Spain is facing growing pressure on its public mental health system as demand for psychological support increases while the country continues to have far fewer clinical psychologists than the European average.
The country has about six clinical psychologists for every 100,000 inhabitants, compared with almost 18 per 100,000 across Europe. The shortage has contributed to long waiting lists and lengthy gaps between appointments, making it difficult for patients to receive the regular therapy often required for effective treatment.
The imbalance has also raised concerns about unequal access to psychological care. People who can afford private treatment may be able to see a psychologist weekly or every two weeks, while those relying on public services can face waits of weeks or months.
Demand often rises during autumn, when shorter daylight hours and the return to work, school and established routines can prompt more people to seek professional support. However, mental health professionals say the increase is part of a wider, year-round rise in demand.
Kazuhiro Tajima, a psychiatrist and founder of APIR, a centre that trains resident psychologists, said greater public discussion of anxiety, depression and emotional wellbeing had helped reduce the stigma surrounding mental health.
He said the type of support people seek has also changed. Public mental health services were traditionally focused on diagnosing and treating mental illness, but professionals are increasingly seeing people experiencing distress linked to bereavement, relationship breakdowns, workplace difficulties and family conflicts.
Such experiences do not necessarily indicate a mental disorder, Tajima said, but people can still benefit from psychological support and practical tools for dealing with difficult circumstances.
The increased demand has exposed limitations in a system primarily designed around specialist treatment. Clinical psychologist Fran Gullón said psychotherapy depends on continuity and a therapeutic relationship, which can be difficult to establish when appointments are separated by two or three months.
Long gaps can also affect early intervention. Patients who could benefit from timely support may have to wait weeks or months before receiving treatment, while private care offers an alternative for those able to pay.
Spain has increased the number of Resident Intern Psychologist, or PIR, training positions, with 293 places offered in the latest intake, 13 more than the previous year. However, specialists say expanding the workforce will take time because clinical psychologists complete four years of specialist health-care training.
Professionals also warn against treating every form of emotional distress as a medical condition. Tajima said sadness, worry or difficulty concentrating do not automatically indicate depression, an anxiety disorder or ADHD.
Gullón said the priority should be accurate diagnosis and timely specialist treatment for those who need it.
As awareness of mental health continues to grow, professionals say the next challenge is ensuring public services have enough staff to meet demand. The ability to access psychotherapy, they argue, should depend on clinical need rather than a person’s income.
