The pandemic crisis only accentuated and aggravated the suffering and distress of the population, as well as the shortcomings of the care system itself, primarily structured around the public healthcare system. Thus, the increase in so-called mental pathologies and disorders, along with alarming figures on suicides, among other issues, put the Government on alert. The Government subsequently launched a specific initiative to confront a reality that affects an increasing number of people and sectors of the population in Catalonia.

The National Mental Health Pact (PN) was therefore born (DOC of November 21, 2021) expressing the intention to make a medium and long-term approach that would consolidate the implementation of actions to be carried out in the field in question. It was, at a first and broad moment, about a survey of the state of the art, an extensive X-ray of all the information involved, from cold quantitative data and results, to a presence and dialogue with the services and agents involved.

This procedure, likely the most thorough carried out in the country, brought fresh air to both professionals, who believed they could channel management and resource issues, and users, who saw it as an opportunity to assert their voices and rights, which had been violated for decades. The Plan's management met with almost all stakeholders involved, regardless of their approach, attending inaugurations or closing ceremonies of conferences and other events..

This included not only health devices but also others related to the tasks of promoting and consolidating mental health in our country (education, social services, justice, work...). The purpose of this extensive and meticulous vision was, ultimately, to present reasoned proposals with a hierarchy of priorities to the legislature., so that the Parliament of Catalonia would approve and consolidate concrete proposals to the Government, for the benefit of the population's mental health. This work included a training agreement for Quality Rights (QR) -following the guidelines of the UN Special Rapporteurs' reports regarding patient rights and the corresponding restructuring of service organization- with the provider entities. A first-rate outreach task that will have served, at the very least, to make the field of patient rights part of the reality to be addressed by services and professionals themselves. It was in the part of the PN's conclusion drafting that I have observed with concern and astonishment how some of the main service providers (responsible for and agents of the lack of progress in the unmitigated application of patients' rights and the structural care reforms that this entails - in accordance with the aforementioned UN QR guidelines) they have been at the same time who have had significant prominence in its preparation.

For all these reasons, it is necessary, once again, to remember and keep in mind that the incorporation ofPatients' rights are non-negotiable., There is no valid justification for failing to comply with the necessary guidelines to preserve its priority.

Finally, a first draft of these conclusions has seen the light of day; a long, detailed, and laborious text, with some significant initial measures, but which overlooks, or perhaps substitutes, undertaking direct and clear actions regarding points that have been widely detailed for too many years.

The Ethics Committee subscribed to Catalan Congress of Mental Health Foundation, on the occasion of World Mental Health Day, wants to recall, once again, that there are major structural issues that will determine the actions to be taken “in a cascade,” and without which it is too easy to fall into not addressing – a smokescreen – burning issues that require clear and immediate improvement. These include:

• Place patient rights (people!) at the center of any intervention aimed at improving their health statuseliminate or progressively but inevitably reduce to negligible percentages mechanical restraints, non-consensual or unconsented isolation, involuntary admissions, forced treatments).

• Normalize the Disclosure and implementation of alternative therapies to the biomedical model. of common use, according to the UN rapporteur's report, facilitating it. free choice according to the will of the person being cared for.

• Consequently, increase and adapt support resources to the corresponding community-based approach. Gradually de-medicalize mental disorder care in favor of validated alternative therapies. from the WHO itself (Open Dialogue and others...).

• Ensure the active participation of those affected and their families both in treatments, as well as in the organization and management of mental health care services.

• Validate i generalize the implementation of advance directives for affected individuals, without specific mental health difficulties leading to a reduction.

The goals are indeed ambitious, but let's remember that Spain signed the UN Convention on the Rights of Persons with Disabilities in 2006. Furthermore, on several occasions, UN/WHO Rapporteurs have given unequivocal guidance on the matter. Therefore, we have been Too many years of delay, too much suffering resulting from sustained reliance on ineffective approaches. I am obsolete in addition to the suffering inherent in mental health disorders, and which constitutes a failure to meet acquired commitments.

There is a shared and proportional responsibilityservice providers can no longer afford to overlook the paradigm shift according to UN guidelines, and for their part, the governments, The color doesn't matter, they also shouldn't refuse to agree on terms with service providers for implement concrete actions that will make the desired and expected change effective it improves mental health care in our country.

October 10, 2024

Ethics Committee:
Joan Badia, Esther Francisco, Montserrat Hierro, Jordi Marfà, Judith Martin, Asunción Pié, Alicia Roig, Mercedes Serrano, Silvia Ventura, Fernando Vidal and Edgar Vinyals.

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