The Candidate has no face, no name. He is only The Candidate.
The Candidate has given instructions not to call him on his cell phone because he is traveling to the Congress of Deputies and reviewing his investiture speech. He must master his story, but he is overcome by an impulse to call his wife and travel away from there. He pulls his iPhone out of his jacket and hesitates for a moment, then stops. He looks at the driver's suited back: he decides to name him that in his head, Suited Back. He sits up to make some comment about the traffic, the digestion of lunch, the autumn heat, but he gives up quickly; He sinks his gaze into his briefcase and returns to his speech.
The text suddenly becomes opaque to him and he reviews the number of pages, the balloons of annotations that float between erasures, drawing his attention. Everything seems like an immense shout despite the silence in the cabin of the car, words that surround it, turning it into the apex of all the complaints. The vertex of the four axes that he recites by heart: amnesty, inequality,…
The cell phone rings and something opens in his mind. The Candidate wants to see the name of his wife on the screen, but he finds an unknown number, how can it be her? No one has ever called him on that cell phone without permission from his office, all of his contacts are filtered. He instinctively looks at the driver, as if he too had to express surprise, turn his face, let out an outburst. But the cell phone keeps ringing and Espalda Trajeada only takes it along the Carrera de San Jerónimo in a silence as hermetic as the engine of his Audi A8L.
Say? Answer finally.
The Candidate thought that it could be something serious. Exceptional. Something that could cancel all the plans of the day.
Good morning, Mr. Candidate. My name is Father.
How do you say?
Father, you heard right, I am only Father and I have no face.
You are kidding me? I don't know if you know the number he's calling.
I know, Mr. Candidate, and I apologize for taking a few seconds from you. There won't be many.
If you think I'm going to fall into one of those traps that exist now...
Don't hang up, please. I won't ask you for anything. I just need you to hear a story, a pain. A father's pain.
The Candidate has moved the cell phone away from his face to hang up, but stops his finger.
My son died last Friday. He committed suicide. He was only fifteen years old.
Now he approaches him slowly and asks if he heard correctly. She heard right.
Talk about mental health in Congress, Mr. Candidate. You can't see my face, but now you imagine it. And if you don't imagine it, you should be able to do it when you are president. Fifteen, yes, and four months of waiting to be seen at the mental health center.
Anyone needs to have their story of pain heard and helped, as much as possible, to heal, but it's easy to fall into “I'm just trying not to think about it.” Now, the pandemic ended the old inertia of looking the other way and, finally, mental health is on everyone's lips. The situation is so serious that it has become the main health problem. For example, for young people it is the first of the public policies to improve ahead of employment, education, climate change or the defense of individual rights and freedoms.
There are many topics related to mental health that we could talk to the Candidate about: the increase in mental problems in young people, women and the elderly; how every year a record of suicides and self-harming behavior is broken with an increase in suicides in those under 20 years of age; why employee sick leave for mental health reasons has doubled in the last seven years; of the immoral abandonment of people with serious mental disorders in prisons or the lack of rights of people with great psychological suffering.
We should also tell the Candidate that the use of psychotropic drugs in certain situations is justified and for these people they have been of real help, especially those who suffer from more severe disorders. But what is happening so that a quarter of the adult population in many countries is being prescribed some type of psychotropic drug and the average duration of treatment has doubled in ten years? Why is Primary Care in any autonomous community with records, the prescription of antidepressants has skyrocketed by 400% and depression diagnoses have only increased by 50% from 2010 to 2019? There are autonomous communities that spend half of mental health spending on paying the bill for psychotropic drugs such as anxiolytics, hypnotics and sedatives, antidepressants, antipsychotics or drugs for attention deficit hyperactivity disorder.
There is another issue that hits us hard and that the Candidate must be aware of. The Government of Spain, every four years and since 1999, carries out a macro-survey on women over 15 years of age residing in Spain to find out how many suffer or have suffered some type of violence simply for being a woman. The latest macro survey is from 2019 and offers three dramatic results from the point of view of mental health: i) one in two women, that is, 11.7 million women over 15 years of age, has suffered some type of violence by the fact of being a woman throughout her life; ii) 3.4% (703,925 women) of all women over 15 years of age have suffered sexual violence in childhood (before turning 15); iii) 453,371 women, of the total number of women over 15 years of age residing in Spain, have been raped at some point in their lives.
The physical and mental consequences of this violence are being studied, but we know that they are very important and last over time. For example: i) being a victim of gender violence increases the risk of suffering from anxiety disorders, depression, post-traumatic stress disorders, alcoholism, addictions, eating disorders, personality disorders, self-harm and suicide; ii) people with great psychological suffering are more vulnerable to suffering gender violence. The same thing happens with women from other vulnerable groups such as women with functional diversity or disabilities and migrant women. 70% of women with serious mental disorders have suffered gender violence.
Given that we are in investiture time and that October 10 is World Mental Health Day, allow us to present a brief analysis of the way the political parties grouped around the two candidates approach mental health: PP and VOX. the side of Alberto Núñez-Feijóo and PSOE and SUMAR for that of Pedro Sánchez. To this end, we have analyzed the electoral programs with which they ran for the general elections on July 23. We have also considered the electoral program of Esquerra, Junts, PNV, Bildu, UPN, Canarian Coalition, BNG and the investiture speech of candidate Feijóo presented on September 26. These electoral programs can help us find out to what extent mental health has permeated the political elites.
Our diagnosis has no doubt: mental health appears explicitly in the electoral programs of the four political parties that support or have supported the investitures. This may mean an interest in taking charge of an exceptional time in terms of psychological suffering. The variation of VOX is interesting because in its “100 measures for Living Spain” with which it presented itself in the regional and municipal elections of May 28, mental health is not mentioned. On the other hand, the general program, VOX talks about reinforcing the current National Mental Health Strategy (measure 112), preparing a report on suicide (measure 372) and awareness campaigns on mental health and suicide (measure 373 ). On the other hand, some of its measures such as number 10 (repeal of the comprehensive law on gender violence), number 113 (repeal of the euthanasia and abortion laws), number 114 (suppression of foreign surgical and hormonal interventions from public health) to health: sex change, abortion, euthanasia, etc.), 212 (elimination of free access to healthcare for illegal immigrants) and 375 (repeal of the Trans Law) could increase the risk of suffering from mental health problems in people who lose fundamental rights and currently established benefits.
The ultra party has a special commitment to the elimination of “all public spending related to the Sustainable Development Goals (SDGs) and the 2030 Agenda” (measure 168), the suppression of “all offices for the implementation of the 2030 Agenda” (measure 169) and “all ideological public beach bars such as […] those linked to the implementation of the 2030 Agenda” (measures 172 and 308). This revocation attitude is incoherent.
VOX should know that the United Nations General Assembly, made up of 193 countries, signed, in September 2015, a universal pact for a new way of developing humanity and the planet known as Agenda 2030 with 17 SDGs and 169 goals. SDG 3 refers to health and well-being and target 3.4 focuses on mental health. The elimination of the 2030 Agenda could have negative consequences on the mental health of the population. Their repeal proposals are indefensible.
The PP establishes, in a generic way, the willingness for mental health to be comprehensively addressed. Measure 142 proposes the approval of a new National Mental Health Strategy (ENSM). However, it seems not to be realized that the current ENSM (2022-2026) was unanimously approved by the Interterritorial Council of the National Health System on December 2, 2021 and that it already develops the strategic lines that are claimed in its electoral program such as special attention to childhood and adolescence, suicide, addictions or unwanted loneliness. The popular ones specifically mention the implementation of a National Suicide Prevention Plan (measure 142), a Plan to Fight Addictions in Childhood and Adolescence (measure 170), a National Care Strategy to Unwanted Loneliness (measure 180), a National Plan for Attention to Social and Health Fragility (measure 189), the update of the Spanish Strategy on Autism Spectrum Disorders (measure 202) and, finally, a National Health Plan Physical and Mental through Sports (measure 358).
Candidate Feijóo, in his investiture speech, proposed a State Pact for Families in which the time that minors spend on social networks would be taken into account, “…a problem of the first magnitude. Families know it well. Its effects (sexual violence, suicides, depression...) call us as a society... and I propose to guarantee by law greater barriers to access to technological content by minors." Over time, he recognized that the lack of control over employees' work schedules in Spain had a negative effect on their mental health. Finally, he proposed convening an extraordinary MIR to provide “more mental health doctors in public health, focusing on early care” because “neither the suicide figures nor the consumption of anxiolytics are reasonable. It is clear that this cannot be postponed even a minute longer.” As can be seen, Feijóo's response to so much suffering is above all health.
The PSOE electoral program speaks of the right to universal, public and quality mental health. It assigns it the status of political priority and proposes, neither more nor less, than a State Pact for Mental Health that includes concrete measures related to the maximum waiting time, an increase of up to 30% of places and mutual support and community initiatives. .
The text offers eight new State Pacts and, at least, six of them (mental health, older people, LGTBIphobia, hate crimes, Environmental Rights and culture) along with the updating of the State Pact against domestic violence. Gender has a direct relationship with people's emotional well-being. The socialists also propose a State Plan to address the impact of social networks on mental health in minors, a National Strategy against Youth Suicide and the renewal of the National Addictions Strategy. In short, there are numerous measures related to mental health, especially in girls, boys, adolescents, young people, women and older people elevated to the category of State Pacts, but without a clear management and financing structure.
SUMAR also offers a more holistic formulation with initiatives in care and support, promotion and prevention, as well as rights. For example, it proposes a Mental Health Shock Plan that addresses problems related to psychological suffering from a community, interdisciplinary perspective that is sensitive to the social determinants of mental health. All of this framed in a State Pact for mental health that achieves maximum consensus. They propose a child and adolescent mental health strategy and a state strategy of Zero Restraints to eliminate mechanical restraints and coercive practices in health centers and penitentiary environments. To SUM, community orientation is an inalienable principle.
SUMAR and Junts are the only parties that make proposals to resolve the drama of people with serious mental disorders within the prison system. Junts also demands that the Government finance a mental health telephone line through the Catalan health system.
Esquerra Republicana does not specifically talk about mental health, but establishes as a priority promoting regulations to ensure the mental well-being of users on social networks in terms of training, the fight against cyberbullying and cyber protection. Although the PNV-EAJ does not talk about mental health either, it does propose promoting research and improvements in benefits and services for people with dementia. It also considers necessary “the adoption of measures for responsible use of the Internet and social networks by minors.”
Bildu proposes to multiply the budget dedicated to mental health without specifying by how much and increase the number of resident internal psychologists, ensuring access to free public psychological services for applicants, with special attention to young people. The BNG talks about promoting a mental health plan for young people. The Canarian Coalition wants transfers of State resources to be increased to invest in mental health and an increase in professionals. UPN wants to establish a National Suicide Prevention Plan.
From our point of view, measures based only on attention are necessary, but they seem insufficient. Candidates have to genuinely assume that mental health involves biological, psychological and learning determinants, but also environmental ones or those related to Nancy Fraser's social justice paradigm. Following this author, we should recognize the relevance of redistribution to correct the hemorrhage of inequality in people with psychological suffering, especially the most serious and vulnerable, the recognition of their fundamental rights and the representativeness of any citizen to deliberate on policies. public in mental health. This aspect of governance is the one that is missed the most in all political programs because little or nothing is said about having the participation of the key agents of the associations of first-person experts, family members and professionals, scientific societies, unions. and businessmen, and ordinary citizens. Nor has anyone proposed the creation of some type of management body such as a State Mental Health Agency that brings together and coordinates the proposed policies on mental health, drug addiction and addictive behaviors.
In any case, with some exceptions, the proposals on mental health that appear in the electoral programs point to the possibility of building a State Pact for Mental Health that contemplates at least the increase of professionals related to mental health, the time maximum waiting time, suicidal behavior, specific plans for girls, boys, adolescents and young people, for women in vulnerable conditions, plans in relation to unwanted loneliness, working conditions and new addictions in digital environments. It is a good principle, taking into account the polarization that exists for many issues between political parties and leaders.
We end with another fictional conversation, the one between two chronic losers, the prosecutor Julio Cesar Strassera (Ricardo Darin) and his mentor Alberto Muchnik “Bruzzo” (Norman Briski) in the terrible and wonderful film “Argentina 1985” directed by Santiago Mitre. The transcript reads like this:
-...you're right, no, I agree with you ehh. For fifty years I have been saying that all this is going to shit. A government says it is going to change things and immediately calls the same old sons of bitches. Well, but I tell you something ehh, do you hear me?
-mmm
-Something could go wrong. Someone is careless, right? and a minimal space appears, a slit! It opens and closes, closes quickly. At that moment you have to be inside and there! There, yes! (exhalation) things can be done: the things we couldn't do during the Julio dictatorship. That's how important things were done! They were done with intelligence, with audacity, with fumm sagacity to get in there.
-You are telling me about the story.
-Yeah
-History was not made by guys like me.
-Ahh no! Look, however, you are going to be the prosecutor of the most important trial in the history of Argentina. Take charge. July! July! July! (laugh) I like to see you laugh. Ale (they toast)
Mental health, and life in general, is the defeat and triumph of losers; no human being can call himself a winner.
Rafael Tabarés-Seisdedos is a psychiatrist and psychotherapist, professor of Psychiatry at the University of Valencia and principal researcher at CIBERSAM – ISCIII and INCLIVA.
Rosana Corral-Márquez is a writer, psychiatrist and psychotherapist.
