“We’re reducing patients’ average length of stay”

Susana Jiménez and Raquel Cuevas are pioneers. Both have broken the barriers of hospitals and opened a new path full of challenges and opportunities. Because they are They are responsible for the first two hospital services of clinical psychology in SpainSeparated by a 40-minute drive.

“Everything started to develop a year ago, in June 2022,” said Jimenez, who is in charge of the new department at the Belvidge hospital at the Hospitalet de Llobregat.

The idea of ​​service came from management“, prides himself on having management that understands the benefits of a team of psychologists working autonomously because the patient won’t notice the change, but the professionals will.

[Guerra abierta contra el Prozac: aconsejan relegarlo solo a los casos más graves de depresión]

Cuevas, for his part, has been a neuropsychologist at Hospital de Granollers for 25 years. “I started working as an assistant in various services, in geriatrics and then in neurology, in the psychiatric service. In October 2017 we became an independent psychology division And, as of July this year, we’ve got all the features of any other service.”

For her, it’s a victory that her center chose to take a step. “I am confident that we will help reduce the average hospital stay.”

If we take into account that there are almost no psychologists in the public health system, the merit of both is even greater. National Association of Clinical and Resident Psychologists, EmpireThe number of 2,800 professionals working in health centers and hospitals is 30% of all clinical psychologists in Spain.

The number cannot grow any further. In the last call for specialty health training placements, There were only 231 Psychologist In-Resident (PIR) posts for 4,146 applicants.. With slightly more than 17 applicants for each post, psychologists, biologists, and graduates found it very difficult to obtain a training position: the ratio was 1.43 in the case of doctors, 4.34 for nurses, and 5.15 for pharmacists.

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Reduce pharmacologic pain

“The data handled by the Ministry of Health is not very comprehensive, but in Spain it is estimated that there are 5 to 6 clinical psychologists per 100,000 people in the National Health System, while in Europe there are three times more between 18 and 20 “, explains Antonio Cano, Professor of Psychology at the Complutense University of Madrid.

“There are almost no clinical psychologists in elementary schools; there are even fewer in hospitals and mental health centers,” he continues. In hospitals, these depend on psychiatric services, which Cano criticizes. “Sometimes collaborating with a psychiatrist is best, but other times it can be disastrous. Why over biological and pharmacological sensibilities, of the environment, most clearly of man? Why are we going to reduce a person’s pain to biological terms when they lose a loved one?”

In general, psychologists in hospitals carry out consultation activities with patients from other specialist services who are beginning to develop emotional problems. If they are long-term earners or older, their importance increases.

[“No estamos sabiendo dar respuesta”: por qué el 75% de los trastornos mentales comienza antes de los 25]

They also carry out health promotion and prevention work in certain areas such as chronic pathology. “These patients are prone to depression, therefore Their treatments have a high probability of relapse and a short life expectancyKano explains.

Belvidge had two specialized autonomous units: Eating Disorders and Pathological Gambling and Other Behavioral Addictions. “They are care activities, research, teaching…” says Susana Jimenez.

Psychologists began to play a greater role in these units “and, from a certain point, we began to direct them.” Jimenez lists last year’s data: 665 first visits, 595 psychological assessment sessions, 6,109 follow-up visits and 468 group sessions. “These units already had a lot of activity” and they were already asking for the next step.

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[Doctor Ferre, sabio de las adicciones: “Miles de mis pacientes han cambiado su vida con antidepresivos”]

The service has a total of ten psychologists, full-time and part-time, and one PIR student. They conduct consultations, care for hospitalized patients, collaborate with specific programs for kidney transplant patients, endocrine patients, etc. It’s not something that was foreign to them, but “what’s new is that it’s all done as an independent service.”

Raquel Cuevas actually asserts that, in general, A hospital is a very hostile place for a patient. “Prolonged stays can cause adjustment disorders.” Even seemingly trivial problems can end up in unpleasant complications.

“We consult a patient who refuses to eat, and on examination he explains that his last experience eating was very painful, he ended up in the ICU because of pancreatitis; then he doesn’t refuse, but that’s it. He’s afraid”.

The psychologist in charge of the team at the Sant Jordi Day Hospital, which cares for patients with memory loss as a result of brain damage, explains that when they started as a unit they carried out 100 to 200 consultations a year. . There were 2,000 people in five years, “We are the second most in-demand service after dermatology“.

[El coste de las bajas laborales por problemas psicológicos podría superar los 2 puntos del PIB en 2023]

Epidemics play a fundamental role in this increase in demand. Three psychologists whose impact and subsequent discussions on mental health have made visible the value of psychologists in all health care fields.

“We worked Monday through Sunday,” Cuevas recalls. “The medical team saw the need to go with the families, to help them through the time of dying, to adapt to the uncertainty that all of that represents.”

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Susana Jimenez considers, From that moment on, mental health began to be understood in a more universal wayAn emotional well-being, a patient’s capacity for resilience and empowerment, is understood to be “not the same as the absence of mental pathology.”

[La falsa muerte de los psiquiátricos en España: hay pacientes que llevan más de 50 años ingresados]

Antonio Cano, for his part, said the pandemic “was a turning point, showing that stress affects us all, in some way we need to talk, socialize with each other, hug and communicate.”

Cano recalled that depression was the leading cause of disability in the world, and that guidelines recommended cognitive-behavioral therapy rather than psychotropic drugs, and that “since there were no psychologists in clinical care, This means that anyone with problems will be treated medically“.

Jimenez has plenty on that topic. “Whether there is somatic pathology or other emotional problems, psychological intervention is the first line of treatment that should be used, and is often not done because of a lack of experts and resources.” With the step taken at Belvidge and Granollers, it is less likely to be resolved.

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