July 3 juillet 16:00 – 17:45
Room IASL-106
Chair: Frederico Allodi , University of Toronto
The entrance into modernity of the Spanish health care
system took place in 1985 with the proclamation of the Health Reform Law. This
paper follows the process of its implementation, great achievements and side
effects at the levels of clinical service organization and delivery,
professional participation and training and governmental policy and planning
activities. As a result, an archaic system of asylum-rooted custodial care was
transformed into a community-centered service, multidisciplinary and broadly
oriented to the support of the beneficiaries in their own environments. Some
of the phenomena concomitant to de-institutionalization have been observed,
such as rotating door readmissions and homelessness. Retraining programs have
accentuated entrenched territorial disputes, and the split of the professions
into a bio-medical and psychosocial dualism has become more complex with the
presence of the pharmaceutical companies in the field. Some other phenomena of great import to
clinical care, to the planning of services and to the public at large are
mostly unrelated
to the changes brought about by the reform or entirely new, such as the
prevalence of delinquency and substance abuse, and the presence of large
minority immigrants groups in mentally disordered populations. The response of
the Spanish society and government to those problems is consistent with
democratic procedures and humanitarian concerns. The arguments of this paper
are supported by existing statistics and clinical epidemiology data.
In summary, the mental health reform initiated a decade and a half ago
brought the care of the mentally ill to the level of other European and
industrialized countries. Differences worth reporting exist in some sectors.
In 1985, the Ministry of Health gathered a number of
recommendations from a wide group of mental health professionals, that were
later (in 1986) incorporated in Article 20 of the General Health Act of Spain
(Ley General de Sanidad). The Act followed community health principles and
specifically promoted the transformation of the mental hospitals and their
integration into the health care system. Its implementation has faced
challenges in the uneven development across the various Spanish regions, which
is, in turn, related to their administrative and financial dependency on the
central structures, limited budget allocations specially for the social and
rehabilitation programs and insufficient training of professionals along the
community model. Demographic and clinical statistics are provided for a
district mental health community service in Madrid.
Following the launching of the reform of the health care
system in Spain and in the age of globalization, powerful international
currents swept through all the fields of the system. These currents had a
prominent impact on the causative models of severe and minor mental disorders,
and the appropriate treatment and care of these disorders. They have affected
training, research and distribution of resources, teaching of psychopathology
and sharpened some ethical dilemmas. The paper documents observed patterns in
the inpatient and community services of the health region of Madrid and
specifically compares them to those present in the European Union.
The Mental Health Reform of 1985 was institutionally
launched with the creation of the mental centers across the various regions of
Spain. At the same time, the reform promoted a national training program for
psychiatrists (largely, but not exclusively) who were to be human resources
for the new ambulatory community clinics. Except for a small number of
sheltered residences, the family constituted the main environment of support
for the mentally ill outside the hospital. For many, this, in fact, resulted
in a gap between inpatient and ambulatory care. Social and occupational
rehabilitation services have been the least developed. The support system is described for Spain, in general, and, more
specifically, for the region of Madrid. The paper describes the movement of
family associations for the mentally ill and the concern for the well being of
the new immigrant populations in Spain
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