We interviewed Cristina Molina, director of the Directive Plan for Mental Health and Addictions Services of the Ministry of Health of the Government of Catalonia.

What is the current situation of mental health and addiction programmes in Catalunya? What is the most relevant data?

Catalunya exists in an international context, and data from the World Health Organization (WHO) is valid and replicable in our context. Depression is the main mental illness around the world and plays a relevant role in the quality of life of the population. People who suffer a mental disorder have a life expectancy 15 or 20 years lower than the rest of population. Also, suicide is the most acute consequence of mental illness, as well as being a public health challenge. We have data from local data, from the survey Enquesta de la Salut de Catalunya, that identifies the likelihood of the population to suffer from a mental disorder. The data we have got proves that, for instance, people under 15 years of age have a 4% chance of developing a mental disorder, and that the rate is higher in boys than in girls. We have noticed that there is a clear association with social classes and the socioeconomic level: people from the most deprived social classes are more likely to suffer a mental problem.

And in adults?

With adults over 15 years old, we know that 12.4% of them may have a mental illness, and that in this case the prevalence is higher in women.  Above all else, there is more incidence of these illness in people aged between 45 and 64 years, and there is also a clear socioeconomic connection.

Although we are in front of a prevailing issue, I have to say that in Catalunya, and in Spain in general, data shows that the self-perception people have of their mental well-being is very high: 80% of people consider they are mentally healthy. However, the WHO warns that mental illnesses will be a major health challenge in the future, and that in 2030 depression will be the main global cause of disability.

How are integrated mental health and addiction services in primary care in Catalunya?

This integration is very important, and it is also a priority for the European Action Plan of WHO, approved in Turkey in 2013, as well as for the Health Plan of Catalunya where there is a lot of talk on the need to improve the resolution and capacity of primary care to solve and focus on specific types of health problems.

In fact, the Catalan Health Plan concerts several specialties in which mental health plays a role. This is a key element and an integrated care model. Currently, the percentage of people with a mental illness that receive care in primary care is high and it continues to increase. For example, in 2013, the 22% of patients cared in primary care had a mental disorder. We have a very reachable primary care system that allows people to access and, therefore, it is important to provide tools to primary care teams to facilitate the provision of an adequate care to mild mental illnesses.

When did this integration of services start?

This approach started when the Directive Plan for Mental Health and Addictions Services was developed in 2006. In that moment, one of the lines of strategic actions was to coordinate the specialized care with primary care to enhance it and solve the challenge of integration. The goal was to go a step further than the regular medical inter-consultation. This encourages to define a service portfolio model of mental health and addictions in primary care. This portfolio includes inter-consultation between the specialized team and primary care staff; brief and effective psychological interventions in primary care, movement of psychologists specialized to primary care, psychoeducative groups conducted be trained nurses, etc. All these started to be implemented in the whole Catalunya, and currently we are on the 72% of implementation in adults and in a 61% in child and adolescent population.

This integrated approach has decreased the referral in the first visit due to a mild mental problem to the specialised network. That means that in 2014 there was 17% less referrals from primary care to a specialists with regard to the beginning of the implementation in 2006. Therefore specialised services are now more focused on providing care to severe mental illnesses. There has been an increase of patients with severe mental diseases that have received specialised care, as well as there has been an increase of the rate on successive visits of these patients to mental health centres.

We are also working to integrate mental health care with the addictions, as they were two different networks of care, because we find that a person with a mental illness could have an addiction or that addictions could trigger a mental health illness.