Evaluación del modelo comunitario de atención a los trastornos mentales en España

  1. Manuel Gómez-Beneyto 1
  2. Francisco Rodríguez Pulido 2
  3. Virginia Caamaño Sánchez
  4. Antonia Cifre Llull
  5. Francisco Del Río Noriega
  6. Juan Antonio Estévez Salinas 3
  7. Paz Arias García 4
  8. Iñaki Markez Alonso 5
  9. Ana Martínez Calvo 6
  10. María José Lozano Semitiel 7
  11. José María Redero San Román 8
  12. Iván De La Mata Ruíz 9
  13. Ana Sánchez Guerrero 10
  14. Deirdre Sierra Biddle 11
  15. Francisco Villegas Miranda 12
  1. 1 Universitat de València
    info

    Universitat de València

    Valencia, España

    ROR https://ror.org/043nxc105

  2. 2 Universidad de La Laguna
    info

    Universidad de La Laguna

    San Cristobal de La Laguna, España

    ROR https://ror.org/01r9z8p25

  3. 3 Complejo Hospitalario Universitario de Albacete
    info

    Complejo Hospitalario Universitario de Albacete

    Albacete, España

    ROR https://ror.org/04a5hr295

  4. 4 Centro de Salud Mental 1 (Adultos) Puerta De la Villa, Gijón
  5. 5 Zubiok, Instituto Vasco de Psicoterapia, Bilbao
  6. 6 Hospital Clínico Universitario Lozano Blesa
    info

    Hospital Clínico Universitario Lozano Blesa

    Zaragoza, España

    ROR https://ror.org/03fyv3102

  7. 7 Hospital Ramón Alberca
  8. 8 Centro de Salud Mental
  9. 9 Instituto Psiquiátrico Servicios de Salud Mental José Germain
    info

    Instituto Psiquiátrico Servicios de Salud Mental José Germain

    Leganes, España

  10. 10 Centro de Salud Mental Fuente San Luis. Hospital Peset
  11. 11 Servicio de Psiquiatría Hospital Universitario Marqués de Valdecillas
  12. 12 Área de Rehabilitación Psicosocial, Grupo CHM Salut Mental
Revista:
Revista de la Asociación Española de Neuropsiquiatría

ISSN: 0211-5735

Año de publicación: 2018

Volumen: 38

Número: 133

Páginas: 19-43

Tipo: Artículo

Otras publicaciones en: Revista de la Asociación Española de Neuropsiquiatría

Resumen

Introduction: The objective of this study is to evaluate the implementation of the community mental health care model in the Spanish state in 2014. Secondly, we aim to analyze the changes experienced by the model in 2008, in relation to the economic recession. Materials and methods: We adopted the definition of community model proposed in the Strategy in Mental Health of the National Health System; according to which the model is based on 8 principles and is implemented by means of 39 care practices. The Autonomous Boards of the Spanish Association of Neuropsychiatry conducted a survey on the degree of compliance with the community model in each autonomous community. Results: Responses were obtained from 13 Autonomous Boards, which provided information on the 93% of the Spanish population. Conclusion: The most important shortcomings in the implementation of the community model in 2014 were related to the absence of a public health perspective, to poor management and accountability, and a slowdown in the diversification of community-based teams, services and networks.Globally, the model changed little between 2008 and 2014, but some key practices, such as the free and universal health coverage, the sectorization, the shortening of waiting times, the financial support to users and associations of relatives, and the implementation of the "Dependency Act", deteriorated substantially in many autonomous communities. However, other practices, such as the computerization of medical files, individualized care plans (Care Programme Approach), and the assertive community treatment, increased their coverage in some communities despite the recession

Referencias bibliográficas

  • (1) Comisión Ministerial para la Reforma Psiquiátrica. Documento general y recomendaciones para la reforma psiquiátrica y la atención a la salud mental. Rev Asoc Esp Neuropsiq 1985; 5 (13): 204-222.
  • (2) Ministerio de Sanidad, Política Social e Igualdad. Estrategia en Salud Mental del Sistema Nacional de Salud 2009-2013. Madrid, 2011. [Consultado 12-3-2017]. Disponible en: http://www.aepcp.net/arc/SaludMental2009-2013.pdf
  • (3) Ministerio de Sanidad y Política Social. Evaluación (y actualización) de la Estrategia en Salud Mental del Sistema Nacional de Salud. Madrid, 2010. [Consultado 12-3-2017]. Disponible en: https://www.aen.es/docs/Informe-de-Evaluacion_Salud-Mental_CISNS.pdf
  • (4) Ministerio de Sanidad, Política Social e Igualdad. Estrategia en Salud Mental del Sistema Nacional, Actualización 2015/19. Madrid, 2015. [Consultado 14-3-2017]. Disponible en: https://www.redaccionmedica.com/contenido/images/Punto%2017-1 Actualización%20Estrategia%20Salud%20Mental.pdf
  • (5) Killaspy H, Bebbington P, Blizard R, Johnson S, Nolan F, Pilling S, et al. The REACT study: randomised evaluation of assertive community treatment in north London. BMJ 2006; 332(7545):815-20.
  • (6) Nugter MA, Engelsbel F, Bähler M, Keet R, van Veldhuizen R. Outcomes of FLEXIBLE Assertive Community Treatment (FACT) implementation: A prospective real life study. Community Ment Health J 2016;52(8):898-907.
  • (7) Arango C, Bernardo M, Bonet P, Cabrera A, Crespo-Facorro B, Cuesta MJ, et al. Cuando la asistencia no sigue a la evidencia: el caso de la falta de programas de intervención temprana en psicosis en España. Rev Psiquiatr Salud Ment 2017;10:78-86.
  • (8) Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, et al. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10:CD006525.
  • (9) Wheeler C, Lloyd-Evans B, Churchard A, Fitzgerald C, Fullarton K, Mosse L, et al. Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review. BMC Psychiatry 2015; 15:74
  • (10) Goodwin N, Lawton-Smith S. Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management. Int J Integr Care 2010;10:e040.
  • (11) Garcia-Altés A, Argimon JM. La transparencia en la toma de decisiones de salud pública. Gac Sanit 2016;30:9-13.
  • (12) U.S. Department of Health and Human Services. Mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.
  • (13) McCranie A. Recovery in mental illness: The roots, meanings, and implementations of a “new” services movement. En: Pilgrim D, Rogers A, & Pescosolido B, editors. The SAGE Handbook of Mental Health and Illness. London: Sage Publications Ltd, 2010.
  • (14) Slade M, Amering M, Farkas M, Hamilton B, O’Hagan M, Panther G, et al. Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems. World Psychiatry 2014;13(1):12-20.
  • (15) Shepherd G, Boardman J, Burns M. Implementing recovery: a methodology for organisational change. London: Sainsbury Centre for Mental Health, 2010. Disponible en: http://www.workingtogetherforrecovery.co.uk/Implementing_recovery_methodology.pdf
  • (16) Thornicroft G, Szmukler G. Textbook of Community Psychiatry. Oxford: Oxford University Press, 2001.
  • (17) Bennett-Levy J, Richards D, Farrand P, Christensen H, Griffiths K, Kavanagh D. Oxford guide to low intensity CBT interventions. Oxford: Oxford Univertity Press, 2010.
  • (18) Real Decreto-ley 16/2012, de 20 de abril, de medidas urgentes para garantizar la sostenibilidad del Sistema Nacional de Salud y mejorar la calidad y seguridad de sus prestaciones. Boletín Oficial del Estado, núm. 98, de 24 de abril de 2012: 31278-31312.
  • (19) Observatorio de Salud Mental de la Asociación Española de Neuropsiquiatría. [Consultado 18-3-2017]. Disponible en: http://www.observatorio-aen.es