Only one in seven people who contact public health for a mental health problem obtain an appointment with a specialized psychologist or psychiatrist in less than a month (14%), according to CIS data. Hopefully the wait will be limited to three months (21%), but the chances of it taking even longer are significant (24%). And the rest? They drop out or turn to private health care. Yes, they can.
At a time when having a regular job is not even synonymous with being able to meet essential expenses, paying for an individualized psychological consultation is almost possible for people with fewer resources. Precarity and the relationship between mental health and employment are the theme of this year’s World Mental Health Day, celebrated every October 10.
In recent years, initiatives have multiplied to try to provide psychological care to those who need it but cannot afford it: migrants in distress, students immersed in anxiety and patients from modest neighborhoods. In reality, these are clinics in which people of all types mix. The classic waiting room, a few wide armchairs and chairs, framed prints, magazines on a coffee table and maybe some relaxing music. Patients waiting for their appointment, each with their own story. At first glance, no one would know who among them can afford standard therapy or who benefits from those programs that attempt to reach those who have the least.
Itiziar Domínguez is a psychologist at Amalgama Social, an association founded almost ten years ago in Madrid. She, who is also a social worker, has been at the center for seven years. The service was born after realizing that many people could not afford the prices set at the private clinic, called NB, where the project originated. “We started offering places completely free. We grew very quickly, so we decided to structure this offer attended by trainees of the master’s degree in health psychology,” he explains.
Thus, NB controlled the cases, which gradually increased. It is for this reason that Amalgama Social also decided to create the Psikevirtual service, a telephone number (912907177) through which psychologists assist anyone who needs to talk. The center adjusts the cost of therapy to the patient’s income and expenses and also accepts donations and contributions to keep the service sustainable. The initiative is made up of 70 psychology professionals and the price range varies greatly: from free therapy to prices of 40 euros to 100 euros per month, which entitle you to a weekly session, even if the majority of patients, they explain, are between 40 and 60 euros and come from the south of the Madrid region.
“At the beginning, people came who had practically non-existent resources, often from Social Security, particularly migrants. Over time, I’ve noticed that younger people are coming now, like students who don’t have money for private therapy, and more women than before, although they still outnumber “They have to go to therapy,” explains Domínguez.
In their experience, the majority of these patients come for mood-related disorders, such as depression and anxiety, but also for grieving processes. According to their calculations, Social Amalgama has around 260 patients and they have benefited from more than 11,000 individualized therapy sessions since their birth.
Leaving therapy for an unstable life
Since 2011, the Mentes Abiertas clinic has also offered this service to people with fewer resources. Although three recently graduated psychologists began this journey, today it is professionals with at least two years of experience who care for patients. “Thousands of patients and more than a hundred psychologists have passed through here. We not only want people to go to therapy, but to maintain it,” says Nacho Calvo, one of the directors. In the case of this entity, they charge around 40 euros for a one-hour consultation, while in the private sector they can reach up to 100 euros.
The socio-economic instability of the poorest people also has an impact on psychological care: “They experience such complex situations that many people abandon therapy when they find work due to incompatibility of relationships. hourly. This generally does not happen among people who can afford a private life, who access it with a stable job and schedules that allow them to organize themselves,” adds Domínguez.
“Many people have problems with anxiety, emotional management and conflicts, especially moods. Traumatic experiences and eating disorders are something more specific,” describes Calvo. The psychologist defends that income level has a direct impact on people’s mental health. “This is a very significant source of overload and stress, aggravated by the limitations of public health, where doctors, without having time to treat you, usually provide you with medication to relieve pain only with substances,” he emphasizes.
According to data managed by the Official College of Psychology of the Valencian Community, at the national level the ratio of psychologists per 100,000 inhabitants is five or six professionals, much lower than that recommended by the Organization for Economic Cooperation and Development, which underlines that there are 18 psychologists per 100,000 inhabitants. One of the biggest public health problems is the waiting time to access a psychological consultation. “Often people have to wait weeks or even months, which can make their problems worse,” says Paula Muiños, general health psychologist and member of the board of directors of the college entity.
Same problems, fewer resources to deal with them
“The problems that these people experience are generally similar to those of others, such as anxiety about living, grieving processes, feeling of uselessness, depression and a feeling of inadequacy or mediocrity,” explains Juan García- Bouza, general health psychologist. He began serving underprivileged people in the capital Tetouan after completing his formal training in 2014. “My experiences and calling to service somehow motivated me to give back what I learned to society “, he remembers.
At that time, García-Bouza charged around 10 euros for a one-hour session. He nevertheless states that “therapies are expensive compared to current salaries, because the financial situation remains a handicap and many people have to juggle and split hairs to be able to go to the psychologist once a week, as many do “. therapists tend to compromise.
Rosa Domínguez, psychologist at the Ágora Relacional training center, located in the Madrid district of Chamberí, remembers that about ten years ago they started with a service aimed at people with limited economic resources. “We found that public health care was not enough and that private health care was exclusive because of its prices. So we started offering some places completely free,” he explains. But saturation prevented them from maintaining this service.
From their perspective, these types of patients came to the clinic with the same problems as anyone else. “A senior manager with a good salary can also suffer from depression, even if there are certain social statuses in which these problems are accentuated,” comments the therapist.
Ways to decongest public health
Muiños demands that the figure of the psychologist be included in primary care, something “key” because “it facilitates access to psychological treatments without having to go through long waiting lists or complicated references”, according to his own terms. In this way, it requires that school psychologists also be integrated into schools and institutes to identify and prevent various problems.
This would avoid saturation of the health system. On the other hand, he considers that there is “the need to incorporate psychologists into the primary care of social services, since their deficit does not allow specialized care for families at risk of social exclusion”. Domínguez points out that, in any case, if a person who cannot afford therapy needs help, “there are more and more psychologists and psychiatrists in hospital emergency rooms.”
“The service vocation of psychologists can play a key role, since many professionals decide to dedicate part of their time voluntarily or with low remuneration to contributing to the mental health of those who need it most,” explains Muiños, who, however, considers the weight the situation must not rely on volunteering. “Psychological care should not be a luxury or a whim, it is a necessity and a right that must be guaranteed. »
