“Although we do not have data, we know, from families, that there are a lot of territorial inequality. Families from all over the Catalan geography turn to our association because the centers [especializados en TCA] are all very centralized in Barcelona,” she says. Barbara Alcaide, psychologist of the Associació Contra l’Anorèxia i la Bulímia (Acab). “In other regions they don’t have resources. Above all, we are talking about psychiatrists specializing in ACTs.” explains.
“In Catalonia, to be treated in a specialized ACT unit, you have to come to Barcelona.”
In the same province of Barcelona this inequality exists. “Everything is centralized in Barcelona capital o Metropolitan Barcelona. There are people from many areas of the province who have to travel to the capital to access a specialized ATT unit.” Alcaide recounts. In Barcelona, two hospitals have a child and adolescent ACT unit (Sant Joan de Déu and Clínic) and two others for adults (Bellvitge and Sant Pau).
But outside the capital, there are general hospitals with. psychiatry units not specialized in ACTs. (although they may have professionals trained in this problematic). “In Catalonia, in order to be treated in a specialized ACT unit you have to come to Barcelona”notes Alcaide. Although Catalonia has strengthened mental health in recent years, Salut has been forced to expand staffing levels with “new professional profiles” Because there are no psychiatrists or psychologists.
Lack of professionals
The “problem” is that there are “few professionals,” he points out. Narcís Cardonerdirector of the Servei de Psiquiatria del Hospital de la Santa Creu i Sant Pau (Barcelona) and president of the Catalan Society of Psychiatry, which is part of the Acadèmia de les Ciències Mèdiques. “I believe that there are resources. But there is also such a marked lack of psychiatrists and clinical psychologists and Barcelona tends to agglutinate many of these professionals.” Cardoner adds. There are “remote” areas of the Pyrenees Where, despite having resources, there are no professionals willing to go there to work. “The lack of psychiatrists prevents homogeneous coverage all the positions”.
However, it is unknown how many positions are unfilled in general hospitals, adult mental health centers (CSMA), child and adolescent mental health centers (CSMIJ), day hospitals… There are centers in Lleida or at northern metropolitan area of Barcelona with vacancies that have not been filled for some time. “In contrast, hospitals and centers in Barcelona are better covered. I insist that it’s not that we don’t have resources – there has been investment in mental health in recent years – but rather that there are few professionals.” says Cardoner. This, as in medicine in general, has to do with retirements that cannot be covered. “There has been no foresight.”
According to the Conselleria de Salut, the ratios in Catalonia are 12 psychologists per 100,000 inhabitants (twice as many as in the rest of Spain) and of 14 psychiatrists per 100,000 inhabitants. (11 in Spain). Even so, these figures are much lower than those of the Europe average (18 psychologists and 38 psychiatrists per 100,000 inhabitants).
The coordinator of the Centre de Salut Mental d’Adults Benito Menni de L’Hospitalet de Llobregat and member of the governing board of the Col-legi Oficial de Psicologia de Catalunya, Óscar Pino, certifies that the lack of specialists is a “big problem”. “We have no replacement rate: more people are retiring than there are specialists being generated.”More waiting list
The lack of professionals leads to the waiting lists to access these resources are long. For example, in Lleida there is a average of three months to access a first visit at a CSMA or CSMIJ. “People who can, go private, but most families nowadays have economic problems serious,” he notes Josep Lavin, president of the Coordinadora de Salut Mental Catalunya-Terres de Lleida.
Despite the improvable situation, Catalonia is one of the autonomous regions that has invested the most in mental health in recent years. It has invested in a suicide prevention plan and in the Codi Risc Suïcidi, a protocolized program of assistance and preventive actions for suicidal behavior. “When there is a urgency, is always attended. Although not all hospitals have psychiatric emergencies, all of them have their referral hospital. But we have to improve accessibility.” admits Joan Vegué, director of the Pla directori de Salut mental health and health addictions.
Vegué emphasizes that last year Salut started up home crisis care programs for children and adolescents, something that will be completed in June of this year. It is a kind of extension of the work of the CSMIJ, but in the home. At the moment, the following are deployed 27 and in June the 52 CSMIJ of Catalonia. This represents an increase of three professionals per center, but, as Vegué acknowledges, these are not psychologists or psychiatrists, but rather. “new professional profiles”: workers, educators or therapists.