—I told Andres, my husband, who was in a well and couldn’t get out by myself, he didn’t have the strength.
For Catalina Sánchez the months of March and April of confinement did not seem to go bad at all. May was already different. As the pandemic progressed, he says, “it was bringing strong consequences.” He decided that he needed a psychologist. This woman about to turn 70 lives in Leganés and the Extremadura accent from Cáceres, where she was born, sneaks into the phone. He suffers from fibromyalgia and ocular myasthenia gravis, a chronic autoimmune neuromuscular disease that generates weakness of the voluntary muscles of the body, in this case, the eye. The confinement, not being able to see his children and grandchildren and the anguish caused by the uncertainty about everything that surrounded the virus did nothing more than “add one and another and another thing.” He assures that he had never thought of going to therapy, but at that moment he knew “it was that or that.” He started going to a psychologist before the summer started, his diagnosis was a depressive picture. Continue with your weekly appointments. It was not the only one.
In April of last year, the WHO already warned that the number of people with psychological problems was going to double due to grief, isolation and the economic crisis. In July, Madrid psychologists scheduled appointments for September because their agendas were overflowing until that month. Something “tremendously unusual”, according to Fernando Chacón, president of the Official College of Psychology of Madrid (COPM). The normal thing, he assures, “is that the private consultations in summer are paralyzed a little. July is coming, people say ‘I’m feeling better, we’ll talk when we return from vacation’ “.
Without closed data, this organization estimates that in the region requests for appointments have risen between 20% and 30%. At first it was anxiety, and then, as the months went by, depression or symptoms of reaching it. Sadness, loneliness and hopelessness are some of the words that define what is happening among the population of Madrid, as in many other territories. On March 28, 2020, just one day after the free telephone number (900 124 365) of psychological support that the Community launched with COPM professionals was activated, they had already answered more than 700 calls.
Although a change is beginning to be perceived, the pattern continues to repeat itself, according to Chacón: these professionals are seen later than is recommended and more women than men do. “The lack of psychological culture” he affirms, does not help what the specialists draw as the next great wave: that of mental health.
Since the pandemic began, the psychologist Mercedes Bermejo, director of a private center in Pozuelo de Alarcón and coordinator of the COPM Clinical Section, assures that the 25 professionals who work with her have perceived a “clear” increase: “The consequence of the The current situation is that humans are exposed to chronic uncertainty prolonged over time, with the need to control, anticipate and plan that we have ”. In the population this generates an “increase in the alteration of moods, diet, sleep, addictions, anxiety … Pandemic fatigue and satiety make our survival capacity take to the extreme”.
From anxiety to depression
When a stressful situation arrives, the brain is activated to solve it. That, Chacón develops, “produces anxiety, and when it is not solved for a long time, the exhaustion phase arrives, and then depression appears as a disorder or its symptoms.” The impact of stress depends on two factors: “The intensity of the stressor (it is not the same as an intensivist in an ICU watching how people die, someone who has lost both parents, who has lost their job or who is affected confinement) and vulnerability (affects more vulnerable people) ”. And it is despair that most leads to depression: “When you see that the situation is negative and whatever you do, you think that you will not be able to change it. That is a bit what has happened with the pandemic ”.
During the first wave, recalls the expert, the “activation of all together to get out of it” happened; later, in the summer, “it seemed that we had overcome it, but the second came and the psychological impact was important, because of the feeling that everything we had done had been of no use”. The same happened with the third. Now “there is the same risk, that it seems that all the effort of February and March is not worth it.” The cumulative effect after more than a year is “dangerous,” he says.
The psychologist says that “disorders in people who did not suffer from them have skyrocketed and obsessive disorders have worsened.” In this evolution, the economic factor is “key”. Madrid closed 2020 with 432,516 unemployed, 27.46% more than the previous year; and with 2.17% fewer affiliates to social security than in 2019. Businesses that close, families that are left without income, unemployed that run out of unemployment, hunger queues … “These are repercussions that are beginning to be seen now, the stress derived from that does not appear immediately, because you can have savings, unemployment, friends to help you or you think you are going to find something soon and that keeps you, ”says Chacón.
When all this lasts too long, as it is already happening, “the psychological effects appear.” And here, the expert introduces the relationship between crises and suicides. They are produced around ten a day in Spain; in Madrid, the National Institute of Statistics figures 349 for 2018, the last year of consolidated data: “The effect of the economic crisis is beginning and is likely to last, we will have to see how it evolves.” In these circumstances, says the psychologist, a strong public system is “important.”
A public network with shortcomings
In the community there are 17,232 registered professionals, the vast majority of them in private consultations; The public network currently has 322 clinical psychologists and 593 psychiatrists, around five and nine per 100,000 inhabitants, respectively, according to the statistics of the Madrid Health Service. Even so, autonomy has been one of the most advanced in this area in the last two decades, it is one of the few that has psychologists in primary care and has doubled the number of clinicians in these years.
But no territory has the ratios that professionals consider optimal nor do they have sufficient investment; a problem that supposes that there is part of the population that does not have access to this care. “There are many families who do not have financial resources for these treatments, which are long and costly and it is difficult for them to adjust more,” says Bermejo. In Madrid, the average price per hour is 50.50 euros, according to the study last fall by the Price Observatory of Mundopsicólogos.com.
The latest report on the year of the pandemic of the Ombudsman, from November 2020, included “the concern about the insufficient attention in this area, which places Spain as one of the most lagging countries in its environment: its shortcomings are being revealed with special intensity in these months due to the impossibility of meeting a very growing demand, related to the psychosocial effects of the pandemic ”. The report warned that since the end of July, “they began to receive more complaints referring to the collapse of activity in different health centers, or the maintenance of the closure of certain local centers and clinics, complaints, therefore, that refer to the overflow of primary care (especially in the Community of Madrid, but also in other autonomous regions) ”.
The region, the one that invests the least percentage of GDP in Healthcare — 3.7%, compared to a national average of 5.6%, according to the latest Public Health Expenditure Statistics of the Ministry of Health— and in primary care and health care. second behind Andalusia (1,262 euros) that spends the least per inhabitant, 1,340 euros, has seen over the last year how the pandemic exacerbated the insufficiencies that already dragged the health centers. In addition, since March 2020 it has closed the emergency services, which supply care in this area during holidays, nights and weekends.
Although the Ministry of Health has not offered data on the waiting list for these patients, a spokesperson explains that in January 2020, 59% of those who came to the Mental Health Services of the Community of Madrid were referred from care primary; that percentage dropped to 34% in March and 11% in April. The pandemic caused a decrease in assistance to the public system. In the following months, referrals from primary care began to recover. In June they reached 42%, “above expectations”, says the spokesman; in August it reached 45% and in October, 50%. From that moment on, the recovery was slower. Remember that the Community has a Mental Health Plan in which “more than 33 million euros” have been invested, in addition to “a Priority Assistance Response Plan in Mental Health in the post-crisis by covid-19, endowed with 3, An additional 5 million euros ”.
A reinforcement that began on June 1, 2020 “and remains in operation with three specific lines of action: care for health professionals, covid-19 patients and relatives of patients or those who died from covid-19,” he concludes. Those 36.5 million euros represent around 0.44% of the budget that the regional Executive managed for 2020 (with the budgets carried over from 2019), 8,165.9 million euros. For professionals it is not enough. Mercedes Bermejo summarizes that “now more than ever, public resources are important so that this pandemic does not leave more emotional damage than the one we are already seeing.”