Calcedo-Barba Alfredo, Antón Basanta Joaquín, Paz Ruiz Silvia, Muro Alvarez Alvaro, Elizagárate Zabala Edorta, Estévez Closas Verónica, López López Angeles, Barrios Flores Luis Fernando
Institute of Psychiatry and Mental Health, Gregorio Marañón General University Hospital, Medical School, Complutense University of Madrid, Madrid, Spain.
Spanish Society of Legal Psychiatry, Madrid, Spain.
Front Psychiatry. 2024 Aug 21;15:1340155. doi: 10.3389/fpsyt.2024.1340155. eCollection 2024.
Spain healthcare system is decentralized, with seventeen autonomous regions overseeing healthcare. However, penitentiary healthcare is managed nationally, except in Catalonia, the Basque Country, and Navarra. These variations impact mental health care provision for inmates with serious mental illness (SMI).
To delineate differences between regions in terms of mental health care provision for individuals with SMI, available resources, and the perspectives of healthcare professionals operating in the Spanish prison environment.
Employing an explanatory sequential mixed-method approach, the study conducted an extensive literature review, quantitative data collection through structured questionnaires, and qualitative data collection via focus groups and four in-depth interviews. Analysis involved calculating percentages and ratios for quantitative data and thematic analysis for qualitative data interpretation to comprehensively understand mental healthcare provision.
In December 2021, about 4% of inmates in Spain had SMI. There are three distinct models of mental healthcare within the Spanish prison system. The traditional penitentiary model, representing 83% of the incarcerated population, operates independently under the General Secretariat of Penitentiary Institutions at a national level. This model relies on an average of 5.2 penitentiary General Practitioners (pGP) per 1,000 inmates for psychiatric and general healthcare. External psychiatrists are engaged for part-time psychiatric assessment. Acute psychiatric hospitalization occurs in general nursing modules within penitentiary centers or in Restricted Access Units (RAUs) in reference hospitals. Two penitentiary psychiatric hospitals provide care to unimputable SMI inmates from all over Spain. Innovative penitentiary models, constituting 17% of the prison population, integrate penitentiary healthcare within regional public health systems. The Basque Country features a Mental Health Unit with full-time care teams within the penitentiary center. Catalonia emphasizes community care, providing full-time dedicated psychiatric services within and outside prisons, ensuring continued care in the community. Both models prioritize personnel with specialized mental health training and compensation akin to non-prison healthcare settings.
Regional disparities in penitentiary mental healthcare models in Spain result in resource inequalities, impacting specialized care for inmates with SMI and opportunities for healthcare professionals. The models in the Basque Country and Catalonia offer valuable experiences for penitentiary healthcare.
西班牙的医疗保健系统是分散的，由17个自治区负责监督医疗保健。然而，监狱医疗保健由国家管理，但加泰罗尼亚、巴斯克地区和纳瓦拉除外。这些差异影响了对患有严重精神疾病（SMI）的囚犯的心理健康护理。
描述各地区在为患有SMI的个人提供心理健康护理、可用资源以及在西班牙监狱环境中工作的医疗保健专业人员的观点方面的差异。
采用解释性序列混合方法，该研究进行了广泛的文献综述，通过结构化问卷收集定量数据，并通过焦点小组和四次深入访谈收集定性数据。分析包括计算定量数据的百分比和比率，以及对定性数据进行主题分析以全面了解心理健康护理情况。
2021年l2月，西班牙约4%的囚犯患有SMI。西班牙监狱系统内有三种不同的心理健康护理模式。传统监狱模式占被监禁人口的83%，在国家层面由监狱机构总秘书处独立运作。该模式平均每1000名囚犯有5.2名监狱全科医生（pGP）提供精神科和一般医疗保健。外部精神科医生进行兼职精神科评估。急性精神科住院治疗在监狱中心的普通护理单元或参考医院的受限访问单元（RAU）中进行。两家监狱精神病医院为来自西班牙各地的无责任能力的SMI囚犯提供护理。创新监狱模式占监狱人口的17%，将监狱医疗保健纳入地区公共卫生系统。巴斯克地区在监狱中心设有一个配备全职护理团队的心理健康单元。加泰罗尼亚强调社区护理，在监狱内外提供全职的专门精神科服务，确保在社区中持续护理。两种模式都优先考虑具有专门心理健康培训的人员，并给予与非监狱医疗环境类似的薪酬。
西班牙监狱心理健康护理模式的地区差异导致资源不平等，影响了对患有SMI的囚犯的专科护理以及医疗保健专业人员的机会。巴斯克地区和加泰罗尼亚的模式为监狱医疗保健提供了宝贵经验。
