad madrileña en una media alta. ¿Cuáles son las cifras actuales para psicólogos clínicos, enfermería de salud mental y terapeutas ocupacionales?

La incorporación de los planes mencionados superan en incorporación de

de todas las categorías desde 2017 hasta la culminación del plan 2022-2024, en el que además está prevista la incorporación de

. En el plan 2018-2020 superaban los 225 que, junto a unidades adicionales que planteamos, alcanzaban casi 700 profesionales de todas las categorías en todo este periodo de tiempo.

Como gestora, pero también de su visión como profesional asistencial, ¿Considera que son suficientes para dar respuesta a la elevada demanda de la población?

Es muy importante que la

y de la

en salud mental sea mantenida para que el crecimiento del sistema sea armónico y para poder acometer las actuaciones reorganizativas. En ese sentido, creo que el

, estamos en la buena senda. También nos ha permitido enfrentar la situación pandémica, quizá en mejor situación que en otros contextos. Creo, y estaría faltando a la verdad si no lo dijera, que tenemos que seguir en esta senda. Hoy por hoy, el

es poder contar con más

disponibles. Es necesario ampliar las plazas de psiquiatría y, sobre todo, de psicología clínica porque, en este momento, la financiación de las plazas es un hecho. No tenemos los problemas que puede haber en otros ámbitos de la sanidad, pero es de suma importancia que tengamos

para poder contratar.

Sería un importante refuerzo para acabar con las listas de espera que siguen aún siendo largas...

Nuestro objetivo, vuelvo a recordar, es cubrir las necesidades, priorizándolas. En salud mental se da un fenómeno denominado

que consiste en que, con frecuencia, las personas que más necesitan la atención son las que menos la solicitan. Esto es muy importante. Por supuesto,

, pero debemos realizar una priorización en función de la vulnerabilidad y complejidad. En personas que son menos tendentes a pedir ayuda tenemos que ser un

, que se adelante y que facilite su acceso. Esta perspectiva se tiene en cuenta a la hora de planificar y de ver dónde posicionamos los recursos, porque

. Hay que analizar otra serie de variables como los determinantes sociales de la salud, por ejemplo, que inciden en que, en un momento dado y ante una misma población numéricamente hablando, pueda haber

del tipo que sean. Estos criterios se han recogido y tenido en cuenta en los planes de salud mental porque, por ejemplo, no es lo mismo un contexto fundamentalmente urbano que uno rural a la hora de plantear el

. Esa diversidad hay que tenerla en mente para responder adecuadamente.

Esto viene al hilo porque, como sabe, el grupo socialista de la Asamblea de Madrid ha anunciado que incluiría en su programa electoral la presencia de psicólogos en los centros de enseñanza y su pretensión de reducir a dos semanas las listas de espera en salud mental.

Creo que el camino adecuado es el que estamos llevando a cabo desde esta entidad. Ese camino pasa por dos claves presentes en el Plan de Salud Mental: primera, el

profesional. Para ello, los planes deben ser participativos, han de incluir

y tener una

. Cuando ese afán está presente en la mayoría de las actuaciones, profesionales, sociedades científicas y usuarios estamos de acuerdo. Puede haber luego

pero el grado de consenso, cuando se busca y hay voluntad de que se encuentre, se encuentra para lo que es esencial y necesario. La otra clave se basa en la financiación, la inversión y la priorización de la salud mental

. And all this without losing sight of other focuses of fundamental priority such as the professional, the human factor, which in mental health is the latest technology. The

We are the

So we can't lose focus and that's what we've been working on for some time. In this regard, I refer to the facts. No shock plan proposed in a transversal and punctual manner will be successful because the complexity of this area requires a

to be able to account for all the challenges posed.

What other innovative or preventive plans, one of the future challenges in your opinion, are contemplated?

Prevention is a future challenge, especially but not exclusively, in the adolescent and young population. It is, without a doubt, a key objective in which we work together with the General Directorate of Public Health and

: eating disorders, behavioral addictions or the Suicide Prevention Plan itself in which

[According to the latest data, 5.2 deaths per hundred thousand inhabitants, compared to the national average of 8.3 per hundred thousand inhabitants].

The analyses also indicate that this year the average number of suicides in Spain has registered a slight increase. What could it obey?

Suicide is a complex and multifactorial issue in which they affect

. It is very likely that the context caused by Covid-19 has contributed to the increase in some of these factors, but we cannot reduce it to a single factor.

Is the public administration always going to respond to those who feel that their mental health is faltering?

Mental pathology must have attention and coverage of need. When there is a

, the response should be professional, with psychotherapy, with nursing care interventions and with administration of psychotropic drugs when necessary. But we are finding what we call

l, of everyday life -a problem that is prior to the pandemic-, in which the response has to be

: to be more involved in prevention and health promotion and to act with actions called

l; even from education and emotional management in childhood and adolescence. It is good news that mental health has come out of the dark and is in the public debate today, but it is very important to address it rigorously. Otherwise, we can

, run the risk of generating noise that, even with the best intentions, is harmful. In that

It's where we have to move.

Next May there will be regional elections. But, regardless of the results, which lines would you like to see consolidated?

He spoke of consensus and financing. The Strategic Plan in Mental Health has a time horizon, until 2024, and is a sheet of

for these two ingredients in that period of validity. The culmination of this roadmap, as

, would be something I would be reasonably satisfied with.

The capacity for dialogue, listening, shared work are some of the most recognized qualities among those who know it. Are they essential attributes for the entire group involved in their management and thus ensure that the 'diseases of the soul' are more understood, more visible, better cared for and treated, less stigmatized...

It is critical that we do not miss the opportunity afforded by the fact that mental health is in focus right now. And I think not to lose it

that they break the consensus we have achieved - and I am not talking about Madrid but also at national level; from the psychiatric reform and what the transition around the community model meant. That would be a mistake.

s for proposing maximalisms that can make hostages among the people who need us most. This is the time for mental health and, therefore, the time for all of us to put the

and the focus on the need for investment. At present, approaches of a different nature, of course respectable, would, in my opinion, go against achieving the culmination of this being the

of mental health in Spain.