Dr. Eduard Vieta: After the lockdown, patients with mental health problems came to us with more serious conditions and later”

Interview with Dr. Eduard Vieta, Head of the Psychiatry and Psychology Service 

Mental health disorders, both serious and mild, are highly prevalent

Is it true that there has been an increase in mental health problems as a result of the pandemic? 

Yes, it is true. We predicted that this would happen and it did.  We have shown that the pandemic and restrictions on freedom have an impact on people’s mental health, and the blocking of primary care and certain processes in hospitals have led to the late diagnosis of certain disorders. People were not going to hospitals, especially during the first wave, because hospitals were seen as a source of infection. Nevertheless, this happened with a lot more specializations and not just with psychiatry and clinical psychology.  After the lockdown, patients came to see us with more serious conditions and later. 

Mental health disorders, both serious and mild, are highly prevalent.  They affect 1 in 4 people in their lifetime.  Therefore, some disorders received worse treatment when the priority was COVID-19. On the other hand, primary care was blocked and the lockdown also meant the people who were already vulnerable became ill.  

You say there were more people, that they sought treatment later, but do you also mean that all of a sudden more people were trying to get help? 

Yes, all three things.  

In women, there has been a sharp rise in some illnesses, such as eating disorders

What type of patient did this happen to? 

It happened more to young people and women. Women are more vulnerable to certain disorders such as anxiety and depression. Men, on the other hand, expression the symptoms in a different way: they have a greater tendency to become addicted, for example.  In women, there has been a sharp rise in some illnesses, such as eating disorders. We are seeing an enormous increase, and also a rise in the number of young people self-harming. 

Is there any explanation for the increase in cases of eating disorders? 

They are mainly young women. Girls who stop eating because they want to get thin hide this when they are at home. However, if they spend more time at home, their parents notice it and this causes more conflict.  

And what about self-harm? 

Self-harm is a way of expressing emotional distress. Causing oneself physical pain helps relieve the emotional pain. We have seen an increase in these cases as a result of the lockdowns. 

There are other factors than can lead to mental health problems, aren’t there? Factors such as the place where you are born and the household income. 

Mental disorders are more prevalent among the lowest income groups and in the most disadvantaged environments. Spending lockdown in a small flat with a large number of people is very different from spending it in a spacious house with plenty of light and access to outdoor space. Psychopathology leads to poverty and poverty leads to psychopathology. 

Mental disorders have always been a great taboo in our society.  Why is that? 

When you have a problem that affects your behaviour, the emotions, your way of relating to other people… it is confused with the ‘I’. Many people make value judgments about people’s behaviour, when sometimes the reason the person is behaving 'strangely’ is because they are ill. For example: if someone is depressed, people might tell them that they are ‘lazy’. If someone is very happy, people might tell them they are a ‘maniac’. Many of the technical terms used in psychiatry have been turned into insults. For example, in the past, a ‘cretin’ was someone with a mental problem derived from hypothyroidism. Now it is an insult. ‘Imbecile’ used to be a technical term. It was used to denote a category of intellectual disability.  These situations are always stigmatized in a negative way.  

Even the treatments you give are, to a certain extent, stigmatized… 

Yes. People think that they can change your personality, that they create addiction… we also have another problem, which is that in psychiatry everyone has their opinion. This does not happen with other specializations. For example, no one dares to give therapeutic advice to a neurosurgeon.  When someone says, "I'm depressed...", everyone wants to chip in with their advice. 

How has the pandemic affected your daily life? 

Right at the very start, and without knowing how the pandemic would evolve, we already realized that home lockdown would end up affecting the population’s mental health. We had to adapt our approach to electroconvulsive therapy, for example. We had to rethink how we managed home hospitalization… It was a change in the way we worked with a very delicate patient profile. 

We also carried out various surveys to analyse how society was coping with the lockdown. This type of tool is very useful because it has given us a lot of information and has allowed us to obtain very interesting data that enable us to rethink how we act. 

At the Hospital Clínic there is an adult psychiatry and psychology service and a child and young people’s psychiatry and psychology service. The activities have to go hand in hand between the two services, don’t they? 

It is the logical evolution in the sub-specialization in psychiatry.  Today, only Spain and Bulgaria have still not approved child psychiatry as a specialization. This is ridiculous! 

At the same time, it is very good that we have these two services at the Hospital Clínic, that we have a neuroscience institute along with the neurosurgery and neurology services.  It makes perfect sense! We work with the same organ. There are other places that are not as advanced.  

Primary care centres have been overwhelmed by the high number of cases that are arriving.  How does that affect you? 

The primary care centres are the gateway to community and specialized mental healthcare. If the primary care centres cannot cope, this has repercussions on the care we provide. At present, the mental health specialists who support primary care centres come from the adult mental health centres (CSMAs), community care units. However, in primary care they would prefer the psychologists, in particular, to be dependent on them, even though that would be a serious mistake. Because they would end up choosing health psychologists and not clinical psychologists and, lacking the necessary training, they would have to take on all the cases of people with mental disorders that come to them.  

If primary care hires fewer professionalized profiles unconnected to the hospitals

In which ways does the coordination of primary care and a tertiary hospital like the Hospital Clínic, for example, need to be improved? 

I am sure there is room for improvement, but what is very clear is that the community care and support model in primary care is the best. In other words, the coordinated work between primary and specialized care.  However, it is true that the specialists and primary care could work together in an even more coordinated manner. Now, if primary care hires fewer professionalized profiles unconnected to the hospitals, we will lose out, and that is the main risk we run. 

Do politicians believe in mental health support policies? 

We have participated in so many advisory boards and so little progress has been made that is it desperate situation.  I have some confidence in the current team. For a long time, we have seen how many professionals whom we have advised in the Government have been used to say they have met us, but afterwards they have done whatever they wanted.  We have had thousands of meetings during which we have asked for certain changes, and when it doesn’t interest them they never do anything. However, when they are interested in something, they present it to you like a done deal and you just have to rubber-stamp their decision.  

It’s a bit frustrating, to be honest.  

This year, the TV3 Marató is devoted to mental illness… 

This will definitely help us. It will help us to break down the stigma a little. There will be investment in research. I have high hopes for it, actually.