Changing mental health services in Madrid: international issues

With the backing of a socialist government that came to power in 1982, mental health services in Spain are shifting away from institutional and custodial care toward community-based services. Provincial governments now control most mental health programs as a result of a law passed in 1983. In Madrid, mental health service priorities include preventing psychiatric hospitalization, developing a range of residential facilities, reducing the population of chronic patients in hospitals, and improving the quality of hospital care. A network of 20 health promotion centers is being developed to serve newly identified patients, while long-stay hospital patients who can be discharged will become the responsibility of social services. From an international perspective, the most interesting aspect of the Spanish transformation is how the country will deal with the problems other nations have encountered in implementing systems reforms.