Catalan Government admits saturation of youth mental health services

BarcelonaClàudia (not her real name) is 17 years old and sums up 2020 as "a shitty year". Her grandmother died suddenly without being able to say goodbye and her father was left without a job a few weeks after the Catalan Government ordered a lockdown to stop the advance of covid. Living together was difficult: the arguments at home were becoming more frequent and louder, there was too much tension, she recalls. And when summer came and lockdown ended, she stayed isolated. She had practically no relationship with her friends and looked for excuses not to leave her room, often eating lunch and dinner there. "I was angry at everyone, but too tired to cope. The only thing that got me out of the loop was cutting my thighs. It calmed me down when my head was racing," she explains. And if her family hadn't caught her doing it, she says, she would have continued.

Clàudia's case is not isolated: the Department of Health calculates that, since the outbreak of covid, consultations about suicide and self-harm among young people have increased by 27%. In general, all mental disorders have increased a lot in recent months among teenagers, who are also the most vulnerable to emotional breakdowns due to their age, family and socioeconomic context, the latter beyond their control. Health authorities estimate that the demand for psychological help among young people has shot up by 30%, especially due to eating disorders, self-harm and anxious-depressive disorders, but also due to severe behavioural disorders. Experts consulted by ARA paint a bleak picture: they claim that the mental health network is overwhelmed.

"It is true that there has been an increase in mental health problems in young people and teenagers, and that is why the Health Department we have reinforced primary care and Child and Youth Mental Health Centres to respond to this demand," admitted the president of Department of Health's Advisory Council on Mental Health and Addictions, Joan Vegué, who pointed out that this upturn will soon reach its peak. Since minister Josep Maria Argimon took over at the Department last summer, mental health been a priority concern. The Department will alot €80m in the 2022 budget to reinforce psychiatric and psychological care, initially to address the most complex cases

Asked by ARA, Vegué admitted that standard mental health services are ill-suited for their task and require an overhaul to make them more accessible to young people – especially the most at risk. In this sense, the Health Department has committed to home care. Next week ten teams will start work to serve around 250 young people aged 12 to 25 who suffer serious psychopathological disorders.

These teams will consist of about forty psychologists, psychiatrists, nurses and social workers and educators, with the aim of approaching young people facing complex family, social and economic situations and also suffer from a severe or moderate mental and behavioural disorder linked to substance abuse; people who present disruptive or transgressive behaviour, creating alarm in the social, family, educational or work environment; and people with difficulties in maintaining social skills, interacting and communicating. "In short, people that we struggle to reach appropriately and which escape through the cracks of the classic mental health network", Vegué summarises.

The child and teen psychiatrist and head of one of the teams, Àurea Autet, says that this strategy is not intended to draw a distinction among young people around the severity of the disease, but of the conditions that can aggravate it. "We cannot address their problems as we have done so far, we must offer them comprehensive care because they are patients in whose evolution family, social and educational environment play a significant role," she explains. The psychiatrist has admitted that for years the health system has been "papering over the cracks" to look after for these teenagers, and says that the big mistake has been to see to treat them without taking into account the social complexity in which they live and without offering them strategies which go beyond health and connect with social services and schools.

A struggling network

"This does not mean that all young people who suffer have a disorder or need to go to a psychologist or psychiatrist", Autet wanted to clarify. However, despite the fact that the increase in the number of visits to mental health clinics is not sudden –it has been progressively rising in recent years–, the pandemic has had a multiplier effect which has collapsed youth mental health services, according to the coordinator of Catalonia Psychology Association's childhood and adolescence committee, Roger Ballescà. "The mental health network is spread throughout the country, but struggles financially and has been short of hands and time for years," he explains.

The psychologist denounces that the care on offer is "scarce" and often shallow or infrequent. The average care when a young person enters the system is estimated at 6.3 visits per year, about one every two months, but psychologists do not rule out that waiting times could be higher in some areas. In addition, young patients' minders complain about emergency care, which is also hard to access.

"If before we were already at the limit, now cases have to be very serious, like a suicide attempt, [to obtain attention]. At the center we have a broken teenager who needs permanent emotional and physical containment. For three weeks she has been going to the emergency room to visit the hospital, seven times in the last week alone, but the waiting list for admission is so high that they send her back home to suffer", warns David Montejo, the director of the CRAE of l'Hospitalet de Llobregat, a home for children and teenagers. He recalls that in an environment like this there are professionals trained to "sustain" the situation, as well as agreements with mental health centres to ensure visits in a maximum of three weeks. "But a family cannot manage this. We are experiencing an increase in episodes of crisis with saturated public resources, and this can not be," he says.

Ballescà adds that the pressure of care is "extremely high", but says that what really stresses the professionals is that they cannot do more "for lack of time". "It is not just a question of demanding an increase in economic resources, but also that they are allocated differently. We are leaders in pharmacological spending due to this lack of time and we should be oriented towards a psychological approach that avoids medicalisation," he says. Montejo agrees, who says that "the good will of professionals is there", but the problem is the "lack of prevention: emotions and mental health care in schools, for example, do not receive sufficient attention. We know that the peak of cases due to the pandemic will pass, but there is still much more to be done.