He is 21, his diagnosis irreversible, yet for weeks he has drifted through the streets without a hospital bed to call his own. Despite repeated private and court‑ordered medical opinions demanding immediate psychiatric admission, Catalonia’s public health system has effectively barred him at every turn. Clinical records, deemed comprehensive and urgent by experts, have been dismissed; ward doors remain locked.
Now surviving on the street, he remains without medication, without supervision, without hope. His condition makes it impossible for him to live at home or in any unsupervised environment—he needs continuous psychiatric care.
“My son can’t ask for help—his illness won’t let him. And the system, instead of stepping in, shuts him out. They’re just waiting for a tragedy… or for him to end up in a prison cell,” his father laments.
This is not an isolated incident but part of a broader, structural pattern. Catalonia has intentionally accelerated the closure of long‑stay psychiatric units, shrinking 200 beds across its major hospitals over the past two years. The government's expressed goal is to shift towards community‑based care—but the infrastructure to support such a transition remains underdeveloped, leaving the most vulnerable patients without safe alternatives.
In the absence of hospital beds, emergency psychiatric teams adopt a crisis‑only approach. Official policy dictates that unless a patient is visibly aggressive, agitated or self‑harming, admission is refused. Families report that calm patients—regardless of severity—are told to “come back when there's drama,” effectively criminalising chronic decline instead of treating it.
One such tragic consequence: as untreated individuals resort to begging, loitering or minor disturbances, law enforcement becomes their primary point of contact. Witnesses confirm the policy: “They’ll only intervene if he’s shouting or violent. If he’s calm but deteriorating, they send him away,” his father says.
In parallel, criminal justice data paints a bleak picture: 60 percent of individuals with mental disorder convictions in Catalonia serve their sentences within prison‑based psychiatric wards . This mirrors a wider European trend in highly securitised mental health, where cost containment and stigma outweigh humane treatment.
At the Parc Sanitari Sant Joan de Déu mental health conference, experts warned that courts frequently insist on “zero risk” before allowing transfer from prison to community care—a condition deemed practically unachievable clinically. As a result, many individuals languish in prison long after stabilisation, with little to no community reintegration support.
Inside Catalonia’s households, caregiving falls overwhelmingly on female family members. Nearly 88 percent of psychiatric care occurs informally at home—mainly overseen by mothers—who average 22 hours a week of unpaid labour. Three‑quarters report anxiety or depression; over a third suffer serious physical health decline UOC. With formal support minimal, the pressure on families is crushing.
Mental health remains a ticking time bomb: prescriptions of antidepressants rose by 169 percent from 2020 to 2023, with over 1.2 million Catalans receiving treatment. The prevalence of moderate or severe depression in adults has increased by 28 percent since 2019 premium.cat+1uab.cat+1, while primary care recorded 44,447 cases in 2023 alone.
The mortality toll is even more sobering: individuals with psychotic conditions—schizophrenia, schizoaffective disorders—have elevated mortality risk, chiefly due to natural health issues like cardiovascular disease and cancer. Schizophrenia shortens life expectancy by over a decade on average premium.catuab.cat+1pubmed.ncbi.nlm.nih.gov+1. Yet institutional neglect persists.
Worst-hit patients are swiftly discharged after even minor rule infractions—such as short absconds. These "perfect discharges" leave no real follow‑up: patients are literally ejected into the streets.
All the while, the Catalan Government celebrates a year without a single long‑term psychiatric admission. But this figure masks a terrible truth: many are being denied admission, denied care and looped into the prison and forensic system instead.
The Catalan Government points to “zero long‑term psychiatric admissions” last year as a triumph. Yet that figure—hailed as progressive—belies a far darker reality: those most unwell have been systematically shut out, shunted into streets, prisons or invisible domestic cages. Without immediate establishment of specialist inpatient units, high‑security community facilities and legally mandated, proactive follow‑up protocols, the cycle of neglect will persist. Until then, families will continue to bear impossible burdens, and society will watch as the ill are driven from care into custody.
Experts insist Catalonia urgently needs:
- Specialist inpatient units designed for long‑term severe mental illness, not just crisis care.
- High‑security community facilities, modelled on UK‑style “intermediate units”, to support reintegration.
- Robust social care linkages delivering real supervised housing, not just house‑ownership or rental. guarantees.
- Early‑warning protocols to trigger intervention when chronic decline is documented—even in the absence of crisis.
Until Catalonia confronts this crisis, its mental healthcare system will remain a revolving door: from hospital to street, then from street to prison—while the truly unwell are left in limbo.
Carlos Alves de Sousa
United Photo Press
