"The implementation of QualityRights cannot be solely in the hands of individual wills, a law is needed"

" QualityRights are an excuse to completely change the way we look at people with a mental health problem. Without these Quality Rights we would not be able to provide care to the person from the point of view of their rights. The International Convention on the Rights of Persons with Disabilities, approved in 2006, clearly established that the rights of people with any disability must be guaranteed, but not only guaranteed, but respected. Therefore, it is necessary for the entire population, professionals and first people to be very clear about what exactly we are talking about. We are talking about human rights, naturally, but also about added rights because, unfortunately, we tend to violate the rights of people who cannot defend themselves. Under this idea, we are leading, from the National Mental Health Pact (PNSM), the transformation of mental health care in Catalonia."

"During the pandemic and when I was at the head of the Program for the Comprehensive Approach to Highly Complex Mental Health Cases of the Department of Health, we had a lot of contact with the WHO because, truly, it was very, very complicated to guarantee all the rights that they told us we had to guarantee in the guides.

When the PNSM was launched and after many conversations with ethics experts and with the first people, we understood that it was necessary to acquire a firmer commitment to rights and we contacted them again. In this sense, the proposal has been an agreement with the WHO through which we commit to actively disseminate and promote virtual and face-to-face training on the rights of people with mental health problems at all levels of society, and to implement the QualityRights in political action, all with the support of the WHO.

To promote the training , which anyone can do online on the WHO e-learning platform, we translated all the documentation into Catalan and Spanish and it is available to citizens, through Support Girona and SOM Mental Health 360 .

It is no longer just professionals who need to be trained, but citizens must understand that we are violating many of the rights of these people simply because they have a mental health disorder.

At the same time, we are working on a strategy for training trainers that will allow this knowledge to cascade to different layers of society, from professionals to social entities and beyond."

"The first thing is to train trainers who will be the ones who will go throughout society to train people who, later, can continue to train other people within their direct environment. This training provides all the information that any person needs to be able to assume all these rights, understand what the Convention says, what it means to respect rights and what it means to guarantee. And, above all, how a person with lived experience in mental health explains what they are asking for, what they feel and what they need to feel equal within society.

Our goal is to reach 100 thousand people trained in three years . Therefore, those we have to convince above all are the large institutions, all the employers' associations. They have to understand that this transformation is indispensable.

Training alone will not change things, but it will be necessary to legislate and also enable environments for the exchange of experiences, knowledge, dissemination and empowerment through large platforms, as we are doing with Support Girona and SOM Salut Mental 360. It is all these movements at the same time that will make it possible to lead this transformation."

"It is difficult to take the picture from the point of view of the whole map, but it is true that there are many health providers, experts and professionals who believe it . And they believe it so much that they themselves, before we launched this strategy, were already implementing it. It is necessary to understand that the issue of QualityRights is not just an issue of rights, in general, but that a number of very important issues arise from it. For example: restraints cannot be made; involuntary admissions cannot be made depending on the methodology or without informing the person affected; people must be able to make an Advance Decision Planning (ADP) so that, in the event of a crisis, they have previously stated what care they want to receive; all the peer to peer training , etc.

What happens is that all this is not reflected as a country through a law, protocol and circuit. So we must thank all those who are moving forward before we, who are much slower, can consolidate what the entire mental health network should do, which is not only health, we must also think about residential homes and people who, at some point, are in prison. Therefore, we are talking about guaranteeing the rights of the person wherever they are and, therefore, it involves more than one department within the Government.

"The PNSM's strategy is to promote a law, but it will take time and, therefore, we will not wait for a mental health law to be passed to begin consolidating all these issues. We are involving the entire Government to see how we should do it, but I think that by 2024 it must be very clear what the bad practices are that should not be used and, therefore, provide training, provide information and look at indicators and evaluate."

"Indeed, this strategy involves different departments: Health, Social Rights, Labor, Education, etc., since the person can feel vulnerable and not respected in any area. It is certainly difficult to put together, but the PNSM is a government pact, a country pact, and we are having a very good response when it comes to implementing these actions that guarantee rights. What the departments are asking us to do is, above all, that we inform them well, that we train them and give them the tools to be able to do it. They need this support from us because they do not have enough experience or capacity to make this revolution in two days. And that is what we are working on now: understanding what each department needs so that the person, wherever they are, can be calm and have a remarkable quality of life."

"Because it is necessary to explain very well what a mental health problem is, to fight against stigma and so that, from a very young age, at school, they know that this problem exists, like any other health problem."

Life changes, society advances and care for people with mental health problems goes far beyond providing medication or alleviating their symptoms. It goes far beyond, the person you have in front of you is exactly like you. Therefore, in addition to alleviating the symptoms, you must try to help them recover their life and, therefore, be able to continue exercising as a full citizen.

I think that citizens should know that they too can have a mental health problem at some point in their lives, it can happen to all of us, and in this context they need to ask themselves: what would they like to happen to them? How would they like to be treated when they are walking down the street, when they are in an emergency room, when they are with their family or when they are alone? If one is able, for a moment, to put themselves in the shoes of the other, they will understand the importance of knowing their rights, respecting them and helping, at a certain moment, someone who needs it because one day it could be you. That is why QualityRights training is needed.

Mental health recovery

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It happened to me, for example, with homeless people. When I was little, they told me that people who lived on the streets were the bad guys. Of course, I developed this fear and rejection that has lasted until now, until through campaigns and having the knowledge, I understood that they are people whose lives are cut short for different reasons and that it can happen to you or anyone around you. Because a social cause ends up destroying a person's life. Understanding the whole context changes the way you look at others and, therefore, changes your attitude.

We need people to understand that homeless people, or people with mental health problems, have not sought it out and are not in this situation because they want to, but rather that there are social or biological conditions that have made this person have to live with this problem. And it is essential that this type of campaign is not done from compassion, or charity, but from you to you, from recognition as equals .

"One day, older people were telling me what they had suffered, what their experience was, and I said: 'You come from an ancient and very long silence.' This is a phrase that we often use when we talk about the time of the dictatorship, but it is very applicable to the situation that existed, not so many decades ago, with people with mental health disorders, locked up under lock and key and isolated from society.

These people are the ones who have had the strength to say: "we've come this far", and, even if they are called crazy and insulted, they have said that enough is enough. This strength is what forces the rest of us to realize, which is why the first objective of the PNSM is the empowerment of the person and that they can live with us with the same conditions of equality and quality of life. All the work that the associations have done and are doing in relation to documentation, conferences, campaigns, etc., with almost no financial support, is very remarkable. They have really come a long way. Therefore, the PNSM is dedicated to them, it is the reason for being, and it allows us to avoid each one going their own way individually without reaching consensus, without listening to each other and setting common goals. This transformation is a country's commitment.

"The two strategies have to go together and this slows down progress a bit. In any case, we are moving forward together, consolidating the fact that any action we take must be aligned with the Qualityrights . We will start to move forward little by little and, over time, both strategies will be integrated."

Training and awareness-raising of mental health professionals from the recovery model

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I think people accept it, professionals accept that they cannot continue working without knowing that this is the most important thing and this encourages me a lot because, truly, everyone is getting serious about it. I have not found anyone reluctant, the change in mentality is spectacular in Catalonia, also thanks to the fact that we are doing a lot of networking and dissemination."

"For me, the main challenge is to achieve 100% normalization of mental health problems, that society is prepared to coexist, respect and help. For example, that children perfectly recognize people's rights; that people do not turn to look at or insult a person with a mental health disorder; that they do not judge; that they do not run away from situations experienced by these people if there are moments of crisis or agitation just out of fear, but that they approach, that they understand. When all this happens, that is when society will be ready.

Unfortunately, there is a long, long way to go before people understand what the abilities and capacities of a person with mental health problems are. We only see the disabilities, we only see what they cannot do and we do not see everything they could do if we gave them a helping hand by guaranteeing their rights. In other words, opening many more doors. When all the doors are open for everyone and we do not have problems with excessive unemployment in people with mental health problems, or acute care centers bursting with closed doors... when we start to see this becoming normal, then I will be happy.»

"It is essential that in places where the administration has powers, therefore where all citizens are concentrated, such as education and health, we can offer staggered training. In other words, it is not a matter of giving a talk to 6-year-old children and that is it, but rather that this topic must be present throughout the educational path of the person as they grow and assume what social commitment, diversity, empathy towards those who are different from you, etc., means, and it must be done in the classroom from primary education to higher education and continuing with work environments. It must permeate everything in an organic way."

"We cannot leave an issue as important as this to the voluntariness of individuals or institutions. We detect that there is a great desire to make these changes, but we are asked to be specific about what changes need to be made, what they imply and how they are evaluated because otherwise it will be difficult for them to be carried out for various reasons. The context we have right now is one of a lack of professionals in the field of health and an avalanche of demand. This makes providers prioritize the most immediate care or ensuring that the person is well.

That is why the administration must have a strategy, an economic commitment and an evaluation to be able to implement it. With the PNSM strategies approved by the Government we will be able to put the needle through its paces to define what professionals should do and under what conditions, and with what benefits for the person affected.

It is not easy because there are still those who do not understand the value of the experience of the person with lived experience when it comes to treating and accompanying. That is why it is necessary to give time to attention, we must guarantee it from the administration and it involves a change in the way of treating the person. It is difficult, but I believe that we are very prepared to do it.

"I think we are the only ones in the State that are working on this issue as a country strategy. That is, the only ones that have ended up making an agreement with the WHO on this issue. When I talk to the other autonomous communities, it is true that some are promoting aspects such as peer to peer or PDAs, but in a specific way, without an overview of the entire social and healthcare fabric. In this sense, Catalonia is quite a reference in how we are doing it and we plan to translate our strategy into Spanish and English to be able to explain or accompany, if asked, other territories that want to implement a strategy.

Well, it is true that in Catalonia this issue has been discussed for many years. Sant Joan de Déu, for example, began to introduce the vision of the integral person more than 20 years ago, and it has been totally different from the rest of the services that may exist in Catalonia. All this helps us to be leaders, especially due to the initiatives of many providers and many services.

At a European level, I think they have a different mentality, they have this view quite integrated, although there are also areas that are more developed than others, such as France, England, and Italy.

A very important aspect is the model of society. That is, in Mediterranean societies, the coexistence of the family, without which we would not be able to get by, is very different from more Nordic societies or in the United States, for example. This character and value that we give to the family is key to being able to make this transformation. It is something that we share, for example, with Latin American countries, in which the family is the nucleus.