Spain covers an area of some 506 000 km2 and has a population of just over 41 million. It is a high-income country (according to World Bank criteria) and devotes 7.5% of its gross domestic product to health.
Organisation of healthcare
Spain's National Health System has universal coverage and is financed through the general budget of the state, although the system is organised territorially. Healthcare has two levels: primary care, which is the gate into the system, and specialised care, which is managed independently of primary care, although some regions are considering unifying the two. Psychiatric care is part of specialised care.
Around 6% of the population have additional health insurance and can be treated privately, which gives them greater choice in their healthcare. The private insurance companies set limits on the length of psychiatric hospital stays and the number of out-patient consultations per year that can be reimbursed.
Mental health policy and service organisation
The budget, planning and provision of health services are taken care of by each of the 17 comunidades autónomas (regions), which are responsible for their own mental health policies under the framework of the 1986 General Health Law and the 1995 Decree for Psychiatric Reform. The Law on the Cohesion and Quality of Healthcare reinforces the uniformity and standards of the care provided in each comunidad autónoma.
Each of the comunidades autónomas has a mental health plan, framed as part of a general health plan. Social reintegration is a key feature of mental health policy. The details of each region's policy are set out in its plan. There is a specific national plan for drug misuse, which is drawn up by the Ministry of Internal Affairs, since it includes actions pertaining to the control of the traffic in illicit drugs.
For mental health services there is also a general (i.e. national) decree that covers clinical diagnosis and follow-up, pharmacological therapy, individual, group and family psychotherapies and hospitalisation; hypnosis and psychoanalysis are excluded. The cost of all psychotropic drugs is covered by the National Health System.
All comunidades autónomas share the following organisational principles for their mental health services (Reneses, 2003).