"It is essential that mental health be introduced into non-healthcare settings."

"World Mental Health Day began to be commemorated in the 1990s and allows us to highlight the needs and difficulties, both structural and related to resources, that all of us who are in some way involved with the world of mental health encounter. It is also a great opportunity to clarify misconceptions and change acquired prejudices, and that is the main way to fight stigma."

We must take advantage of this date to remember that mental health is fundamental for proper social functioning ; sometimes we forget. After all, if we review the definition provided by the World Health Organization (WHO), in its broadest sense, mental health is a state of mental and emotional well-being that allows individuals to cope effectively with the numerous stresses of daily life. This state enables them to pursue their own life plans, develop their potential, and function productively and collaboratively within their environment. This is good mental health!

If everyone had it, society would be perfect, but that's not the case. Therefore, investing in mental health is investing in health and in the proper functioning of society.

This year, it is especially important to remember this need for investment. We are immersed in a global pandemic that has led us to live through a highly unusual situation. All the research being published indicates that, in addition to the suffering caused by the deaths, this crisis will leave lasting effects, and we will see symptoms of emotional distress both in people with pre-existing mental health conditions and in others who have not previously experienced any problems. We all know that when there is a socioeconomic hardship, like the one that is already emerging, it generates greater distress. A very significant percentage of the causes of mental illness are external; these are called socioeconomic determinants. So, the more stressors we have in this regard, the worse our mental health will be, and therefore, the worse our social functioning will be.

"Talking about a general model doesn't allow for precision; it's necessary to adapt the models to each reality and each territory, but there are several aspects to consider that would be priorities in my opinion:

• The allocation of resources.

The world is marked by significant inequalities, not only in the amount of resources available but also in how these resources are allocated. However, according to WHO data, even countries with high GDPs underinvest in mental health compared to other sectors. Therefore, a lack of investment in mental health prevention and promotion is the norm.

In low- and middle-income countries, it is estimated that more than 70% of people with mental health conditions do not receive care. Globally, there are fewer than one mental health professional for every 10,000 people. This means that mental health services are severely under-resourced.

The priority is to provide human resources and structures to create or improve mental health services.

Furthermore, their availability and accessibility must be ensured, and they must be aligned with the Human Rights Convention. In many countries around the world, the human rights of people suffering from, for example, serious mental disorders are not respected.

• The commitment to a community mental health model.

What does that mean? It means that therapeutic intervention takes place primarily in the community, in the place where the person lives and interacts. This model aims to avoid long-term hospitalizations that lead to social isolation and make it more difficult to return to one's familiar environment. The implementation of this model must be carried out in conjunction with non-medical community services, within a comprehensive approach to mental health. That's the key point: mental health is not solely the responsibility of the healthcare system.

It is essential that mental health be introduced into non-healthcare settings: in social settings, in schools, companies, sports organizations, in all relational spaces, in short.

A good social welfare policy is the best prevention policy in mental health.

These models, of course, must then be adapted to each society and be sensitive to vulnerable populations. There are individuals or groups that we know have a higher prevalence of mental illness, and therefore these services must be structured around these groups.

The model of community-based mental health care is not uniform, not even in Spain. We have made significant progress, and this is reflected in mental health budgets. In Catalonia, for example, slightly more is now invested in community-based care than in hospital-based care, but there is still a long way to go.

It is also true that community services need to be much more proactive, reaching out more to groups we don't currently have access to, groups that don't find their place perhaps because we don't offer the answer they are looking for or perhaps because we haven't been able to contact them.

• Early detection.

Early detection is the best response. Specific programs have already been established for first psychotic episodes. There is still much work to be done in the child and adolescent field. In the case of the pandemic, we know that many people are experiencing symptoms of distress, post-traumatic stress, or more or less pathological grief due to a sudden death. It is important to address these issues early so they have a better prognosis.

Services should be more proactive, open, and tolerant when targeting those with greater difficulty of access or adherence.

"Services must strive to be as accessible and personalized as possible. In service planning, technical and theoretical indicators are often used, sometimes with inaccurate data. This information is used to plan large-scale services for major syndromes, but it leaves out people with intermediate or less common syndromes, or with very complex problems, who cannot find a therapeutic pathway for them. Fortunately, this is also changing, although it will be a slow process. In many regions, this planning is already being done in collaboration with different stakeholders: with patient associations, family associations, scientific societies, and so on. All of this provides planners with more information to allocate resources where they believe they will be most effective."

The future of mental health lies in collaborative service planning among all stakeholders . Only those who use the service or who recognize the need for it can be sensitive enough to determine what is required. Furthermore, a region or country must understand how to allocate resources; it's not always possible to do everything one would like. Budgets are never unlimited, therefore, agreements must be reached to determine the limits of what can be achieved.

The recovery model, a paradigm shift in the approach to mental health

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"I would say we are in a collaborative phase and building mutual trust, but we lack the experience to overcome the difficulties. For example, at the Sant Joan de Déu Health Park, we are developing a pilot program with Federació Veus in which three people with firsthand experience work with the teams in different settings. The idea is excellent, but we are still having difficulties with implementation, partly due to a lack of regulation."

We need to involve everyone in rethinking services, and therefore these current policies, which are just beginning and require more resources, are important. Understanding the interests of all affected sectors will allow us to make better decisions, always respecting social balance and needs.