FCCSM DECLARATION:
“FOR A DIGNIFIED EXIT FROM THE CRISIS”
Barcelona, July 2011
Preliminary Considerations
It's starting to be widely accepted and recognized that the global economic and social crisis has been the result of financial speculation, which was favored by the policy of deregulation of public control mechanisms at both state and international levels.
The ideology of the market and free competition, with the participation of hegemony, introduced at all levels, of exclusionary biomedical thought, has turned health into a consumer good and has favored a trend towards the “medicalization of life.”.
The process of establishing democracy in Spain allowed for the promotion of a Psychiatric Reform. This reform challenged the asylum/mental institution model and superseded previous psychiatric care dependent on provincial councils, as well as outpatient neuropsychiatry consultations from the Catalan Health Institute (ICS) and psychiatric services in some general hospitals. It led us to a new paradigm of community orientation, structured as a network of “public use” mental health services, localized within specific territories. Despite recent budget increases, this network has never achieved equitable funding compared to the rest of the healthcare system. From within this network, professional teams have tended to provide continuity of care, primarily for individuals with severe mental illness.
Evolution and Current Status of the Mental Health Network
Following the antipsychiatric response, the psychoanalytic personalizing perspective, and the contribution of psychopharmacology, the new model driven by the progressive movement of professionals has promoted over the past decades a profound transformation of what came to be called mental illness care, due to its comprehensive, therapeutic, and rehabilitative assistance.
For years, epidemiological data have indicated significant growth in morbidity and disability stemming from psychiatric disorders. Depression, the second leading cause of disability in 2014, is projected to be the second leading cause of illness in 2020, after ischemic heart disease. Suicide is the second leading cause of mortality among young people. One-third of the population will be affected by a psychiatric disorder in the course of a year. The WHO also points out that two-thirds of
affected by a mental disorder do not seek help from a healthcare professional.
The Mental Health and Addictions Master Plan (2006), resulting from broad consensus, especially within the public network professional movement, has achieved a theoretical and technical foundation and organizational and functional proposals that represent a significant leap forward in the quality of care. This Plan, informed by the Advisory Council of the same PDSMiAd and approved by the Department of Health, echoed the serious epidemiological and psychiatric morbidity information, making it a significant justifying factor for its promulgation. Introductory epidemiological circumstances that are also found in both the Helsinki Declaration (2005) of the EU Health Ministers and the document on ”Mental Health Strategies of the Spanish National Health Service,” prepared by the Ministry of Health and approved and adopted by the health departments of the autonomous communities.
In this regard, it is important to remember some of the most important recommendations and proposals included in these documents:
- Need for promotion and improvement of mental health in all EU countries.
- The importance and nature of the issue require an approach from
public policies. - Primary care should be the gateway and the responsible level for
The clinical management and monitoring of patients. - A determined fight against the stigmatization of the mentally ill is needed.
- Mental health professionals are recommended to receive training adapted to
community orientation. - The empowerment of users and family members should be supported and promoted.
On the other hand, and as could not be otherwise, the community-based rollout of care and the territorial and psychological outreach (and the stimulation from the healthcare market's consumerism!) have led to a gradual increase in demand that is becoming more complex and more repetitive in terms of visits. A complexity that has highlighted and reiterated the biopsychosocial nature of psychiatric disorders and suffering, which consequently require consensus on a comprehensive, high-complexity care model in which (in accordance with the proposals of the PDSMiAd) prevention is to be prioritized, community orientation, demonstrable practice, and “scientific evidence.” This last requirement is well illustrated by the proliferation of clinical guidelines, many of which are inspired by the American Psychiatric Association's (APA) diagnostic classification of mental disorders; classification and diagnoses promoted from a biomedical perspective and favored and sponsored by the pharmaceutical industry. This fosters a contradiction between the awareness of the complexity of the problems and the corresponding need for a complex response, and the reductionism with which guidelines and protocols are often applied.
Resolutions in the face of the crisis
We ask to stop the cuts and move forward in improving the public mental health network, address the recognized increase in psychiatric morbidity, collaborate in caring for the psychological suffering of the population, and take measures to rationalize the still deficient budget allocated so far to mental health. For this, we consider it necessary:
- Overcome political, ideological, and theoretical resistance that hinders and obstructs the progress of a person-centered, equitable, and quality public mental health model.
- Say no to austerity (“Unfair, ineffective, and inappropriate”: Let's Change Europe! European Manifesto against the Neoliberal Austerity Policy) and yes to increasing taxation on high incomes. Reform of fiscal policy with serious prosecution of tax fraud.
Information from the administration regarding the actual scope of potential cutbacks. - Say no to the budget reduction in mental health, which could represent a version of “socializing losses (in health matters) and privatizing profits.” This is all the more true considering the historically low percentage that the budget allocated to mental health represents within the general health budget.
- Say no to the privatization of entities and services. The mental health network, for technical, efficiency, and justice reasons, must be for public use and management and aimed at the common good of the health of all citizens.
- Restoration of the person, biopsychosocial being, as a subject of knowledge and care. Critical review of the biomedical model as a privileged and exclusive method of study, diagnostic classification, and treatment of psychological and psychiatric problems.
- Increase in the percentage allocated to mental health within the healthcare budget.
- Significant percentage decrease in the budget allocated to psychiatric hospitalization.
- Decrease in spending due to high consumption of psychotropic drugs (not always indicated, antidepressants!).
- Foundations of assistance according to the conceptualization of the Psychotherapeutic Function. Progressive establishment of indicated psychotherapeutic interventions from the Psychotherapy Program in the public network of Mental Health and Addictions (SM and Ad), in Primary Care, and in the specialized Mental Health network.
Extension of specific psychotherapy techniques.
Supervision and support of therapeutic teams, both at the primary and specialized healthcare levels. - Rectify the tendency towards streamlining administration and deregulation in the provision and regulation of services.
Improvement and strengthening of planning, direction, and management bodies, overcoming hospital-centric tendencies and recognizing primary care, both normatively and materially, as the center for reference and management in the follow-up of medico-administrative and therapeutic processes. - To defend and improve the management and operation of services, according to the principles of territorialization, of geodemographic sectors of care that are manageable by professional teams and accessible to the population. Ensuring the allocation of sufficient material and administrative resources, as well as coordination and supervision that makes possible the proper functioning of the mental health network according to the principles of comprehensive care, community orientation, and assertive approach outlined in the PDSMiAd.
- Advance in the establishment and improvement of user, family, and citizen advisory and participation bodies.
Finally, we propose the establishment of a committee with representation from the various sectors involved, for the discussion, development, and consensus of responsible measures in response to the crisis situation presented.