DOUS ANOS DE PLAN DE SAÚDE MENTAL DE GALICIA POSCOVID-19: INSUFICIENTE EN RECURSOS, INSUFICIENTE EN RESULTADOS. SUSPENSO EN DEREITOS

En xuño de 2020, o entón presidente da Xunta de Galicia, Alberto Nuñez Feijóo anunciaba “o maior plan de saúde mental que se fixo desde a transferencia do Sergas”, cun investimento previsto de 83 millóns de euros e o aumento de 241 novxs profesionais ata o ano 2024.
Anunciaban a súa aprobación unhas horas antes de iniciarse a campaña electoral ás eleccións galegas nese ano, e insistían en chamalo “Plan de saúde mental de Galicia poscovid-19” (en adiante, PSMG) porque adecuaban a inversión económica e de recursos ao contexto da crise sanitaria na que estabamos inmersas con toda a súa crueza neses primeiros meses, e así facer fronte ás previsibles repercusións psicolóxicas da covid na sociedade galega, de aumento do malestar emocional e unha maior demanda de atención na sanidade pública.
Disque fixeran os cálculos tendo en conta este escenario de gravidade, no que parecía que estabamos preparados para afrontar.
Dous anos despois, nada se sabe da memoria anual de seguimento do PSMG, malia que o propio plan establecía a súa avaliación periódica, a través de memorias de seguimento dos seus proxectos (proxecto 12 do Eixo nº 5). Non é posible, entón, fiscalizar a implantación das medidas, nin avaliar a actividade da Administración galega nese eido.
Temos anuncios. Temos promesas. Temos declaracións.
Temos algúns avances. Existen novos dispositivos en funcionamento, aínda que de forma desigual nas diferentes áreas sanitarias e con diferente calendarización sen que haxa un criterio clínico; sería o caso dos hospitais de día infanto-xuvenís, programados en diferentes etapas temporais e cun atraso dun ano con respecto ás previsións iniciais; ou os programas de prevención do suicidio, que a día de hoxe non existen en todas as áreas sanitarias. Creáronse novas unidades de saúde mental de adultxs e infanto-xuvenís, e tamén programas de psicoxeriatría e sociosanitarios
Anunciaron, hai poucos días, a contratación actual de 117 profesionais de saúde mental desde o inicio do PSMG.
A piques de cumprir dous anos do plan, no ecuador da súa execución, debera facerse unha valoración do mesmo. Tarefa en extremo difícil dado que non existe informe oficial de seguimento.
Pola nosa parte, só podemos cualificar negativamente a valoración do PSMG, sendo desalentador e preocupante a evolución do mesmo.
1.- Insuficiencia de recursos para a atención en saúde mental desde os servizos públicos
En 2019, o MGSM publicou un documento elaborado por un grupo de traballo onde se recollían os recursos humanos que existían nese momento, as previsións que realizara a mesma Xunta de Galicia 25 anos antes, e as propostas dos diferentes colectivos profesionais para a mellora na atención.
Cando se publica o PSMG en 2020, alertamos que o aumento proposto polo goberno da Xunta non chegaba á metade do necesario. Prevén a incorporación de 241 profesionais ata 2024, cando se necesitaban arredor de 560 traballadorxs. E iso en previsións conservadoras de 1997, cando non pasáramos pola crise económica de 2008 e a crise sanitaria de 2020, e o forte aumento da demanda de atención que vimos experimentando nos últimos anos.
En maio de 2022 contabilizan un total de 117 novas contratacións nos dous primeiros anos, incumprindo os seus propios prazos. Neste ano deberan ter contratadxs 163 profesionais, e non hai que esperar a finalizar o ano, dado que o orzamento anual xa está aprobado.
Os problemas aludidos polo Executivo para a cobertura de postos específicos en determinadas categorías non responden ao déficit de profesionais formadxs, senón á desmotivación, á precariedade e ao desasosego do persoal de saúde no país. A tal respecto cómpre sinalar que a estabilización de persoal, o recoñecemento da carreira profesional e a dignificación das condicións de traballo vén de se producir a golpe de sentenzas, europeas e do Tribunal Supremo, e só despois da loita do persoal polos seus dereitos. O entorno SERGAS favorece a perda de traballadorxs, é irrespectuoso coa conciliación e os descansos e, en definitiva, non resulta atractivo e atraínte.
Por outro lado, a creación e posta en funcionamento de unidades, programas e proxectos é moi desigual nas distintas áreas sanitarias, non se sabe por que motivos, tal e coo sinalamos anteriormente. A destacar, sendo como é unha prioridade urxente, o aumento dos esforzos dirixidos á prevención do suicidio. A día de hoxe non temos programas en todas as áreas e nalgunha delas incluso se perdeu, alomenos temporalmente, como foi o caso de Pontevedra.
Os recursos de atención comunitaria seguen a ser extremadamente deficitarios, tanto para a poboación infantil, como a xuvenil e de adultos. E o programa de enlace de psicoloxía clínica en Atención Primaria é anecdótico. Existen 462 centros de saúde, e só prevén a contratación de 7 profesionais, un /ha por cada área sanitaria. O peor é que están incumprindo este parco obxectivo.
2.- Insuficiencia de resultados
Anunciaron o PSMG dunha forma moi triunfalista. Nada máis e nada menos que 5 eixes de actuación e 98 proxectos a desenvolver ata o ano 2024. Cada un deses proxectos, cunha descrición de obxectivos e indicadores de resultados. O papel aguántao todo.
Acaban de publicar as listas de espera para cirurxías e consultas a data de decembro de 2021. Levaban un retraso inxustificable, contrario o ao dereito de acceso á información pública. Non só se fomenta a opacidade da información pública, senón que vulnera o Ordenamento (Lei de transparencia).
Os datos de lista de espera en saúde mental son verdadeiramente alarmantes. É a cifra máis alta desde que se publica na web do SERGAS, desde 2014. O dato de 2020, ademais, non é unha diminución real, xa que o acceso a Atención Primaria estivo moi limitado, polo que as derivacións a saúde mental foron adiándose.
Non vamos a aturar que sexan datos que se manexen dun xeito frívolo, argumentando razóns circunstanciais, e maquillando as cifras con creatividade contable. Porque cada un dos números que sustentan esa estatística son persoas que están esperando por unha consulta de saúde mental. Con grao de malestar e intensidade da súa problemática que non somos quen de valorar porque están a espera.
En decembro de 2021, un total de 10.020 persoas estaban esperando por unha primeira consulta. As Unidades de Saúde Mental están sobrecargadas, non poden facer fronte á demanda de atención, e coa frecuencia que sería necesaria para dar unha atención de calidade, conforme aos estándares esixibles e niveis de intensidade segundo a gravidade e urxencia. Faise imposible a necesaria e eficaz coordinación e colaboración entre administracións e sectores (sanitario-educativo-social) para unha atención integral.
Québrase a equidade no acceso á atención sanitaria, aumentando as desigualdades de base que existen na sociedade, e converténdose nun círculo vicioso entre os determinantes psicosociais e o risco de mala saúde mental. Os servizos públicos deberan servir de amortigüadores e reparadores desas desigualdades, pero estamos asistindo a un desmantelamento acelerado do sistema, nomeadamente en Atención Primaria. Ao mesmo ritmo, parece aumentar o negocio dos seguros privados.
3.- Suspenso en dereitos
A demora no acceso ás prestacións sanitarias, as dificultades para ter unha atención coa frecuencia e duración axeitadas, as dificultades para poder optar a tratamentos non farmacolóxicos, seguindo as guías clínicas sobre intervencións eficaces, son exemplos de incumprimentos de dereitos sanitarios.
E se esta situación de perda de dereitos é grave, cando se conculcan son dereitos fundamentais a situación pasa a ser insostible.
O PSMG inclúe dous obxectivos directamente ligados a dereitos fundamentais: a planificación anticipada de decisións e a contención cero. Ambos obxectivos xa deberan estar cumpridos na actualidade.
Podemos afirmar sen xénero de dúbidas que son os obxectivos máis importantes de todo o plan, os que indican o cambio ao modelo de saúde mental baseado no enfoque de dereitos, tal como está establecido nas regulacións internacionais e nacionais, de obrigado cumprimento.
Desde que o Convenio sobre os dereitos das persoas con discapacidade entrou en vigor en 2008, pasaron os anos suficientes para adecuar as lexislacións e as prácticas ao seu protocolo de aplicación.
A Xunta de Galicia suspende de forma categórica.
En 2017 o Mecanismo Nacional de Prevención da Tortura e outros tratos ou penas crueis, inhumanos e degradantes (MNP) visita por primeira vez o Hospital Psiquiátrico de Conxo e valora a situación das persoas que alí residen. O resultado do seu informe é demoledor. E a actitude da Xunta segue a ser provocativamente neglixente.
Só podemos concluír nestes termos, por canto que pasados nada menos que 5 anos, nada se fixo para superar as eivas que quedaban confirmadas no informe oficial do MNP.
En 2021 o MNP volveu a facer unha visita de seguimento. En datas recentes presentan a memoria de 2021 ante o Congreso dos Deputados. No que respecta ao informe sobre o Psiquiátrico de Conxo as conclusións son de novo moi negativas.
Destacamos algúns puntos do texto:
- O inicio e o discorrer da visita estivo marcada polo feito de que o responsable do hospital declinou acudir ao centro para atender a visita do MNP. Unicamente o último día d súa estancia nas instalacións acudiu, tras a chamada do director do MNP, para comunicarlle un feito grave que un paciente revelou ao equipo do mecanismo
- Cabe destacar que o edificio que alberga aos residentes non mellorou desde a primeira visita realiza e presenta un importante estado de deterioro, que xera unhas condicións insalubres para a estancia dos residentes.
- En relación coa aplicacións das contencións mecánicas, observáronse diversas circunstancias que chamaron a atención….cabe destacar que a utilización de ditas medidas no ámbito da saúde mental implica un sufrimento traumático que pode comprometer o proceso de recuperación dos pacientes
- Non existe un libro de rexistro específico no que se anoten todos os casos nos que se aplica a medida, tanto se se trata dunha suxeición mecánica como dunha contención farmacolóxica…é un indicador de transparencia dunha práctica susceptible de constituír maltrato.
- As contencións estanse a realizar nunha condicións de supervisión insuficiente
- O MNP advertiu que algúns dos pacientes amosaban signos evidentes de exceso de medicación
- Á luz das entrevistas realizadas a residentes, unha das sancións que comunmente se lles impón é o “castigo a pixama”. Comprobouse a existencia dun comunicado de enfermaría, que se atopaba pegado á parede, na que se podía ler que os pacientes en réxime pechado vestirán con pixama hospitalario, bata e pantuflas, engadindo que se teñen frío poderán poñerse unha camiseta por debaixo do pixama. …a imposibilidade de poder usar a súa propia roupa é unha medida que non conduce ao reforzamento da identidade persoal e da autoestima.
Tamén hai outro informe desa mesma visita realizada, esta vez con perspectiva de xénero, con resultados igualmente preocupantes, no sentido dunha desigualdade manifesta entre mulleres e homes que residen neses centro, en tempo de estancia, posibilidades de irse de alta e alternativas residenciais, uso de actividades ocupacionais, ausencia de proxectos de intervencións con enfoque de xénero, ou posibilidades de disfrutar dos dereitos sexuais e reprodutivos, entre outros.
A gravidade desta situación aumenta en canto que, tras 5 anos de parálise desde o primeiro informe do MNP, e tras a visita en xullo de 2021, nada se fixo. No que respecta ao informe de seguimento da primeira visita en 2017, o MNP aínda non recibiu resposta a día de hoxe.
En canto ao informe sobre enfoque de xénero, parece que a Xunta respondeu aceptando a maioría das recomendacións, pero sen aclarar ou concretar as accións correctoras que din que van levar a cabo ou están supostamente a levar. Ao MNP non parece valerlle as promesas e anuncias ao que nos teñen acostumados o goberno da Xunta.
4.- E agora, que?
Entendemos que estar no ecuador dun plan cuatrianual é tempo suficiente para realizar unha valoración do mesmo, xa que permite valorar se consegue os obxectivos que se marcara e da tempo a corrixir as desviacións no seu grao de cumprimento, ou os erros que se puidesen cometer na avaliación de necesidades, e estar nunha perspectiva equivocada.
Somos conscientes de que hai medidas que precisan dun tempo de desenvolvemento para conseguir progresos.
Pero non podemos obviar que este plan elaborouse coa idea de reforzar precisamente a atención á saúde mental no momento no que estabamos, de crise sanitaria, aumentando as previsións orzamentarias, e de incremento de persoal e de recursos para poder facer fronte o que se viña enriba.
Porén, a realidade indica que ese aumento de persoal e unidades non leva sequera a manter estable a lista de espera de consultas de saúde mental, xa non falamos de diminuír, que sería o esperado. Pola contra, temos un aumento de lista de espera como non se viu nunca, pasando dunha lista de espera de arredor de 4 000 persoas en 2014 (en plena crise económica) a case 8 500 en 2019 (previo a covid) e ás 10 000 persoas na actualidade.
Non podemos acostumarnos a estas cifras. Como non podemos acostumarnos a outras como poden ser as mortes por suicidio, que non diminúen nos últimos anos.
E, finalmente, o que non pode ser xustificado de ningún xeito, non permite dilación ningunha e atenta directamente a dereitos fundamentais, é a falta de medidas que permitan superar o uso das prácticas coercitivas en saúde mental, como poden ser, pero non son as únicas, as contencións mecánicas e farmacolóxicas.
Porque sen dereitos, non hai saúde mental.
There is certainly a lot to find out about this issue.
I really like all of the points you made.
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