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Twenty-twenty European policies for mental health Piazza Armerina, September 2013
The Mental Health System in Andalucía (Spain)
Marcelino López Álvarez
Psychiatrist and sociologistDirector of Programs, evaluation and researchAndalousian public foundation for social integration of people with mental illness (FAISEM)SevillaSPAIN
Introduction:
Spain don’t have “one” mental health system
In fact we have 17, because we have 17 regions (Autonomous Communities), each of one has their specific mental health system
Psychiatric hospitals – community servicesHealth – social servicesPublic – private servicesOrganizational models and professional orientation (biological – community and psychosocial)Role of associative movements (Family and Users)
They have only some little common aspects
Some general legislation
Formal integration of health services in the National Health System
Negative effect of the current restrictive policies to manage the economic crisis
Hospitals and Clinics
Beds
Reduction (%)
1975 120 44.034
1986 98 32.493 26,2 %
2007 99 16.028 50,7 % (1986)63,6 % (1975)
Psychiatric Institutions and beds in Spain1975, 1986 Y 2007
Community Mental Health ServicesMental health Teams or Centers, linked with Primary health care services Psychiatric units in General hospitalsLittle and different Rehabilitation ServicesLittle and different social services (residential and day support) and employment programs
A formal Common “Mental Health Strategy” from the National Health System
Usually there is not separate funding in Health services
Usually not public provision in social and employment services and programs
Andalucía: public provisionMadrid: public founding but private provisionUsually partial public founding and provision by the family associative movement
Without accurate common information
Andalucía is one of the 17 Regions (Autonomous communities) of Spain
8 provinces
18% of the territory and the population
Traditionally «less developed»
Psychiatric Reform 1984:
Closure of the 8 Public psychiatric hospitals:
Mental Health services integrated in the Andalousian Health Service (SAS)
Social support resources in a public foundation (FAISEM)
Andalucía Spain
Territory 87.561 Km2 504.540 Km2
Population 8.400.000 47.000.000
The closure of the public psychiatric hospitals in Andalucía (1984-2005)
Hospitals closed (!984-1999) 8 (2.987)
Long Stay Residents in January 1985 2.67230% “Elderly “ (>65 years) 30% “Mental Disability”40% “Chronic”
Admissions 1985-1999 315
Dead during the period (19852005) 813
Discharges includes in the study 2.174
Own and family home 5,3 %Nursing homes for elderly people 37,4 %Residential homes for people with Mental Disability 26,8 %Specifics accommodations 24,0 %Private Psychiatric Hospitals 0,6 %Penitentiary Psychiatric Hospital 0,4 %Homeless 0,6 %Others 1,1 %Unknown 3,8 %
Private and Penitentiary Psychiatric Hospitals
1985 2008San José (Málaga) 350 350Sagrado Corazón (Málaga) 350 350S. Francisco José (Málaga) 200 150N. Sª Del Carmen (Sevilla) 40 -
Totales 940 850
PRIVATE
1985 2008Carabanchel (Madrid) 150 -Foncalent (Alicante) 320 320 ( 32)Sevilla-II (Sevilla) - 168 (132)
Totales 470 488 (164)
PENITENTIARY (Spanish Gouvernement)
The Mental Health System in Andalucía
PERSON
FAMILY
COMMUNITY
USMI
UHSM
CT
HD
URA
UCSM
PRYMARY HEALTH CARE TEEMS COMMUNITY SOCIAL
SERVICES
LITTLE RESIDENCE
APARTMENT
HOME SERVICE
SOCIAL CLUB
WORKSHOP
SOAE
S FIRMS
FAISEM
SSPA
COORDINATION
COMMITEE .
UGC
MENTAL HEALTH
TRAINING
SERVICIO
ANDALUZ
OF EMPLOYMENT
SPECIALISED SOCIAL SERVICES
The organization of Mental Health system into the Andalousian health “Mental Health Departments” (Clinical Management Mental Health Units) that depends from the Medical Direction of one General Hospital
Community M H Unit
Mental Health Services in the General Health Service
24 Mental Health «departments»
Community Mental Health Units: 76 (1 /108.000)
Hospital (short stay) Units (General Hospitals) : 19: 560 beds (6,8 / 100.000)
Therapeutic Communities: 14: 240 beds (2,9 / 100.000) 420 day places (5,1 / 100.000)
Child and adolescents Units: 14: 40 beds (0,4 / 100.000) 250 day places (3,1 / 100.000 )
Day Hospitals: 11: 264 places (3,2 / 100.000 )
Rehabilitation Units: 9 :305 places (3,7 / 100.000)
Mental Health Emergences Services in 19 General Hospitals
Servicios de Salud Mental (SAS) Actividad 2010Personas atendidas: 198.995
Primeras consultas: 97.214 Total consultas : 842.356 Distribución diagnóstica:
Neurosis/ T. de Personalidad: 46% Esquizofrenia y ots. Psicosis 14% T. Afectivos: 27% T. Infancia y adolescencia: 6 % T. Orgánicos /Disc. Mental/ ots: 5% Drogodependencias 2%
Hospitalización de corta estancia (USMHG): Ingresos totales: 10.262 Estancia Media: 15’9
días Indice de Ocupación: 94,0% Distribución diagnóstica:
Psicosis : 60% T. personalidad: 12%
Social support services in FAISEM (1)
FAISEM:Public Foundation (Regional Government of Andalucía
HealthSocial ServicesEmploymentEconomy
Participation of Associative movementsFamilyUsersProfessionals
Social support programs and servicesHousingOccupationEmployment
Support for the Family and Users AssociationsTrainingResearchTechnical cooperation
Housing
“Home- House:” (20 places, 24 hours) 57 ( 940) (10,2 /100.000)
Apartments (3-4 places) 197 ( 753) (9,1 / 100.000)
Home support: 585 (7,1 / 100.000)
Employment
Vocational Guidance and support teams: 8 (2.400)
Training Courses: 53 (261)
Supported employment 321 Social Firms 10 (305 workers with SMD)
OccupationDay Centres, Workshops , and Social Clubs: 156 (3.250)
Social support services in FAISEM (2). 2012
FAISEM Budget 2013
Regional Minister of Health and Social Services: 7.670.522Andalousian health Service: 21.612.313Dependence Agency (Social Services): 3.874.624Andalousian Employment Service: 1.150.000Minister of Education: 400.000Users contributions (“Taxes”): 3.890.784Others: 734.125
TOTAL: 39.332.368
Social Firms (2012)Total income: 12.741.110% from subsidies: 16,7Balance: + 1.023.121
Coordination (Mental Health services and FAISEM)
Andalousian Mental Health Plan
Severe Mental Disorder Care Protocol
Personal care protocol
SMD Coordination Commission in every Mental Health “department”
Provincial and Regional Coordination Commission
Mental health DepartmentsFAISEMSocial Services