Mental health institutes come under scrutiny

Mental health institutes come under scrutiny

21st April 2008, Comments 0 comments

The incident of the mentally ill man who killed his mother is prompting the public to relook at what has been done for this group of people.

Last week a man undergoing psychiatric treatment decapitated his own mother and then walked around town for several hours with her head wrapped in a towel.

Five years ago, a doctor suffering from schizophrenia attacked eight people in the Madrid hospital where she worked, and killed three.

The first reaction from the public is to ask how such tragedies could happen in the first place. Inevitably, the media has asked whether the Spanish health system is able to deal with people whose illness suggests a predisposition to violence.

But the majority of doctors say that the mentally ill, in proportionate terms, are far less violent than the rest of society, and that if they are treated properly, the best place for them is at home.

Nonetheless, many professionals also add that the system is under-resourced, understaffed and under-funded.

Although this is not the case in Murcia, where Angelo Carotenuto murdered his mother. Carlos Giribert, the region's deputy director of mental health says "there is room for improvement, but we have sufficient resources. Carotenuto was under supervision - he had been getting treatment."

So what went wrong? "Aside from being mentally ill, Carotenuto is a drug addict, which makes his behaviour much more difficult to predict." This raises the question as to whether somebody with his problems should be in the community.

But Alberto Fernández Liria, head of the Spanish Neuropyschiatry Association, says that the mentally ill make up just three percent of the population, but "commit much less than three percent of violent crime".

Like most in his profession, Fernández Liria says that the mentally ill are usually victims, and are highly vulnerable. That said, when they do commit crimes, they tend to attract the attention of the media.

It is widely accepted that the mentally ill are more likely to respond to treatment if they are allowed to live normal lives. In 2005, following the initiative of the United States and the United Kingdom,

Spain signed up to the World Health Organisation's Helsinki Declaration on Mental Health, which recommended treatment in the community.

In 2007, Spain launched a mental health strategy that stated: "Many studies show that the community model is more efficient, improves lives, and makes patients and their families happier than undergoing traditional care in mental hospitals."

But the weak point of the new approach is that families of the mentally ill tend to be poorer, less-well educated, un-informed, and given little support.

There are other weaknesses. As the government's new strategy accepts, patients' conditions are often well advanced by the time they come into contact with the health care system. Equally, health centres and hospitals often lack specialist and experienced staff.

Many families now effectively looking after members with mental health problems agree. "We look after our son, but we aren't doctors," says José María Sánchez Monge, the head of FEAFES, the organisation that brings together families looking after dependents with mental illness.

He says that skills training is required, and more support and access to holistic treatments taking in rehabilitation, drug therapy and psychological counselling. He says that at the broader level, more needs to be done to overcome the stigma attached to mental illness.

"These are chronic illnesses, but with the right treatment, people can recover." The good news is that it is possible to supervise treatment of patients at home without overburdening the family, and without necessarily falling into the trap of what psychiatrists call "the revolving door" of constantly returning to hospital for short periods.

A successful case study is the team working in Avilés in Asturias. This pioneering approach dates back to 1999, when the local health service decided to allow serious cases to return home, visiting them in situ.

Out of more than 100 patients, only three have had to be involuntarily admitted to hospital, which is significantly lower than the national level. Such an approach is costly in terms of the personnel required, but is much more efficient in terms of the improvement to peoples' lives.

The problem is that the resources available vary greatly from region to region. There are now seven teams similar to the one in Avilés working throughout Spain. The model is gradually being applied at national level, but there is still a long way to go.

[El Pais / Monica Salomone / Expatica]

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