The Commissioner of Mental Health: “Today's young people are medicalized natives, they speak of their discomfort in medical language”

The psychiatrist Belén González (Yeste, 34 years old) is the first commissioner for Mental Health, a new position that the Ministry of Health created a month ago to address the increasingly frequent (or, at least, more visible) discomforts in the society.

In these weeks she is defining her project, which focuses on structural policies that prevent the suffering of citizens before they have to get to a medical consultation.

With limited powers in healthcare (in the hands of the autonomous communities), her priority in this area is to improve the networks that treat the seriously mentally ill, who "are not being treated as they deserve."

Ask.

The ministry has the authority to call for training places for clinical psychologists or psychiatrists. Do you want to increase their number?

Answer.

Yes, there is an intention to expand the positions in Clinical Psychology and Psychiatry, but it is the communities that have to train these professionals, maintain them and give them tolerable working conditions.

Q.

Spain is far below the European Union, both in the number of clinical psychologists and psychiatrists.

Is the idea to reach this average?

A.

We do not have a number, but we certainly do want to expand them, especially in what there is the most difference with the EU, which are clinical psychologists.

But we also understand that the mental health of the population is not only resolved by adding more psychologists and psychiatrists, not even by adding more of the rest of the professions that are essential in mental health care and that we tend to forget, such as social educators, therapists. occupational, nursing... What we want is to be able to provide a response to psychological suffering that is not based on alleviating the pain when it arrives at the consultation.

For example, work policies, education policies, childhood policies.

The bulk of the suffering right now has to do with living conditions.

Q.

You mention education, youth, work... are you already talking to the respective ministries to implement policies?

A.

We are establishing lines of work.

But society has stated a problem that has to do with suffering: “We are having a bad time.”

And this is being expressed in medicalized terms.

“We have anxiety, we have depression.

"I don't want to continue living."

Because?

Because this language is what legitimizes suffering.

So much so that right now, for them to give you a leave of absence, to be able to rest from your work, the only way is for your family doctor to give it to you.

You have to go with a health claim.

We have converted global suffering into health language.

The commissioner's task is to reverse this, to translate it into political measures.

Why is there so much depression in certain work activities or in certain companies?

If 10% or 20% of a staff is on sick leave due to depression, it is not a mental health problem, that is a work problem.

There we must make work policies and work for fairer and more dignified jobs.

We have to understand what suffering has to do with: with the fact that they have no future prospects, with the fact that their jobs are disastrous, with a situation of hopelessness due to a climate crisis that is not being handled in the way and with the urgency with which It should be handled with the fact that we are watching a genocide on television that we are not addressing in the way we would like and it makes us feel powerless.

If it has to do with all this, we have to take measures that will solve these issues, not prescribing drugs or not doing psychotherapy to be able to better tolerate situations that are intolerable and that have to be changed.

Q.

Aren't these social changes very ambitious for a commissioner of a ministry?

A.

All that is not going to change.

Hopefully.

The commissioner has no power to change all that.

But he does have the ability to point it out, to look at the causes of the discomfort: whether it is housing or work, and ask those who can solve that suffering to be held accountable.

Q.

Can you tell me any specific measurements?

R.

Labor has already started a line on job insecurity and mental health.

We are already working so that we can access more decent jobs that cause much less suffering.

P.

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I mentioned sick leave, are you considering any way that they can be taken outside the clinical setting?

A.

I don't know if we could get there.

It would be a nice idea not to have to justify from another place than just the illness.

What I think is important to point out is that it's not just healthcare workers who can change things.

We are very interested in the mental health of young people, but then they throw tomato soup at a painting that has a glass and we call it terrorism.

No man.

We cannot leave them the only way of expression through healthcare, because in the end what they are going to do is feel sick.

If they cannot protest in another way, if they cannot express their discomfort in another way, they are going to do it through the means that exists and that is the health way.

We are medicalizing social problems.

Belén González, on the Paseo del Prado in Madrid, on February 8.

Jaime Villanueva

Q.

Are there people who think they have a mental illness when really they are just suffering?

A.

Yes, I think we resort too much to healthcare, but I insist, because many times there is no response from anywhere else.

Before, the discomforts were collected within the community, the neighborhoods, the families, the work spaces;

now it is no longer possible.

We have such an individualistic philosophy, of such productivity, that all efforts are directed towards production and profitability and not towards the relationship with others.

Furthermore, with the practically absolute incorporation of women into the world of paid work, what has happened is that the community spaces that were supported mainly by women are falling apart.

When we go to seek comfort, accompaniment, understanding and we go to seek struggle with the rest of the community, we find that there is no community, and what we do is go to the doctor.

Q.

Young people have broken the taboo of talking about mental health.

A.

They talk about mental health like they talk about VPNs [virtual networks to connect to the Internet anonymously].

That is to say, today's young people, just as they are technological natives, are medicalized natives: the language they use to refer to their discomfort is medical.

But they didn't invent this.

It is the language that has been provided to you.

When you say that you have depression, what happens is that you consider that there is a problem within you to face something and you stop asking yourself what is making you feel bad.

Since you already have an answer, you stop wondering what's wrong with you.

This is the problem with diagnoses and that young people are using this language to name their suffering.

Q.

Not only is it a language, there are also many more suicide attempts and self-harm.

Is it part of the same phenomenon you describe?

A.

You have to have a conversation with them, ask what is happening to them and why they are doing this.

Self-harm, which is what we are seeing appear more frequently, does not always have an autolytic purpose, many times it has the purpose of conveying suffering that they cannot tolerate.

Plus, they are now much more visible.

On social networks it is much more exposed, so we are much more aware of it.

What we can't do is just get alarmed and legislate them to stop doing that.

This is what psychiatry has done on many occasions: repress behavior, and it is not the solution.

You have to listen to the suffering and accompany it.

You have to see the origin and resolve the origin.

Ask people what's wrong, don't ask them to stop doing what they're doing.

Q.

Regarding suicide, do you have new policies planned?

A.

What we have realized is that we need better data.

We know some determinants that did influence an increase in suicides, such as lack of integration in the community or being in a situation of gender violence, or even infrequent mental health care for serious mental disorders.

First we need to put in place urgent measures like those that have already been implemented and that the autonomous communities are carrying out.

And, secondly, what is up to us is to improve the information about it to be able to make a better diagnosis and better approach the problem.

Q.

There is a lot of talk about suicide in young people, but if we look at the historical series, there were more in other times.

Actually, those who commit suicide the most are men over 50 or 60 years old.

Do you have any plan against this?

A.

We have a problem in how we experience suffering based on gender socialization.

Men have been socialized in a way in which they cannot depend on others, feel that fragility, feel that they will not be able to have the success they expected.

When their expectations are not met, we do very frequently find suicides in men of that age, because they cannot tolerate the change towards other forms of identity that allow them to get closer, ask for help, be more dependent... Saying: “I can't do it alone.” ”.

Q.

In these years of coalition government, what has been done well in mental health and what has failed?

A.

There have been very important decisions regarding mental health.

The ERTE protected the mental health of the population at levels that no decision about assistance could have done.

The

law of only yes means yes

has protected the mental health of women who suffer gender violence or who are at risk of suffering it more than any intervention within the healthcare field.

The commissioner does not have to make policies from other ministries, but he does have to point out that there are policies that greatly protect people's mental health.

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