Sat. Apr 4th, 2020

The legal limbo of mental illness in Spain

In Spain, masked food treatments are administered to people with mental illnesses, long-term drugs are injected without informing them, and even with their reluctance, and the court is not asked for the necessary authorization to force them to undergo involuntary treatment.

It is denounced by the Bioethics Committee, a collegiate body attached to the Ministry of Health that adds that "in terms of involuntary outpatient treatments (TAI), the Spanish legal system presents a gap" and that the scarcity of resources can increase this practice by professionals dedicated to patients with psychosocial disabilities.

This week, on October 10, World Mental Health Day has been commemorated, a reality for which Spain does not have a strategy despite being a serious public health problem – with more than 3,600 deaths a year – nor does it have legislation adapted to the recommendations of experts on how to treat and administer treatments to these people.

However, according to the Bioethics Committee, practices against the will of the patient are less and less frequent due to the greater awareness of society and health professionals about the importance of respecting patients' rights.

"Doing something against the will of the patient ends up being harmful because, no matter how well you intend, you are inflicting harm on him," Vicente Bellver, a member of the Committee, told Efe.

Bellver is also the rapporteur of the report commissioned by the Government to the Committee to define its position on the draft that the Council of Europe is preparing regarding income and involuntary treatment of people with mental illness.

A report requested by the Executive in the absence of a European consensus on the aforementioned document of the Bioethics Committee of the Council of Europe, which has been opposed by numerous expert committees and even bodies of the Council of Europe itself such as the Parliamentary Assembly or the Commissioner for Human Rights.

According to these organizations, the text of the European Bioethics Committee "not only does not guarantee human rights but also allows them to be violated and can continue to be violated," said Bellver, who believes that the aforementioned report does not guarantee the right of people with Mental illness not to be treated against your will.

In Spain, the Basic Law of Patient Autonomy recognizes that all actions in the healthcare field require the prior consent of the patient and that every patient has the right to refuse treatment. A principle that does not always apply.


The TAI is a measure that requires judicial authorization and is adopted when the person affected by a mental health problem leaves the treatment and fears that it may have serious effects on their health and / or the lives of others.

However, its application, explains the Committee, is not exempt from controversy, with defenders who see it as the solution for the affected person to take their medication and improve, and opponents who label it as a violation of fundamental rights and who believe that it entails an increase in coercion and stigma of the psychiatric patient.

Among the defenders are the Spanish Confederation of Family Groups and Mentally Ill (FEAFES), the Spanish Society of Psychiatry and the Spanish Society of Legal Psychiatry and among the detractors is the Spanish Association of Neuropsychiatry.

The lack of consensus among experts, international organizations and those affected has prevented Spain from having specific legislation in this area.

The Spanish Bioethics Committee warns that in recent years several courts in some Spanish cities – specifically Bellver has referred to Valencia – are authorizing TAI in order for the patient to comply with their treatment and avoid the extremes of hospital admission or civil disability

And he considers that, although it may be a beneficial alternative for some patients, the scientific community warns that more studies are required and that many of these people could respond to intensive follow-up programs without the need for judicial intervention.

TAI is not a treatment, but the way it is administered, and the question asked by the Committee is whether it responds to the stigma and difficulties that people with mental health problems have to enter the labor market and access socio-sanitary resources

According to the Committee, the assessment of the TAI should be done taking into account all those involved in the treatment of those affected: family members, caregivers and trusted persons, "who are the first support for the sick."


In his report he also refers to the involuntary hospitalizations to which these patients are sometimes subjected to in Spain.

A practice that is strongly opposed and urges the Executive to "repeal any rule that authorizes the adoption of involuntary measures in a person because of his psychosocial disability."

He claims that this measure is contrary to the United Nations Convention on the Rights of Persons with Disabilities – approved in 2006 – because it enshrines discrimination, unduly deprives personal liberty, threatens their physical and moral integrity and can cause abuse.


For this reason, it asks the Executive to promote a legislative reform that repeals the norms that allow these internments, and that these are limited to a general regime, regardless of whether or not the individual has a disability. And that this law of organic rank be endowed.

In the decision on hospitalization and involuntary treatment, "disability cannot be a criterion to attend" and "cannot in any case justify a deprivation of liberty by itself."

Specifically, the Committee requests the repeal or modification of article 763 of the Law on Civil Procedure in which mention is made of the psychic disorder as a criterion for determining detention and that decisions are taken according to the Basic Law of Patient Autonomy, which establishes as a general rule the requirement of patient consent for any action in the field of health.


In addition, it requests that the Spanish Committee of Representatives of Persons with Disabilities (Cermi) and the affected groups participate in the preparation of all measures. And do not depend on the political majorities of the moment.

In 2011, the Committee on the Rights of Persons with Disabilities already expressed concern about the abuse in Spain of urgent detention measures and the ill-treatment suffered by people with psychosocial disabilities in the centers where they are hospitalized.

The alleged benefits of involuntary income and treatment are arguments of the past, says the Committee, which alludes to the growing evidence that the use of coercive measures causes more psychosocial harm, exclusion and isolation than the person already suffers from his mental disorder.

On the contrary, the real benefit of many other practices based on the person's consent is demonstrated.

And he adds that, in accordance with universally established ethical principles and with the recognition of the rights of users, "it is necessary that assistance be given with humanity and with compassion, terms already in disuse, but that ultimately invite us to humanize the deal. "

The Bioethics Committee was created in 2007 by the Biomedical Research Law. It is an advisory body in charge of studying topics of great controversy such as surrogacy or euthanasia.

Macarena Baena

. (tagsToTranslate) limbo (t) legal (t) mental illness (t) (t) Spain

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