Carolina had been postponing the decision for months, until one day she couldn't take it anymore. "It was in 2019 when I realized that I had to do something to get out of the hole I was in. It was hard for me to get out of bed and go to work, but I had to do it in order to pay the bills." Her ordeal began two years earlier due to a toxic relationship. "It consumed me inside. I cried every day. Now I think about it and I don't understand how I lasted so long without going to the psychologist." In February, Carolina, who is not really Carolina but a fictitious name to preserve her identity, steeled herself, picked up the phone and made an appointment with her primary care doctor. It was the first step for her to be referred to the Social Security specialist.
"The worst thing about that was that he didn't believe me. He underestimated what was happening to me," explains this 32-year-old from Madrid to 20minutes, coinciding with the celebration this Thursday of the World Day to Fight Depression, the main cause of disability, according to the ONU. She left that consultation with even more diminished self-esteem and without the sick leave she needed so much: "I felt like I was useless, like I couldn't solve my problems, but sadness overwhelmed me like a tsunami every day, I felt I couldn't go on with my life".
Should the European Union develop mental health awareness strategies?
Faced with such helplessness, Carolina decided to go to a private psychologist, who wrote a report in which she asked the family doctor for an immediate discharge. "I came back and he gave it to me with that document. He also referred me to a psychologist, the problem is that they gave me an appointment for six months later. Six months! I still don't understand it today."
As the possibility of waiting so long did not contemplate her, the young woman decided to follow her therapy in a private practice. But, of course, those sessions are paid for... and they are not cheap. "He left me 240 euros a month [a session cost him 60 euros and he went once a week] because on the other hand they didn't attend to me," she says, indignant. "Luckily, I was able to pay for it, although I had to make an effort. I don't regret it because thanks to therapy I got out of that hell, but I imagine that many people won't be able to pay for it like I did. And today, my situation has changed, I couldn't afford it again.
Carolina's case is not unique. 10.8% of Spaniards have been diagnosed with a mental health problem. This data, however, is outdated because it is derived from a report from the Ministry of Health from 2017, the last official. In other words, it does not take into account the impact of the pandemic, which, according to several studies, has aggravated problems such as anxiety or depression. One of the most recent, carried out by the specialized health insurer Aegon, points out that 36.6% of the population considers that their emotional state has worsened in the last year, in a context in which 20.6% present symptoms compatible with a possible case of depression "or, at least, moderate depressive symptomatology". The Sant Joan de Déu hospital in Barcelona, for example, treated 47% more mental health emergencies in the first quarter of the year compared to the same period of the previous year.
An "insufficient" system that affects the most vulnerable
The reality of Carolina, which is also that of thousands of people in Spain, is denounced in turn by Fernando Chacón, vice president of the General College of Psychology, in a telephone conversation with this newspaper: "Psychological care in the National Health System is clearly insufficient. The ratio in the OECD is 18 clinical psychologists, while in Spain the average is below 6". These data translate, according to Chacón, into high waiting lists. "It is four or five months in first consultations and the interview period is two or three months because they are saturated."
"it's too late"
The same goes for psychiatrists. The Spanish average per inhabitant is 11 per 100,000, when in the EU it stands at 18. This was stated at the Depression and suicide in Spain conference, organized by the Foundation for Medicine Sciences and Health Products (Fundamed), which featured with the support of the Spanish Society of Psychiatry (SEP) and the Spanish Society of Biological Psychiatry (SEPB), and the collaboration of Janssen. At that meeting, Dr. Celso Arango, president of the SEP, pointed out that the average is also lower in mental health nurses, for which he urged an investment in human resources within the care provided to these pathologies in health public.
This newspaper has contacted the Health Departments of all the autonomous communities, but only Andalusia offers the data: the average delay time was 60 days, that is, two months, in December 2021. That figure, without However, it can be found on the websites of seven other autonomies, such as Madrid, where it stands at 36.28 days. It is followed by Galicia (32.6), Navarra (31), Murcia (28.8), Castilla y León (27), Castilla La Mancha (22.7) and La Rioja (13).
In the Balearic Islands, as detailed by the coordinator of the mental health area at 20minutes, the waiting list was 41 days before the pandemic. Since then, they have managed to prioritize serious mental disorders, although they admit that the delay "has increased" in mild ones. In others, such as Aragón, the specialty of psychiatry does not even appear on the waiting list for outpatient consultations, while the Canary Islands offer the data in absolute numbers: 2,796 patients were waiting to be seen in June.
This situation is precisely what drives many patients to private consultations, because waiting several months when depression is overwhelming is not an option. But not everyone can afford it. "The system is not only insufficient, it is not equitable because the most affected groups, those with fewer financial resources, suffer more stress, more tension, are the ones with the most disorders and are the only ones who cannot afford it," he details. Chacon. “Right now, if it is not for the public one, a citizen has two options: either take out private insurance or pay an average of 60 euros per session for the private psychologist. That means that it will cost you more than 200 euros per month especially at the beginning because it is normal for it to be a weekly treatment. It is absolutely insufficient".
Private insurance, option b
Adeslas, Mapfre, Sanitas… All private health insurances have psychological coverage, although the operation varies from one to another and the consultations have peculiarities. To begin with, many have a grace period, usually six months, which shields certain specialties, such as psychology. Also, not all sessions are free. At Adeslas, for example, patients have 20 annual sessions at no cost... 20 minutes each. For eating disorders, the time is increased to 40 minutes.
Carolina, for example, was able to benefit from this service, but only for a short period of time. "Since they last 20 minutes, she had to put them together to do a decent session," explains this young woman from Madrid, who admits having "ventilated" them right away. She even fused three to make sessions of an hour or two to reach 40 minutes (the recommended minimum). "It worked for me for a while, but if you need to go weekly it's not the solution."
Vanesa Pérez, a psychologist and patient at the same time, agrees with her. "I have private health insurance and I have been using it, but they were shorter consultations than they should be. They lasted between 20 minutes and half an hour. If you follow a long-term therapy, it does not help you much," she reflects. Given this circumstance and the obstacles to accessing the National Health System, this woman turned to a private psychologist. "I was able to afford it, but not everyone can afford it. I have spoken with many chronic patients who cannot. The cost of a chronic patient or a family with a member with a disability is enormous. It is multiplied or tripled by that of any another," he denounces.
For this reason, Fernando Chacón, vice president of the General College of Psychologists, asks that human resources be increased in Spain to solve a "deficient" system: "Psychological intervention should be included in primary care." Oriol Lafau, mental health coordinator for the Balearic Islands, agrees with him: "It has improved a lot, but we don't have everything we should have. There are still many things to do."
REPORTS THAT MAY INTEREST YOU:
If you want to contact 20minutos or make a complaint or make a correction on any issue, you can send us an email to zona20@20minutos.es. You can also subscribe to the 20-minute newsletters to receive the most outstanding news or the printed edition every day.
