Reform in Spain Universal health coverage, predominantly funded through general taxation Mental in Spain Dr. Marta Torrens. Institute of Neuropsychiatry & Addictions-Parc de Salut Mar. Universitat Autònoma de Barcelona. Madrid, 24.04.14 Governance of the health care system is decentralised to the 17 Autonomous Communities (ACs) in agreement with a countrywide Council of the National Health System (NHS) Decentralisation of all health care responsibilities to the ACs began in the 1980s and finish in 2002 Current situation: Diversity of health and social care service in ACs Mental Reform in Spain Moving from de-institutionalisation to a community mental health model: 1983 Establishment of the Ministerial Commission for Psychiatric Reform (official report published in1985) 1986 The General Health Act : Psychiatric care, was for the first time included among the package of benefits covered by the NHS. Mental Reform in Spain The 1986 General Health Act, had five objectives in respect of mental health: a) Opening of mental health units in general hospitals, b) Development of a network of community mental health centres in local catchment areas, c) Creation of specialist services for specific population groups (such as older people and children), d) Development of intermediate community services (i.e. day hospitals and day centres), e) Enhanced coordination with social services. 1
Mental Reform in Spain Moving from de-institutionalisation to a community mental health model: 1983 Establishment of the Ministerial Commission for Psychiatric Reform (official report published in1985) 1986 The General Health Act : Psychiatric care, was for the first time included among the package of benefits covered by the NHS. 1995 Royal Decree 63/1995 : define mental health as a specialist care service including diagnosis and follow up, medication, individual, group and family therapy and hospital care. Principles and values of Mental health in Spain 1.Autonomy Ability of the service to respect and promote the independence and self-sufficiency of individuals. 2.Continuity Ability of the care-providing network to provide treatment, rehabilitation, care and support on an uninterrupted basis on a lifelong basis (longitudinal continuity) and coherently, among the services of which they are comprised (transversal continuity). 3. Accessibility Ability of a service to provide care to the patients and the family members thereof when and where they need it. Principles and values of Mental health in Spain 4. Comprehensiveness Implementation of all the basic facilities of a service in each health district. Recognition and realization of the right to receive care within the full range of needs caused by the mental disorder in question. 5. Equity Distribution of the health and social resources of adequate quality and proportional in quantity to the needs of the population in accordance with explicit, rational criteria. 6. Personal recovery Includes the recovery of health in the strict sense and of the consciousness of citizenship despite the disability caused by the disorder in question. Principles and values of Mental health in Spain 7. Accountability Recognition on the part of the health institutions of their responsibility to patients, family members and the community. 8 Quality 8. Quality Characteristic of the services which is aimed at continuously heightening the probability of achieving the desired outcomes by using tested procedures. 2
Mental health care in Spain As with general health care reform, at the end of 2002 Each AC defined its own mental health plan with specific regional priorities. There was a widening of differences in models of mental health care across Spain Problems in the coordination of health and social cares services Mental in Spain Moving from de-institutionalisation to a community mental health model: 1983 Establishment of the Ministerial Commission for Psychiatric Reform (official report published in1985) 1986 The General Health Act : Psychiatric care, was for the first time included among the package of benefits covered by the NHS. 1995 Royal Decree 63/1995 : define mental health as a specialist care service including diagnosis and follow up, medication, individual, group and family therapy and hospital care. 2006 Royal Decree 1030/2006 : provided more details for primary and specialist mental health services, including preventive measures such as better early detection. Development of a NHS mental health strategy with regional governments, professionals associations, family and service user organizations: Health Networks Health Mental Mental health Community services Out-patient/ambulatory clinics Community Mental Health teams Hospitalization General hospital Psychiatric Hospital Support to Primary centers Long-term residential care in the community (Day hospital, Partial Hospitalization) Rehabilitation, occupational therapy and help with employment Acute In-patient Psychiatric unit Acute Psychiatric Unit Emergency room Long-term residential care in psychiatric hospital 3
Challenges for mental health care Health Networks Improving community services (continuity care) Improving Social care integration Integration/coordination with Substance Abuse network Drug Addiction Mental health Background of Drug Abuse in Spain Latest 70s 1990 Heroin dependence epidemic/hiv epidemic 1985: Approval of National Plan on Drugs Development of drug abuse treatment network (public system) decentralised in 17 CAs 1991-2000 Development of MMT (500 cases to 78.000 cases) 2000-present Cocaine epidemic /cannabis epidemic Recreational drug use Increase of psychiatric comorbidity: dual diagnosis Framework of Addiction in Spain Early 1980s Ministerial Order 31/October/1985 Real Decree 19/January/1990 Real Decree 15/January/1996 National Drug Strategy 2000-2008 National Drug Strategy 2009-2016 4
Addiction Mental health care Challenges for mental health care Improving community services Improving Social care Community G Hospital Residential Integration/coordination with Drug Addiction Out-patient center for Drug Addiction Day Centers Detoxification Units Terapeutic Communities Rehabilitation Centers Harm Reduction Programmes: Self-administration rooms Addiction & Mental disorders Addiction & Mental disorders: Treatment Acute Hospitalization Partial Hospitalization Residential Treatment Mental Health Center Psychiatric comorbidity Addiction Mental Disorders Detoxification Unit Partial Hospitalization Therapeutic community Drug Abuse Center Accesibility to treatment? 5
Addiction & Mental disorders: Addiction & Mental disorders: Treatment Psychiatric comorbidity is frequent among substance abusers: 40%-60% in seeking treatment Substance abuse in frequent among mental health seeking treatment: 35-60% 35% to 70% of individuals with substance use disorder and mental health disorders are not receiving any treatment Integrated Parallel Sequencial Mental in Spain: SUMMARY Based in a community mental health model Based in a continuity care Differences in 17 CAs Main Challenges: Improving community services Improving integration with social care Improving substance abuse disorders care Thanks for your attention! Marta Torrens mtorrens@parcdesalutmar.cat 6