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The pandemic has not brought a tsunami of mental disorders, it has uncovered them
It seems that the pandemic has brought a tsunami of mental disorders, but the truth is that its impact has been small and very localized in some population groups; what covid has done is uncover a reality that already existed before, and that is that Spain is a great country to have cancer, but not anxiety.
"We have a health system that is very good, very reliable, and essential for what is serious, for what is expensive, for what cannot be made profitable, which is precisely the spirit of the public health system that they want to charge," says Javier Prado, of the National Association of Clinical and Resident Psychologists (Anpir).
That includes serious mental health problems, for which "Spain can be a good country." "The problem -he argues- is the slight, the moderate, if you have a duel, problems with work, with life that are starting to cost you, that you don't just feel joy with the things that used to generate it for you".
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"The great debate" of psychoactive drugs
And here comes the "great debate": 70% of mental disorders are so-called common - not minor, but the most frequent - which, according to the latest European Survey in Spain (EESE) of 2020, the most recent there are anxiety and depression. And most are ventilated with psychoactive drugs.
5.8% of those over 15 years of age answered having had a diagnosis of chronic anxiety (3.5% men and 8.06% women); the figure for depression is similar (5.28%, although it triples in the unemployed and shoots up to 23.71% among those who are unable to work), and it also doubles in them (7.22% compared to 3, 23% of them).
But it is a "self-declared" frequency, the document points out: "The appearance of depressive symptomatology is more frequent than depressive symptoms in the strict sense. Relating grief to depressive disorder, speaking of the adolescent 'slump' as if it were depression, even states of fatigue or decay are confused with depressive symptoms, it may be a reason for the increase in diagnoses".
According to the latest 2019 report from the International Narcotics Control Board (INCB), Spain leads the world consumption of benzodiazepines.
According to the Spanish Agency for Medicines and Health Products (Aemps), in 2021 the daily consumption of anxiolytics and hypnotics per 1,000 inhabitants exceeded 93 million daily doses (almost 59 million of the former and 34 million of the latter), which is to say: 2.4 million more than in 2020 and just over 6 million more than in 2019.
"How many people - asks the expert - of those who are taking psychotropic drugs should be taking it or is it motivated by a mental disorder? We no longer talk about depression or anxiety receiving psychopharmacological treatment before psychological treatment: the thing is how many patients have a problem of real anxiety or depression, what are we calling depression and anxiety?
Because there "there are labor problems, gender issues, precariousness." "It is important -says Prado- that we open up this issue that 12 or 13 million Spaniards are taking psychotropic drugs to spend in their day-to-day life in all its complexity, understanding that it is a polyhedral reality", not translating it into "we are going to arrange with more psychologists or what does it mean that they have a mental disorder".
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The pandemic, "nothing to do"
"The pandemic -ditch- has nothing to do with it, it has to do with how this country is progressively going towards progressive precariousness."
The psychologist considers it good that the covid has contributed to visibility and to the fact that mental health is being talked about, but he believes the way in which he communicates "should improve".
"It almost seems -he continues- that there has been a tsunami of mental disorders related to the fact that there has been a pandemic that has transformed our lives", but "if we analyze the scientific literature, but the well done one, we can find a quite related impact small, not even moderate, and very localized in specific sectors".
That is older people, due to isolation, loneliness, and lack of support networks; adolescents, with a notable increase in self-harm, and vulnerable populations with serious mental disorders (schizophrenia, bipolar disorder, etc.). "There, the collapse of the system has worsened some services that were previously deficient."
"It would be very good if we tried to understand that what the pandemic has uncovered was a reality that already existed; saying that things are worse than they do not help and we must try to adjust to the scientific data: there has been a very small impact on very specific populations. There are not 25 million Spaniards suffering from mental disorders at all, otherwise, this country would not get ahead".
What happens is that before only specialists saw it, and now everyone sees it. An example of what counts is suicide: in 2020, 4,000 people took their lives, when historically the figure was stabilized at 3,600.
Technically, "in terms of recovery, it is not a catastrophe, it is slight, but it is that before 3,600 died, which is a lot and there were already too many, but nobody talked about it."
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Stigma and few resources
Mental health thus comes up against several barriers: the main one is the stigma that "is everywhere" but that is beginning to be dismantled, although "there is no greater stigma than telling someone to ask for help from a system that is not being braced to respond.
In addition, lack of resources -although it celebrates the 231 PIR positions convened for 2023, they are far from the 422 per year that Anpir claims to double the number of clinical psychologists to 6,000- and access to the first treatment measures.
Also the progressive disincentive, the gradual cuts since 2008, a "historically accessible" Primary Care, but which is no longer, and a "hospital-centric" model based on emergencies and admissions that, in the long run, costs 23,000 million a year between drugs and low.
"We are probably in one of the best countries to have cancer, survive and not go bankrupt," but with mental health, "if you can afford it, you go to private to do your psychological treatment." "We could spend today to save tomorrow," he proposes.
A serious precedent
Recently, Anpir has brought to the High Court of Justice of Catalonia the Program of emotional well-being and community health of the primary health care of its Ministry of Health, which includes the incorporation of 150 professionals to work from the first level of care in early detection and attention to emotional distress in low-income neighborhoods.
"We regret - he admits - having had to reach this point and not having been able to understand each other with all the mechanisms that exist to avoid this situation, the unilateralism with which it has developed, the opacity, the lack of debate and consideration of what we have to say the scientific societies".
According to the association, to be part of the contracting pool of the aforementioned program, a degree in clinical psychology was not required, the only one that qualifies to provide services in the SNS.
"It seems to us that there is an excess of political power and that it is not good for the citizens," Prado defends before warning that it could set "a serious precedent" that would give rise to the rest of the autonomies "to do the same." "And in the end, we are talking about the fact that if you mistreat primary school, you are dismantling the public health system," he concludes.
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