Twenty-twenty European policies for mental health Piazza Armerina, September 2013

The Mental Health System in Andalucía (Spain)

Marcelino López Álvarez

Psychiatrist and sociologistDirector of Programs, evaluation and researchAndalousian public foundation for social integration of people with mental illness (FAISEM)SevillaSPAIN

Introduction:

Spain don’t have “one” mental health system

In fact we have 17, because we have 17 regions (Autonomous Communities), each of one has their specific mental health system

Psychiatric hospitals – community servicesHealth – social servicesPublic – private servicesOrganizational models and professional orientation (biological – community and psychosocial)Role of associative movements (Family and Users)

They have only some little common aspects

Some general legislation

Formal integration of health services in the National Health System

Negative effect of the current restrictive policies to manage the economic crisis

Hospitals and Clinics

Beds

Reduction (%)

1975 120 44.034

1986 98 32.493 26,2 %

2007 99 16.028 50,7 % (1986)63,6 % (1975)

Psychiatric Institutions and beds in Spain1975, 1986 Y 2007

Community Mental Health ServicesMental health Teams or Centers, linked with Primary health care services Psychiatric units in General hospitalsLittle and different Rehabilitation ServicesLittle and different social services (residential and day support) and employment programs

A formal Common “Mental Health Strategy” from the National Health System

Usually there is not separate funding in Health services

Usually not public provision in social and employment services and programs

Andalucía: public provisionMadrid: public founding but private provisionUsually partial public founding and provision by the family associative movement

Without accurate common information

Andalucía is one of the 17 Regions (Autonomous communities) of Spain

8 provinces

18% of the territory and the population

Traditionally «less developed»

Psychiatric Reform 1984:

Closure of the 8 Public psychiatric hospitals:

Mental Health services integrated in the Andalousian Health Service (SAS)

Social support resources in a public foundation (FAISEM)

Andalucía Spain

Territory 87.561 Km2 504.540 Km2

Population 8.400.000 47.000.000

The closure of the public psychiatric hospitals in Andalucía (1984-2005)

Hospitals closed (!984-1999) 8 (2.987)

Long Stay Residents in January 1985 2.67230% “Elderly “ (>65 years) 30% “Mental Disability”40% “Chronic”

Admissions 1985-1999 315

Dead during the period (19852005) 813

Discharges includes in the study 2.174

Own and family home 5,3 %Nursing homes for elderly people 37,4 %Residential homes for people with Mental Disability 26,8 %Specifics accommodations 24,0 %Private Psychiatric Hospitals 0,6 %Penitentiary Psychiatric Hospital 0,4 %Homeless 0,6 %Others 1,1 %Unknown 3,8 %

Private and Penitentiary Psychiatric Hospitals

1985 2008San José (Málaga) 350 350Sagrado Corazón (Málaga) 350 350S. Francisco José (Málaga) 200 150N. Sª Del Carmen (Sevilla) 40 -

Totales 940 850

PRIVATE

1985 2008Carabanchel (Madrid) 150 -Foncalent (Alicante) 320 320 ( 32)Sevilla-II (Sevilla) - 168 (132)

Totales 470 488 (164)

PENITENTIARY (Spanish Gouvernement)

The Mental Health System in Andalucía

  

PERSON

FAMILY

COMMUNITY

USMI

UHSM

CT

HD

URA

UCSM

PRYMARY HEALTH CARE TEEMS COMMUNITY SOCIAL

SERVICES

LITTLE RESIDENCE

APARTMENT

HOME SERVICE

SOCIAL CLUB

WORKSHOP

SOAE

S FIRMS

FAISEM

SSPA

COORDINATION

COMMITEE .

UGC

MENTAL HEALTH

TRAINING

SERVICIO

ANDALUZ

OF EMPLOYMENT

SPECIALISED SOCIAL SERVICES

The organization of Mental Health system into the Andalousian health “Mental Health Departments” (Clinical Management Mental Health Units) that depends from the Medical Direction of one General Hospital

Community M H Unit

Mental Health Services in the General Health Service

24 Mental Health «departments»

Community Mental Health Units: 76 (1 /108.000)

Hospital (short stay) Units (General Hospitals) : 19: 560 beds (6,8 / 100.000)

Therapeutic Communities: 14: 240 beds (2,9 / 100.000) 420 day places (5,1 / 100.000)

Child and adolescents Units: 14: 40 beds (0,4 / 100.000) 250 day places (3,1 / 100.000 )

Day Hospitals: 11: 264 places (3,2 / 100.000 )

Rehabilitation Units: 9 :305 places (3,7 / 100.000)

Mental Health Emergences Services in 19 General Hospitals

Servicios de Salud Mental (SAS) Actividad 2010Personas atendidas: 198.995

Primeras consultas: 97.214 Total consultas : 842.356 Distribución diagnóstica:

Neurosis/ T. de Personalidad: 46% Esquizofrenia y ots. Psicosis 14% T. Afectivos: 27% T. Infancia y adolescencia: 6 % T. Orgánicos /Disc. Mental/ ots: 5% Drogodependencias 2%

Hospitalización de corta estancia (USMHG): Ingresos totales: 10.262 Estancia Media: 15’9

días Indice de Ocupación: 94,0% Distribución diagnóstica:

Psicosis : 60% T. personalidad: 12%

Social support services in FAISEM (1)

FAISEM:Public Foundation (Regional Government of Andalucía

HealthSocial ServicesEmploymentEconomy

Participation of Associative movementsFamilyUsersProfessionals

Social support programs and servicesHousingOccupationEmployment

Support for the Family and Users AssociationsTrainingResearchTechnical cooperation

Housing

“Home- House:” (20 places, 24 hours) 57 ( 940) (10,2 /100.000)

Apartments (3-4 places) 197 ( 753) (9,1 / 100.000)

Home support: 585 (7,1 / 100.000)

Employment

Vocational Guidance and support teams: 8 (2.400)

Training Courses: 53 (261)

Supported employment 321 Social Firms 10 (305 workers with SMD)

OccupationDay Centres, Workshops , and Social Clubs: 156 (3.250)

Social support services in FAISEM (2). 2012

FAISEM Budget 2013

Regional Minister of Health and Social Services: 7.670.522Andalousian health Service: 21.612.313Dependence Agency (Social Services): 3.874.624Andalousian Employment Service: 1.150.000Minister of Education: 400.000Users contributions (“Taxes”): 3.890.784Others: 734.125

TOTAL: 39.332.368

Social Firms (2012)Total income: 12.741.110% from subsidies: 16,7Balance: + 1.023.121

Coordination (Mental Health services and FAISEM)

Andalousian Mental Health Plan

Severe Mental Disorder Care Protocol

Personal care protocol

SMD Coordination Commission in every Mental Health “department”

Provincial and Regional Coordination Commission

Mental health DepartmentsFAISEMSocial Services