Mental health: Why Spain has become a nation of self-medicators

To mark World Mental Health Day, we lift the lid on some of the figures that reveal why Spaniards are the world’s biggest consumers of tranquilisers and how they’re struggling to get the help they need.

Published: 10 October 2022 15:04 CEST

Mental health: Why Spain has become a nation of self-medicators

A woman takes a pill. Spaniards are the world's biggest consumers of anti-anxiety medication and the EU’s largest consumers of psychiatric meds. Photo: Danilo Alves/Unsplash

One in every five people in Spain suffers a mental health disorder, from depression to anxiety, and schizophrenia to bipolar disease.

That’s an average which is pretty much on a par with other nations such as the United Kingdom, France and the US, and to some extent dispels the myth that Spain is a happier nation than average.

More worrying however, Spaniards are the world’s biggest consumers of anti-anxiety medication and the EU’s largest consumers of psychiatric or psychotropic medication overall, which includes antidepressants, anti-anxiety medications, stimulants, antipsychotics, and mood stabilisers.

The latest report by the International Narcotics Control Board reveals how Spain leads global consumption of anxiolytics, hypnotics and sedatives with about 2.5 million consumers a day.

According to the Spanish Agency for Medicines and Health Products (Aemps), part of Spain’s Ministry of Health, consumption of meds such as Valium, Trankimacin and Orfidal increased by 4.5 percent in 2020 and exceeded 91 daily doses per 1,000 inhabitants.

Even Spanish Prime Minister Pedro Sánchez tweeted in 2021 that “10.8 percent of Spaniards have consumed tranquillisers, relaxants or sleeping pills” whilst speaking of the country’s mental health crisis.

Benzodiazepines, used to relieve anxiety and insomnia, are reportedly among the most used, so much so that Aemps states most of Spain’s adult population has consumed them sporadically or habitually for the treatment of multiple problems.

“Despite being drugs that are only dispensed with a prescription, they (the consumers) exhibit a large component of autonomy in their use,” Aemps states.

So why is it that Spaniards came to be such large consumers of mental health drugs?

The main reason is that there are very few therapists available: only 6 clinical psychologists for every 100,000 people in Spain.

The average in the OECD countries is 20 per 100,000, in the EU it’s 38 per 100,000.

“The solution is more (mental health) professionals as we are well below average,” Fernando Chacón, vice president of Spain’s General Council of Psychology, told Spanish news site Nius Diario.

“Sweden has ten times more psychologists in the public health system than Spain, and Portugal double the amount.”

In 2018, of the 32,000 registered psychologists in Spain, only 2,300 work for Spain’s public health system.

According to Chacón, mental health drugs don’t cure and simply alleviate people’s symptoms, but the lack of face-to-face contact with a therapist means most are left with little alternative than to turn to self-medication.

Keeping in mind that lower income people are statistically more likely to struggle with mental health in Spain, the lack of professionals working for the state results in long waits for anyone who can’t afford to pay for a private therapist.

Waiting times to see a mental health specialist at a public hospital vary greatly between Spain’s regions, but in some autonomous communities it can be two months or longer.

Additionally, the Covid-19 pandemic has had a “severe impact on the mental health wellbeing of people around the world”, as the World Health Organisation reported in March 2022, and Spain is no exception.

“Since the pandemic, the demand for psychological assistance has increased by more than 20 percent in Spain,” Chacón explained.

A quarter of primary health care visits are now for mental health reasons.

In October 2021, Spain’s government launched a €100-million-budget scheme aimed at tackling the country’s mental health crisis, focusing on training professionals, fighting stigmatisation, early detection, a suicide prevention hotline, and promoting emotional wellbeing as early as in school.

Spain’s mental health strategy had not been updated since 2009 and this latest plan, which will run until 2024, is reportedly a priority for the left-wing coalition government.

There is not enough evidence yet that these plans have had much of an impact, although the project is in its early days.

But schemes such as training more psychologists will take longer than the three years the mental health plan will last.

The government is failing to make good use of the thousands of foreign psychologists it has at its disposal, but which are prevented from working for years due to Spain’s convoluted qualification recognition system. It has also not factored in that private psychologists can earn considerably more than those working for the state.

As things stand, 6.7 percent of Spain’s population is currently struggling with anxiety, the same percentage as those who have depression.

Almost half of 15- to 29-year-olds say they have suffered from mental health problems.

And at least 1 million Spaniards have a “serious mental health disorder” but only half receive treatment for it.

These are the government’s own figures, the reality could be worse still.