Setting a new standard for mental health care in Spain

When it comes to improving mental health, we must tackle the social determinants – from insecure housing to gender-based violence – alongside providing better access to treatment. With this in mind, Spain is taking a comprehensive approach to improve its citizens’ well-being

The Covid-19 pandemic has highlighted the importance of mental health, placing it at the centre of global health priorities. In Spain, the Ministry of Health has taken decisive measures to address this issue, recognising its fundamental role in the population’s well-being. As the world moves towards post-pandemic recovery, the need for a comprehensive approach to mental health has become more urgent.

Covid-19 has not only exacerbated pre-existing mental health vulnerabilities but also revealed the necessity for health systems to address these issues directly and sustainably. Mental health is not merely an individual matter; it is intrinsically linked to social, economic and political factors. In a context where labour pressures, housing insecurity, gender violence and other social stressors increasingly affect individuals, the Spanish government has recognised that the mental well-being of its citizens is a public health issue.

Paradigm shift

To this end, the Ministry of Health has taken a significant step by establishing a commissioner for mental health. This pioneering initiative in Europe reflects Spain’s commitment to addressing mental health through cross-cutting public policies. The commissioner is tasked with ensuring that mental health policies are integrated across various domains such as employment, education and gender equality, acknowledging the multifaceted nature of mental well-being.

Spain adopts a comprehensive approach to mental health, recognising the influence of underlying social factors such as precarious employment, gender inequality and the erosion of community support networks. In response, the Ministry of Health is committed to a paradigm shift, promoting a holistic approach that combines clinical support with policies addressing these social factors.

The government is updating its mental health strategy through to 2026. This strategy, based on the successes of the 2021 Action Plan, aims to further integrate mental health within the broader framework of the social determinants of health. A key component is the depathologisation of everyday mental distress, acknowledging that not all psychological suffering requires diagnosis or medical treatment. Instead, the focus is on strengthening social support systems, balancing work and personal life, and viewing mental health as a shared responsibility.

One of the main challenges is the overwhelming demand on the mental healthcare network. Waiting lists and a lack of resources have led to precarious working conditions for professionals. In response, the number of training positions in clinical psychology and psychiatry has been increased, and the specialty of child and adolescent psychiatry has been created. However, it is crucial to improve working conditions to prevent the loss of professionals and ensure dignified care. The Ministry of Health is also collaborating with the World Health Organization’s European regional office on a survey of mental distress among healthcare workers.

Another important aspect is the medicalisation of social problems. There is often a reliance on psychotropic medications, instead of addressing the underlying issues affecting mental health, which contributes to system overload and renders social problems invisible. We are implementing a comprehensive plan for the deprescription of psychotropic medications and promoting social prescribing as an alternative. This approach aims to connect people with community resources, such as support groups and social activities, rather than relying solely on pharmacological treatments.

A comprehensive view

The integration of mental health into broader health and social policies reflects a growing recognition of its importance. By aligning mental health initiatives with other areas such as housing, employment and education, Spain is working to create a more cohesive and supportive environment. This alignment is essential for addressing the complex interplay of factors that contribute to mental health issues and for fostering a society where individuals can thrive both mentally and emotionally.

Protecting patients’ fundamental rights is a priority. We must eliminate practices such as mechanical restraints and non-consensual pharmacological treatments, to foster a culture of care that respects patient autonomy and rights. The mental health commissioner is working on an ambitious project to expand and ensure these rights, including regulatory changes, professional training and collaboration with autonomous communities to adapt the service portfolio to a rights-based perspective.

Moreover, suicide is a major concern for the Spanish government. Each case represents extreme suffering that we must prevent. We are developing a specific plan for suicide prevention and enhancing existing projects, such as the 024 assistance line, with recommendations for health services available to users.

In conclusion, Spain’s commitment to mental health in a post–Covid-19 world is comprehensive and recognises that mental health is key to overall well-being. We need to integrate mental health into all policies because those policies determine rights, quality of life, access to recovery and protection for everyone. By addressing both immediate needs and underlying social determinants, Spain is setting a new standard for mental health governance. Through its ongoing commitment and innovative policies, the Ministry of Health aims to build a more resilient and mentally healthy society.