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HEALTH

Mental health: Why Spain has become a nation of self-medicators

To mark World Mental Health Day, we lift the lid on some of the figures that reveal why Spaniards are the world’s biggest consumers of tranquilisers and how they’re struggling to get the help they need. 

Mental health: Why Spain has become a nation of self-medicators
A woman takes a pill. Spaniards are the world's biggest consumers of anti-anxiety medication and the EU’s largest consumers of psychiatric meds. Photo: Danilo Alves/Unsplash

One in every five people in Spain suffers a mental health disorder, from depression to anxiety, and schizophrenia to bipolar disease. 

That’s an average which is pretty much on a par with other nations such as the United Kingdom, France and the US, and to some extent dispels the myth that Spain is a happier nation than average. 

More worrying however, Spaniards are the world’s biggest consumers of anti-anxiety medication and the EU’s largest consumers of psychiatric or psychotropic medication overall, which includes antidepressants, anti-anxiety medications, stimulants, antipsychotics, and mood stabilisers.

The latest report by the International Narcotics Control Board reveals how Spain leads global consumption of anxiolytics, hypnotics and sedatives with about 2.5 million consumers a day.

According to the Spanish Agency for Medicines and Health Products (Aemps), part of Spain’s Ministry of Health, consumption of meds such as Valium, Trankimacin and Orfidal increased by 4.5 percent in 2020 and exceeded 91 daily doses per 1,000 inhabitants.

Even Spanish Prime Minister Pedro Sánchez tweeted in 2021 that “10.8 percent of Spaniards have consumed tranquillisers, relaxants or sleeping pills” whilst speaking of the country’s mental health crisis.

Benzodiazepines, used to relieve anxiety and insomnia, are reportedly among the most used, so much so that Aemps states most of Spain’s adult population has consumed them sporadically or habitually for the treatment of multiple problems. 

“Despite being drugs that are only dispensed with a prescription, they (the consumers) exhibit a large component of autonomy in their use,” Aemps states.

So why is it that Spaniards came to be such large consumers of mental health drugs?

The main reason is that there are very few therapists available: only 6 clinical psychologists for every 100,000 people in Spain. 

The average in the OECD countries is 20 per 100,000, in the EU it’s 38 per 100,000. 

“The solution is more (mental health) professionals as we are well below average,” Fernando Chacón, vice president of Spain’s General Council of Psychology, told Spanish news site Nius Diario.

“Sweden has ten times more psychologists in the public health system than Spain, and Portugal double the amount.”

In 2018, of the 32,000 registered psychologists in Spain, only 2,300 work for Spain’s public health system. 

According to Chacón, mental health drugs don’t cure and simply alleviate people’s symptoms, but the lack of face-to-face contact with a therapist means most are left with little alternative than to turn to self-medication.

Keeping in mind that lower income people are statistically more likely to struggle with mental health in Spain, the lack of professionals working for the state results in long waits for anyone who can’t afford to pay for a private therapist.

Waiting times to see a mental health specialist at a public hospital vary greatly between Spain’s regions, but in some autonomous communities it can be two months or longer.

Additionally, the Covid-19 pandemic has had a “severe impact on the mental health wellbeing of people around the world”, as the World Health Organisation reported in March 2022, and Spain is no exception. 

“Since the pandemic, the demand for psychological assistance has increased by more than 20 percent in Spain,” Chacón explained.

A quarter of primary health care visits are now for mental health reasons.

In October 2021, Spain’s government launched a €100-million-budget scheme aimed at tackling the country’s mental health crisis,  focusing on training professionals, fighting stigmatisation, early detection, a suicide prevention hotline, and promoting emotional wellbeing as early as in school.

Spain’s mental health strategy had not been updated since 2009 and this latest plan, which will run until 2024, is reportedly a priority for the left-wing coalition government.

There is not enough evidence yet that these plans have had much of an impact, although the project is in its early days. 

But schemes such as training more psychologists will take longer than the three years the mental health plan will last. 

The government is failing to make good use of the thousands of foreign psychologists it has at its disposal, but which are prevented from working for years due to Spain’s convoluted qualification recognition system. It has also not factored in that private psychologists can earn considerably more than those working for the state.

As things stand, 6.7 percent of Spain’s population is currently struggling with anxiety, the same percentage as those who have depression.

Almost half of 15- to 29-year-olds say they have suffered from mental health problems.

And at least 1 million Spaniards have a “serious mental health disorder” but only half receive treatment for it.

These are the government’s own figures, the reality could be worse still.

READ ALSO: How to find an English-speaking therapist in Spain

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BRITS IN SPAIN

Six factors British people need to consider before retiring to Spain

If you're a UK national and thinking of retiring to Spain, there are some important factors you need to think about before making the move, and before you make any decisions about your UK pension.

Six factors British people need to consider before retiring to Spain

Retiring to Spain is a dream for many, but in order to make that dream a reality, you need to know that you can financially support yourself.

For most retirees, their main or only income will be a UK pension, so it’s important to understand how your pension will work once you make the move to Spain. 

There are some specific rules and restrictions you should know when your pension is paid outside of the UK. You also need to understand how your pension will be taxed in Spain.

Financial adviser, Maeve Hoffman, from Spectrum IFA Group, emphasised that people should not take these decisions lightly, telling The Local: “Figuring out what to do with your pension should be part of your wider financial plans for your life”.

“This may be your most important asset, besides your home, and the best answer for what to do with your pension is highly individual. There are no sweeping generalisations when it comes to advice on private pensions. Everyone’s situation is different,” she said.

This article is intended as an overview of how the system works for UK pensioners and is not intended as a substitute for individual financial advice. It’s aimed at people who have worked most or all of their career in the UK and then plan on retiring to Spain – the situation is slightly different for people who have worked in Spain and then retire here.

READ ALSO: Which UK benefits can Brits keep if they move to Spain?

Long-term or short-term

The first thing you need to decide is if you’re moving Spain for the long-term or short-term. 

If you’re looking to stay here permanently, there are certain advantages you can benefit from, but they could make things extra complicated if you end up returning to the UK in the future.

Make sure you ask yourself the tough questions so you can think about every eventuality. Is there a chance that you will have grandchildren in the future that you’ll want to be close to them? Have you ever spent a significant time in Spain, before, apart from just for short holidays? Do you have connections to Spain, such as friends, family or a home? If your health deteriorates, will you want to be cared for in Spain or the UK?

If are unsure about the answers to these questions, then take some time to really think about them. There are alternatives to permanently moving to Spain if you are unsure – for example, you can stay here for three months without the need for a visa.

Understand the different tax rules

British retirees should be aware that the UK and Spain have very different tax systems.

Once you become a tax resident in Spain you have to file a yearly declaration on your global income. Your UK pension will be taxed in Spain and you will no longer be liable to UK taxation, unless you have a government service pension.

You can check if your pension is classified as ‘government’ here.

The UK state pension, as well as any other private pensions, will be taxable in Spain.

Because of this, will want to think about whether your previous plans for your private pension were only advantageous to you as a UK resident. Once you become a Spanish tax resident, they could have unforeseen implications.

For example, there is no tax-free lump sum in Spain. If you want to take out a lump sum, taking it while you are still a UK resident will save you a lot in tax.

Taxes also depend on the region in which you decide to retire to. Some are a lot more advantageous than others, so it’s important you know the rules of where you plan on moving to. 

READ ALSO: Why you should move to this region in Spain if you want to pay less tax

Get reliable, expert financial advice before doing anything

If you have decided you want to be in Spain permanently, then you will need some expert tax and pension advice – but you need to be careful who you take advice from, this is a highly specialist area and it’s unlikely that high street financial advisers will have the knowledge that you need. 

Brexit has also made getting financial advice more complicated, with fewer experts available.

Hoffman told The Local: “Because of Brexit, you cannot use a UK-based financial adviser anymore – you have to use an EU-registered one. This has made things more complicated. When picking an adviser, seek out someone who has expertise on the local taxation rules. They should also be regulated with the financial regulator where you live and where they work”. 

It can be especially complicated to work out who you should and shouldn’t take advice from – for example, some UK-based advisers have continued to give advice to EU-based clients, even though are not following EU regulations anymore. 

Hoffman adds: “There are free, government-based services in the UK that can help you understand your private pension – Pension Wise and Money Helper. Before doing anything, you should consult the free services. Any financial adviser worth their salt would recommend this too. 

“These services have begun to have longer wait times, so be sure to book well in advance of when you plan to draw from your pension.”

Decide whether to transfer your pension

Another question that is important for Brits to think about is whether or not to transfer their pension into either a UK-based SIPP for non-residents, or a QROPS (Qualifying Recognised Overseas Pension Schemes).

The SIPP will keep your pension in the UK, while the QROPS moves it out of the UK. 

These options can be helpful for residents in Spain, but you need to familiarise yourself with their benefits and drawbacks.

“The QROPS is not for someone who is unsure of their future, as if you return to the UK within five years of the pension transfer, HMRC will seek their tax back as if it was a full encashment,” Hoffman said.

You should also beware of scams on this subject, as the post-Brexit period saw many scammers seeking to persuade Brits that it was now mandatory to transfer their UK pension – always be wary of any cold-calling or unsolicited financial advice.

Determine how you will draw from your pension

The next factor to consider is how you want to receive your pension – either as regular income or as a lump sum. The option that you chose will have tax implications in Spain.

Generally, the tax rate will depend on the amount of your pension, but can range from 19 to 47 percent in Spain.

Remember that there is no ‘tax-free lump sum’ in Spain, so it’s best that you don’t draw from your pension that way.

Healthcare and Social Security

You won’t automatically be covered for healthcare in Spain if you retire here, because you won’t be working and therefore won’t be paying social security.

Thankfully, there are various options. UK nationals who retire to Spain (and have never worked in Spain) and have already reached the state pension age can apply for the S1. This means that the UK continues to pay for their healthcare costs and they would not be charged social security. Non-working spouses of an S1 holder can also benefit from this.

READ ALSO – Healthcare in Spain: the steps to apply for the S1 form for UK state pensioners

You can also choose to pay for the convenio especial (which translates to ‘special agreement’). This allows foreigners in Spain to pay a monthly sum into the country’s public health system to have access to it, even if they don’t work. To access it, you will pay a monthly fee of €60 if you are under 65 and €157 if you are over 65. 

Of course, you also have the option of getting private health insurance too.

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