María José Miñano i Jesús López: “Many patients will be more serious if we do not do things well from the beginning”

BarcelonaThe Catalan Society of Clinical Psychology (SCPC-ACAPIR) published a devastating study last June based on the experience of professionals who attend to patients on a day-to-day basis. Its title is already quite significant: Mental health in Catalonia: between institutional discourse and actual practice. Or in other words, politicians sell us one thing but reality is something very different. The president and vice president of SCPC-ACAPIR, María José Miñano and Jesús López, respectively, speak bluntly.

To begin with, there is no clear health map regarding public mental health care resources. How is it possible?

— Jesús López (J.L.): It is very difficult to have a general health map for all of Catalonia because care is provided by provider entities and each entity distributes resources with different criteria and methods. Not even the professionals themselves know all the resources that exist. Many times we make our own maps to try to coordinate.

Does the fact that the service is outsourced make the assistance more difficult?

— María José Miñano (M.J.M.): Without a doubt. It hinders integration, coordination, and healthcare planning. The entities [that provide care] often compete for a resource, and they prefer to run a pilot program that gives a lot of visibility rather than strengthening core areas. There is a business logic that permeates the entire system. We have also found that one entity refuses to refer patients to another's program because it is a competitor. Perhaps it would not be necessary for the entire system to be public, but there should be more powerful organization on the part of the administration. Our feeling at times is that there is no one in charge.

How can it be guaranteed that the care at the CSMIJ is of quality?

— M.J.M.: The Generalitat could ask the provider entities for the number of visits made to a patient by the same clinical professional and with what periodicity, because only this continuity sustains a therapeutic process. Many users complain that every time they are seen by a different psychologist, this happens due to the rotation of the teams, because the professionals are burnt out and leave.

However, there are services at the CSMIJ that do work, such as the child and youth crisis care program.

— M.J.M.: It is clear that they work because professionals can see the patient as much as they need. The problem is that this is to the detriment of the majority of care and is reserved for very few patients. Furthermore, it depletes the core facilities of professionals that should prevent the patient from worsening and needing this intensive resource.

What does it mean?

— M.J.M.: If you work in a CSMIJ and see eleven patients in one morning, and you are offered to work within the crisis care program or in a day hospital, where you will see four or five patients, you leave the CSMIJ because you are exhausted, but above all because you want to work with meaning. It is not about putting resources only into the most severe patients. In mental health, it does not work like that. Many patients will become more severe if we do not do things right in the central pillars that support the system. This is what I mean. If we take resources from where they should be to prevent cases from becoming extremely complex, then even with specialized resources we will not be able to reverse it.

You claim that the problem is not only a lack of resources, but also a design issue of the system.

— J.L.: It would be necessary to create a plan for the population's care needs. That is to say, to know what the population needs, for which problems, and how many professionals are needed to attend to them. We are not aware that this plan exists.

But there is a National Mental Health Pact.

— M.J.M.: I too can make a plan about the economy of The Gambia, but I do not know if it will be relevant, applicable, or significant. The point is that there should be a real plan. With the planned increase in clinical psychologist positions, we are not even covering the professionals who will retire in the coming years. Has anyone looked into this? We do not even know which professionals we have practicing in each entity, and which ones are specialists and which ones are not. There are plans that are just letters to the Three Wise Men.

In their study, they conclude that the Government should “be honest with the population” and admit that the public mental health system cannot cover everything. What can it currently cover?

— M.J.M.: I believe that first it should be said what it cannot offer. You cannot offer emotional well-being when there are living conditions that do not allow you to be well: very difficult situations in families, social crisis, etc. Sometimes feeling bad is part of life and does not require intervention.

But in case an intervention is needed, what can public healthcare cover?

— M.J.M: In child and youth care, if a minor has a severe mental disorder, they will likely be visited quickly at a CSMIJ and will be properly attended to at the beginning, in the acute phase. They will be seen by a clinical psychologist, a psychiatrist, and will begin treatment. That is to say, if the issue is of a serious nature, they will be properly attended to. The system fails to address these issues before they become serious, and to provide an adequate response to situations that can become very complicated over time. This is where we fail.