The lack of coordination between Social Services and Health left the man with Diogenes syndrome of El Prat helpless

No one knows why a 48-year-old man, about 250 kilos in weight and with a history of mental health problems, who had not stepped on the street for years, had to end up calling for help while lying for days on the floor of his apartment without eating or drinking, among tons of waste and garbage. Alejandro B. lived alone in El Prat de Llobregat (Barcelona) and was rescued on Thursday by firefighters and an excavator after calling the emergency service: "I am not well," he said. Neither the City Council nor Health followed his trail since 2015, when the municipal social services closed his file and stopped collecting his medicines, despite the alerts of the neighbors.

What went wrong so that someone who entered the radar of social services in 2003 ended up living in his own excrement 20 years later? "This is a very particular case, but it raises the need to integrate the intervention of the various services of the administration, especially in social and health issues," claims Mariona Puigdellívol, general director of Entitats Catalanes d'Acció Social (ECAS). The Generalitat approved in February the deployment of Integrated Social and Health Care, which aims precisely to avoid cases like this and group two areas that traditionally work in a fragmented way. "In this way we guarantee that someone raises the alarm," Puigdellívol defends.

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Firefighters rescue a man of 250 kilos trapped among the garbage in his apartment in El Prat

The City Council defends that in recent years it did not obtain enough information to reopen the file, closed in 2015. "There were no indications," argues Arnau Garcia, head of social and community action in El Prat. "He does not make any demands and we do not receive information that alerts us to a serious case." When the emergency services appeared three times at his house between 2018 and 2022 alerted by neighbors, who claimed not to know anything about him, the alarm was not activated because the man assured by phone that he was fine. "The most complicated thing is to detect the cases that require help," Garcia continues. Nor was any protocol activated in Health when Alejandro B. stopped collecting his medications.

The Mossos d'Esquadra suspect that Alejandro B. was trapped when a pile of garbage from inside the house fell and blocked the door where he collected the food he bought online. With hardly any mobility, he asked for help for the first time in eight years. "The City Council carried out several interventions between 2012 and 2015, until his situation was normalized in social terms: he has routines and goes to work," insists Garcia. The man was a computer scientist in a company around the airport, but the Consistory does not know if he was currently active and an airport spokesman could not confirm it either. Neighbors had seen him go back and forth to work in a van before the pandemic, but then lost track of him because he stopped leaving the house.

Experts claim to develop guidelines to know when the system should intervene in patients with Diogenes syndrome, a pathology that leads people to accumulate goods by "a great emotional attachment to objects," according to David Córcoles, psychiatrist of a home care team at the Hospital del Mar. The pathology turns neighbors into indirect victims by living with bad odors, insects and dirt, and can be a collective affectation. "If there are complications for the community, which is usual, we have to intervene with mediation," defends the psychiatrist, "but sometimes the administrative steps are too slow." In the case of El Prat, neighbors say the situation was sustainable because Alejandro B. lived with doors, windows and shutters closed.

According to Córcoles, there are currently about 300 people with Diogenes syndrome between Barcelona and L'Hospitalet de Llobregat and the total figure is much higher: "It is an issue that develops behind closed doors, which is not seen," argues the psychiatrist, who ensures that the prevalence of this pathology can reach 5% of the population. "It seems like a lot, but it's like that," he defends.

How far can and should the administration go in caring for people? "In people with full capacities, the will is always theirs," says Garcia. "It is a similar case to that of some homeless people, who prefer to continue sleeping on the street despite the fact that alternatives are offered," he compares. Puigdellívol agrees: "The system has to guarantee the rights of its citizens, but it cannot impose an intervention."

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