Spanish psychiatric reform: what can be learned from two decades of experience?

Abstract

OBJECTIVE: The objective of the paper is to describe the impact of Spanish psychiatric reform on the organization and functioning of mental health services. METHOD: This paper is based on official administrative reports and on relevant related publications. RESULTS: The most significant achievements of Spanish psychiatric reform have been: (i) the development of a new organization of mental health care, decentralized in character and territorially based; (ii) the integration of psychiatric patients in general health care; (iii) the creation of an extensive community network of health centres; and (iv) the development of more positive attitudes towards mental illness. However, our analysis also reveals the existence of significant deficiencies. CONCLUSION: Analysis of the Spanish experience shows that the process of psychiatric reform depends basically on long-term commitments, which in a system such as Spain's must come from central administration and also from the autonomous communities.