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How are people suffering Mental Health Crisis helped in Spain?

Are there any inpatient services for people with mental health problems, and those with learning disabilities?

As a Registered Mental Health & Learning Disability nurse, we saw the evolution of inpatient and community services for both Mental Health & Learning disability clients. Initially People with mental health or learning disabilities were care for in large institutions, normally the old poor house or work house, where exploitation, cruelty and experimental treatments, patients were expected to work for food, and keep. A number of people were dumped at the gates of the poor/workhouse by relatives who saw them as liabilities, one that I know, was told as a child he was going on holiday and remained until the closure of the hospital in the late 2000s.

Despite the closure of the majority of inpatient services throughout the UK, the demand for inpatient services haven't reduced, in fact they have increased particularly with the recent pandemic, and the social isolation, and debilitation of COVID-19. Although Large institutions have their faults, they also had their benefits. The provided places of safety for thousands of people who were in crisis, with 24 hour supervision for some of the most vulnerable people their communities have to care for. For people with learning disabilities, the large institutions were home for them, yes they had many pitfalls, but equally they provided patients the opportunity to have freedom within the grounds of the hospital, be productive with meaningful occupation, particularly within the purpose built occupational services. Even though they only received a pitance for the work they performed, that experience gave them their own self esteem, belief in themselves and community presence. On the other hand, large mental institutions who equally gave users the opportunity to learn new skills that can be put to good use once in the community have been lost.

Working in medium sized special hospital, again in times gone by allowed patients, even those patient who had very high adverse risk assessment with using tools. Obviously, risk management was of high priority, but it never prevented patients from being fully involved and productive. We tend to forget that although have mental health or learning disabilities they can equally contribute to society regardless as to where that society is. We have become to political and have a low expectation of peoples community presence and participation. There should be an expectation as is with others, for people to participate in community work, improving skills, increasing motivation, and self esteem.

The treatment of people in the community albeit admirable, tends to fall well short of the peoples need. Now people in crisis have to go to an emergency department for assessment, before being discharged home without any real supervision. There is not enough staff to support all of the clients in the community, provide them with meaningful collaborative care plans, or community presence for people with learning disabilities. Community Care although is a

fantastic concept is really an inoperable government policy with poor planning, implementation and lack of concern for the impact that the changing care provision has on its users.

So I've started the conversation, I would love to here your experiences of using services in the UK and what if any contrast there is with mental health services here in Spain.

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