A suicide attempt and seven months of waiting: "I need to see a psychiatrist, please"

At the beginning of October, Alina González received this message from her family doctor: “Good morning.

I make the referral to the CSMA [Adult Mental Health Center], they will call you and give you the date and time.

All the best".

Since then, this 22-year-old resident of L'Ametlla de Mar (Tarragona), with a long history of depression and several suicide attempts, has written several times to her doctor to make an appointment with the specialist as soon as possible. .

“I need to see the psychiatrist, please”, she asked him in January in the message application of the Institut Català de la Salut.

Almost seven months have passed until, this Friday, she was given an appointment: May 19.

Among other things, Alina was worried about her medication.

She has been without the direct supervision of a specialist for months.

“I have reached a point where I was regulating it myself, because since I have been there for so many years, I know what dose suits me.

This should never be done, but of course, when they pass you by, it is your only option, ”she argues.

For months, he only received long.

The first excuse that her doctor gave for the delay when she asked for an explanation after a few months without news was that Alina herself had asked to be discharged from the CSMA.

In order for them to see her again, she had to start from scratch and return to the waiting list.

“They tell me about absenteeism on your part and, above all, you decided to go to the private one,” the doctor reproaches him by message.

Alina explains that she left the public system to see a private psychiatrist last year due to a profound crisis that led to a suicide attempt.

“Appointments were not enough and I decided to look elsewhere for help.

But consultations cost about 150 euros and I couldn't afford it.

So in October I made another appointment at the public clinic to continue my treatment there, ”she justifies.

This should not be an argument for delay.

Joan Vegué, director of the Mental Health Master Plan of the Generalitat de Catalunya, explains that a person "is free" to choose the path that he considers.

When he returns to the public he should be treated the same and without so much waiting time: "It's not normal."

He assures that he does not know what could have happened in this particular case, but that the wait for this type of consultation "does not usually take more than 15 days."

When the professionals consider that there is a risk, the suicide prevention plan is activated (if admission is not necessary, which is immediate), which has a period of care for 72 hours for those under 18 years of age and 8 days for those older than 18.

Unlike other specialties, the Ministry of Health does not publish the average waiting time for psychiatric patients.

The average in Spain in all specialties is 75 days for a first appointment.

Some autonomies do publish delays in mental health: it is 44 days in Andalusia, 32 in Castilla y León and 38 in Galicia, for example.

But without a systematic collection by the Government, it is difficult to compare data and make them comparable, since they do not even correspond to the same dates.

Spain, in any case, is very far from European standards in mental health care.

There are six clinical psychologists per 100,000 inhabitants in the public network, three times less than the European average.

Every year there are about 200 vacancies for resident internal psychologists (PIR), and to reach these standards it would take more than double.

Psychiatrists are also scarce: 11 per 100,000 people, almost five times less than in Switzerland (52) and half than in France (23), Germany (27) or the Netherlands (24).

Catalonia, where Alina lives, is also below the European average, but it significantly improves the national indicators: it has twice as many clinical psychologists as the Spanish average, and 13.4 psychiatrists per 100,000 inhabitants.

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Mental health, the great challenge

The Catalan authorities do not know how to explain what could have happened to Alina.

“It can be a specific procedural problem, which can always happen in isolated cases.

But primary care doctors have many skills to assess mental health.

The seriousness that a person perceives of his situation is not always what he considers a professional ”, points out as a hypothesis, without getting into the specific case, Aina Plaza, general director of Health Planning of the Generalitat.

But Alina's problem wasn't that her doctor didn't consider her mental illness serious enough to not refer her to a psychiatrist.

At least, that's not what she told him.

She assures him at all times that she has referred her or that she is going to check what is happening.

On March 31, she received the following message: “The doctor [who was supposed to treat her] has left as a reference for the CSMA.

In that change it turns out that a companion will attend in her place.

She joins shortly.

I'll talk to her myself, so she can visit you as she sees fit, at the CAP [Primary Care Center] or at her office.

I understand that on April 25 she joins.

That day I will give you an answer.

In the meantime I hope you continue the treatment and are in good health.

All the best".

The treatment he refers to is an extension of the medication he was taking.

"The family doctor did it without assessment, she simply saw that the treatment had expired and she extended it," says Alina.

A long history of mental pathology

Her mental health problems come from when she was little: “They found me that I was gifted and that made me not fit in with the other children.

I did not know how to communicate well with them, which caused a lot of

.

About the age of nine I first thought of suicide.

Maybe if she eliminated me, who was the one who didn't fit in with the others, it would solve the problem.

I remember one night I walked into my mother's bedroom and told her, 'I'm going to kill myself because I don't fit in this world.'

Since then, he has practically not stopped receiving treatments of all kinds.

Now, he says, he has moments of peaks and valleys, with periods of very strong crisis, without knowing why.

"There are no external reasons that justify it," she points out.

“You suffer from such high anxieties that you probably need too high a dose of drugs, you have intrusive thoughts every day.

Surely people who suffer from chronic depression know what it is.

You're waiting for the train and suddenly it comes to your mind: 'What happens if I throw myself now?'

Or you are walking down the street and you see that you pass in front of the car and the same thing occurs to you.

Or you're sleeping and you wake up thinking: 'What if I take my own life now?

All those thoughts and those crises have alienated her from all her friends.

She paired him with "abusive consumption" of alcohol that set others apart.

“People do not understand that you hurt them because you are wrong.

It's not even that you want to do something, you just don't look at your cell phone anymore, you don't answer calls anymore, you don't want to know anything about anyone anymore.

People eventually get fed up.

It's normal,” she reflects.

Alina lives with her parents and has a partner who "had a hard time" understanding what was happening to her.

She tries to study psychology and international business and work as a telemarketer when crises allow it.

She now she is not in her worst moment.

But, while she waits for her appointment with the psychiatrist in a few weeks, she wants to tell her story because she thinks that if this has happened to a person with a long history of mental health problems and self-harm, "surely" she would not. will be the only one.