Josep Tristany: “We must reinforce community mental health care and not increase beds in hospitals”

BarcelonaDoctor Josep Tristany is the director of the Mental Health and Addictions Master Plan of the Generalitat, but just over two years ago he was on the other side, attending to patients. It is clear that he knows what he is talking about and that he is eager to improve the system, but he is also aware that it will not be easy at all.

Mental health professionals are burnt out and fed up. Do you understand why?

— Yes, because the mental health network is under a lot of strain due to multiple factors. The topic of mental health has been destigmatized, and this has caused demand to surface. There is also a factor that has to do with the strong social pressure that young people and adolescents receive. They are forced to be happy, successful, but at the same time they have great difficulties in accessing decent jobs or housing. And social networks act as an echo chamber. We are also at a time when society has many difficulties in tolerating discomfort. There are life discomforts that are part of the simple fact of being alive. It cannot be addressed only from the health sector.

Professionals claim that under current conditions they cannot provide quality care at child and youth mental health centers (CSMIJ). Are they lying?

— I would say that they are not lying, but we must value the fact that we have a network with excellent professionals, and that we are a mirror for other autonomous communities. We are light years ahead of the rest of the Spanish state. Even so, we must continue to improve. In the field of mental health, technology is people, and for some years now we have had difficulties finding professionals, both psychiatrists and, above all, clinical psychologists.

How many Resident Psychologist (PIR) positions did the Generalitat request from the Ministry of Health last year?

— 53 were requested, which is the maximum we can have in Catalonia.

Why can't we have more?

— Because the ministry sets conditions for accrediting a position, and one of the requirements is that, for example, for every PIR position that is requested, it is necessary to have six clinical psychologists who must be in charge of the training. Which leads us to a vicious circle. If we do not have more clinical psychologists, we will not be able to train more.

And is there a solution for this?

— Multiprofessional teaching units are attached to hospitals. We have a [mental health care] network with a significant number of community resources, but they do not have hospitalization. We are now working with two provider entities to see if, by forming alliances between them, we can create two more multiprofessional teaching units.

And why hasn't this been done before?

— Because I suppose it was not considered necessary. I cannot give an opinion on people who were in the Government ten years before us.

There is no need to go that far back. Why hasn't it been done in 2024 or 2025?

— This work is being done. The pity is that these are not immediate issues. In case we can have two more multiprofessional units, we will be able to start having some more residents in two or three years, not before.

How many more PIR places will be available then?

— It will depend on the entities that end up forming the alliances and the number of professionals they have, but I would say that it could be four psychiatrists and four or five more psychologists.

The Catalan Society of Clinical Psychology estimates that 50 PIR positions per year are needed just to cover the retirements expected in the coming years.

— Possibly.

So how is the available staff expected to be expanded?

— I believe that this is a subject that does not depend on the Master Plan. We are collaborating on it because it has a direct impact on healthcare, but there are other bodies that are working on it in a more direct way, such as the Directorate General for Health Professions, which is the one that accredits, manages, and liaises with the ministry.

I insist on it because, if the staff is not increased, many master plans can be made but they will not be able to be executed.

— They will be able to be executed because, when we compare ourselves with other European countries, we are slightly below in the ratio of psychiatrists and [clinical] psychologists, but where we are quite far behind is in social educators and occupational therapists, which are figures that we must progressively incorporate into the [mental health care] network.

So will the shortage of clinical professionals be covered by social educators?

— This is a somewhat perverse reading.

You yourself have said that an immediate increase in clinical professionals is not possible.

— To begin with, we will have fifty-odd new clinical professionals each year, and we also need to see what the follow-up of these professionals is, because a significant number stay in the public network, but there are some who leave. And we are also working on this with the general management to know why they leave.

Minors have to spend days in an emergency room cubicle because there are no beds in the psychiatric units of hospitals. How many acute and subacute beds are there in Catalonia?

— 110 acute beds and 67 subacute beds.

And is that enough?

— If we add 200 more beds, tomorrow they will be full. And if we add 500, they will be too. What we must try is for people not to end up being admitted. And that implies strengthening community care.

But if community care is overwhelmed, there are not enough beds, and it will take years to train new clinical psychologists, what can families do?

— What we also cannot do is put on the table that everything is a drama, although there is a part that we must improve. We must prevent and do the work beforehand. And this implies growing the CSMIJ teams, working much more in the natural environment of children and adolescents, and expanding day hospital places. We must also think that removing a child from their natural environment and admitting them to a mental health unit is very dramatic, very hard. We must reinforce community care and not increase the number of beds, which is what other countries in Europe are doing.