Fighting for sanity
42% of Spaniards have trouble sleeping and half of the population says they feel tired. Many have been afraid of dying during the last year, according to the latest CIS barometer, and suicide attempts are on the rise. But there is no need for surveys, looking around us is enough: many people close to us feel bad, depressed or anxious about the future, afraid of losing their job, or their house. They say that the next wave will be that of mental health and according to the WHO, this will be the leading cause of disability in the world in 2030.
Mobility limitations have transformed our lives. For many, after work there is only home, and sometimes it is empty. These days we are torn between seeing loved ones and taking the risk of hugging family or friends, or respecting social distance. Everything is more difficult. And there are those who have not been able to say goodbye to their loved ones, there are friends we have not been able to bury.
Once again, the pandemic has accelerated a pre-existing dynamic, it has made it explode. Spain was already, along with Portugal, the country in the European Union where most anxiolytics and sedatives are consumed, partly as a result of the 2008 crisis. Let's say that before the pandemic we were not in the best situation either. This situation also impacts against a health system in which mental health is completely cornered.
Más País has called for more psychologists and psychiatrists. This is undoubtedly important, but not enough. If health is completely affected by socioeconomic conditions, mental health is even more so. The problems caused by precariousness, lack of work, the housing problem or the shortages of all kinds are not solved with more psychologists or more anxiolytics. Psychiatrist Guillermo Rendueles says that sometimes what people need to be well is simply a good job or satisfactory social or partner relationships. This is the approach that community health starts from.
From this conception, doctors like Carmen Sanjosé, co-author of Transformando el sufrimiento en lucha (Sylone, 2020) (translated as "Transforming Suffering into Struggle"), says that we are facing a problem of a health model. On the one hand, in most of the Health Services, hospital care has been privileged over primary care, or mental health itself. In other words, health policy has been oriented towards that which could offer greater profitability. The cuts and privatizations have also had their impact and have caused waiting lists to escalate.
The book explains that mental health care, like primary health care, has been one of the most neglected aspects, in favour of a productivist conception based on hospitals, drugs and technology. Some of the patients who have suffered most from this model are those with chronic mental disorders whose families depend on insufficient social resources. These resources - residences, workshops, financial aid... - usually depend on the social councils, not on the health ones, and are distributed among different levels of the administration that do not coordinate with each other. Privatization has also increased this fragmentation that prevents a more comprehensive care.
That is, more resources are needed, more psychologists in primary care, but also a redesign of the system that goes beyond the offices, with the participation of professionals, but also of the people who receive care. This would be a good way to contribute to end the stigma suffered by people with mental health problems, voices that we never listen to. The community health model calls for an integrated primary health care that can work with the groups in their environment, and where social resources are included. Prevention and early care would be in the foreground and hospitals would be the last resort.
For this to be possible, there must be a strong commitment to recover and democratize public health. However, subscribers to private health care have increased considerably this past year. When the middle class abandons the public sphere, we know what happens: it gradually degrades. There are too many economic interests pushing for this to happen.
Today we are in a bad place. To get well, better care is essential and this will not happen without struggles that make it possible. Struggling, in fact, is a way of maintaining sanity in these turbulent times.
Nuria Alabao is a journalist and anthropologist