Spain will count suicide attempts and prepare "agile" response circuits

The Government's plan to improve mental health care with an injection of 100 million euros over three years is ready to be approved. The autonomous communities will close the document this Wednesday together with the Ministry of Health in the Interterritorial Health Council, as Minister Carolina Darias advanced after introduce the first public telephone for the prevention of suicideone of the star measures of the plan.

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Early detection and attention to suicidal behavior is one of the priorities of the plan, which includes the creation of a registry of suicide attempts and completed cases "that facilitates the identification of the population at greatest risk." Some communities are already trying to measure how many people have attempted suicide through their health services. Now there will be, according to the action plan to which elDiario.es has had access, a centralized registry in the Ministry of Health.

A "photo realistic"

“For prevention plans, the ideal is to have the most realistic photograph, to get as close as possible to the number of suicidal behaviors”, explains Jon García, psychiatrist of the Basque Health Service. The task is not easy because "people who have had sequelae or have been perceived, but many are not on the radar because they think we are going to judge them or we are not going to be able to help them," adds García.

Spain was stuck in public policies to prevent suicide. It lacks a national plan, there is no coordination in the regional responses and there are no awareness campaigns launched by the Ministry of Health.

This plan aims to partially reverse this delay. Among the measures, the document urges the communities to develop a risk code and to create, with a part of financing from the Ministry of Health, an "agile urgent/preferential referral circuit in the Mental Health Services after the detection of risk of suicide” to ensure that patients in this situation are treated early, before they try again. The document pays special attention to the population most at risk, such as the elderly or children and adolescents.

The goal is for 80% of the communities to have implemented some mechanism to provide preferential care before 2024. “It would be desirable in any health field, but here there is no doubt. The risk of repetition is very high in the days after an attempt, so it is important to reduce the wait," says García, whose health service is already implementing specific control and care in no less than 72 hours, when less on paper.

During this year, the autonomous governments will receive 24 million euros from Health for this and other purposes, although part of the budget must be contributed by each community. That investment is not fixed. At an economic level, only the wickers are known: the plan is budgeted at 100 million euros over three years and 80% of the money will be transferred to the communities.

more sanitary

But what holds the paper needs professionals. The first strategic line of the plan is to "reinforce human resources in mental health." In the document, however, there are no professional ratios or minimum thresholds, a long demand from professionals. It must be borne in mind that health competencies in Spain are transferred to the autonomous communities and the Ministry has little room for manoeuvre.

That the workforce of psychologists and psychiatrists are greatly reduced is no secret. In the recently approved Mental Health Strategy of the National Health System (2022-2026), which complements the action plan, the Ministry admits that "it does not have updated or complete information" or about the specialists in clinical psychology who work in public centers and provides as a reference the graduates , although "it does not mean that all of them are working in healthcare areas". The Ombudsman emerged a figure through an ex officio action in 2020: the ratio of professionals in public health was 6 per 100,000 inhabitants in 2018, three times lower than the European average.

How are templates intended to be reinforced, then? The communities will have to make an evaluation of how many professionals are needed to cover the demand for patients according to "population, epidemiological and care pressure criteria" and make effective the stabilization of their mental health staff (following the law to reduce temporary of the Government) before the end of 2024, in addition to creating the necessary vacancies and transforming interim contracts into stable ones.

The plan also focuses on decentralizing care so that not all cases end up being treated in the hospital setting. To this end, the health ministries must, using their own budgets, develop and strengthen community health resources, improve access to mental health services from Primary Care and train professionals for early detection and prevention of mental illness. gender violence. The plan divides the actions into three groups, depending on the financing: those that are borne by the Ministry's budget, those that are mixed or co-financed, and those that are assumed directly by the communities.

The change in depressive and anxiety disorders in the world

Change in the prevalence of severe depressive and anxiety disorders during the coronavirus pandemic

The COVID pandemic and mental health

The Ministry of Health recognizes the impact that the pandemic has had on the mental health of the population. “All the data reflect an increase in anxiety-depressive disorders and symptoms compatible with post-traumatic stress disorder. In addition, complications associated with mental pathologies prior to the pandemic are recorded, as in the case of eating behavior disorders, psychotic symptoms and addictive behaviors without substance, especially those related to Information and Communication Technologies. Communication (TICS)”, warns the plan.

Addictive behaviors, with or without substances, are another axis. The confinement and interruption of classes encouraged the use of screens and consumption time is greater in the most vulnerable population. According to the latest study by the Reina Sofía Center on adolescence and youth, 70% of young people between the ages of 15 and 29 have at least four devices from which to consume digital entertainment and do so for almost seven hours a day. The plan also encourages the development of psychological support programs for health and socio-health professionals with mental health problems for their work: "caring for the caregiver" and fighting against stigmatization, in general, of any patient with mental health problems through of specific institutional campaigns. Also to prevent suicide.