Spanish psychiatric reform: what can be learned from two decades of experience?

OBJECTIVE The objective of the paper is to describe the impact of Spanish psychiatric reform on the organization and functioning of mental health services. METHOD This paper is based on official administrative reports and on relevant related publications. RESULTS The most significant achievements of Spanish psychiatric reform have been: (i) the development of a new organization of mental health care, decentralized in character and territorially based; (ii) the integration of psychiatric patients in general health care; (iii) the creation of an extensive community network of health centres; and (iv) the development of more positive attitudes towards mental illness. However, our analysis also reveals the existence of significant deficiencies. CONCLUSION Analysis of the Spanish experience shows that the process of psychiatric reform depends basically on long-term commitments, which in a system such as Spain's must come from central administration and also from the autonomous communities.