The pandemic has increased the demand for mental health care by between 20% and 30%, according to data cited by Óscar Pino, coordinator of the Benito Menni adult mental health centre (l’Hospitalet) and member of the Col-legi de Psicologia de Catalunya. The indicators report increases in the number of suicides, in the number of emergencies linked to infant-juvenile mental pathologies, in eating disorders… The rates of emotional distress tend to worsen and, with them, one of the problems that alarms the health authorities: the excessive use of psychotropic drugs.
Original article in Spanish at LA VANGUARDIA by Antoni López Tovar
“We have a problem as a society, which is that we always look for the easy answer first: ‘I don’t feel well, go to a psychologist or psychiatrist, and take a pill’. We are a pill-popping society,” said the Catalan Minister of Health, Josep Maria Argimon. Spain is the country in the world with the highest consumption of benzodiazepines (psychotropic drugs used for mild cases of insomnia, anxiety or emotional disorders) per 1,000 inhabitants, according to the latest report of the International Narcotics Control Board, with data from 2019. The Spanish Medicines Association indicates that 91.07 doses of sedatives, anxiolytics and hypnotics were consumed per 1,000 inhabitants in 2020, an increase of 4.5% over the previous year, and the latest Alcohol and Drugs Survey by the Ministry of Health reveals that 31.1% of Spaniards aged 75 or over have consumed hypnosedatives, with or without prescription, in the last year.
One of the objectives of the reinforcement of emotional health in the Catalan Generalitat’s 2021-2025 health plan is to “de-medicalise a large part of this malaise that the pandemic has exacerbated, but which we must not confuse with mental illness”, according to Minister Argimon.
“We live in a society in which everything has to be resolved quickly, but there are circumstances in life that are inherent to the fact that we are alive. Situations of conflict, work, professional and family difficulties cause certain emotional discomforts, but we should not psychologise or psychiatrisise what is not necessary,” explains Joan Vegué, president of the Generalitat’s advisory council on mental health and addictions.
Where is the boundary between discomfort and pathology? “Sometimes it is blurred. We professionals have the tools to understand that something is an adaptive reaction that involves a certain sadness, fear, uncertainty, but that is not pathology. Exacerbated anxiety, sleeping badly for many days… this is already a symptom, a malaise that generates dysfunctionality and must be treated”, explains Vegué.
The shortest way
A few minutes to see a depressed patient, who even requires medication, and the prospect of a waiting queue for a specialist. The circumstances are ripe for the family doctor to prescribe psychotropic drugs. The incorporation of psychologists into primary care aims to avoid this. Along the same lines are programmes to improve coping strategies. But there is a lack of psychiatrists and clinical psychologists. “I am much more concerned about the lack of accessibility to adequate mental health care than the overuse of drugs,” says Narcís Cardoner.
In Pino’s opinion, the threshold of the illness varies: “It depends on the person, not everything works for everyone, but the frequency and intensity of the symptoms and the fact that they affect your daily life is fundamental. You may not be able to go to work, you may have stopped doing activities that were pleasurable for you.
“If the system were really optimal, we could address many things,” explains Narcís Cardoner, president of the Catalan Society of Psychiatry of the Academy of Medical Sciences of Catalonia. “In a public health system, there are always many attitudes of users that could be corrected: just because you have a fever, you don’t have to go to the emergency room. But the risk of not being able to respond to all needs is currently more important than the percentage of people who make a demand that is not entirely justified”.