1. Twenty-twenty European policies for mental health Piazza Armerina, September 2013
The Mental Health System in Andalucía
(Spain)
Marcelino López Álvarez
Psychiatrist and sociologist
Director of Programs, evaluation and research
Andalousian public foundation for social integration of people with
mental illness (FAISEM)
Sevilla
SPAIN

2. 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 services
Health – social services
Public – private services
Organizational 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

5. 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 Spain
1975, 1986 Y 2007

6. Community Mental Health Services
Mental health Teams or Centers, linked with Primary health care services
Psychiatric units in General hospitals
Little and different Rehabilitation Services
Little 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 provision
Madrid: public founding but private provision
Usually partial public founding and provision by the family associative
movement
Without accurate common information

7. 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

8. The closure of the public psychiatric hospitals in Andalucía (1984-2005)
Hospitals closed (!984-1999) 8
(2.987)
Long Stay Residents in January 1985 2.672
30% “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 %

9. Private and Penitentiary Psychiatric Hospitals
1985 2008
San José (Málaga) 350 350
Sagrado Corazón (Málaga) 350 350
S. Francisco José (Málaga) 200 150
N. Sª Del Carmen (Sevilla) 40 -
Totales 940 850
PRIVATE
1985 2008
Carabanchel (Madrid) 150 -
Foncalent (Alicante) 320 320 ( 32)
Sevilla-II (Sevilla) - 168 (132)
Totales 470 488 (164)
PENITENTIARY (Spanish Gouvernement)

10. 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
F
A
I
S
E
M
S
S
P
A
COORDINATIO
N
COMMITEE .
U
G
C
M
E
N
T
A
L
H
E
A
L
T
H
TRAINING
SERVICIO
ANDALUZ
OF
EMPLOYMENT
SPECIALISED
SOCIAL
SERVICES

11. 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

12. 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

13. Servicios de Salud Mental (SAS) Actividad 2010
Personas 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%

14. Social support services in FAISEM (1)
FAISEM:
Public Foundation (Regional Government of Andalucía
Health
Social Services
Employment
Economy
Participation of Associative movements
Family
Users
Professionals
Social support programs and services
Housing
Occupation
Employment
Support for the Family and Users Associations
Training
Research
Technical cooperation

15. 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)
Occupation
Day Centres, Workshops , and Social Clubs: 156 (3.250)
Social support services in FAISEM (2). 2012

16. FAISEM Budget 2013
Regional Minister of Health and Social Services: 7.670.522
Andalousian health Service: 21.612.313
Dependence Agency (Social Services): 3.874.624
Andalousian Employment Service: 1.150.000
Minister of Education: 400.000
Users contributions (“Taxes”): 3.890.784
Others: 734.125
TOTAL: 39.332.368
Social Firms (2012)
Total income: 12.741.110
% from subsidies: 16,7
Balance: + 1.023.121

17. 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 Departments
FAISEM
Social Services