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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What are the rules on IVF in Spain?

Spain has some of the best fertility clinics in Europe and people travel from all over for assisted reproduction techniques here, both because of the high success rates and standard of care, but what are the invitro fertilisation rules in Spain?

What are the rules on IVF in Spain?

Spain has the second lowest fertility rate in the EU, with an average of 1.23 children per woman, according to the latest data provided by the European Statistical Office, Eurostat, corresponding to 2019 and updated at the end of June 2021.

A report by the Spanish Fertility Society (SEF), says that more and more couples are having problems conceiving and many are choosing to undergo assisted reproductive techniques in order to become parents.  

They consider infertility as: “the inability to achieve pregnancy after one year of sexual intercourse with normal frequency and without the use of any method of conception”.

Although male infertility factors are responsible for between 25 percent to 35 percent of cases, the number of older women who want to have children in Spain is the number one issue, the society explains.

But, it’s not just Spaniards who use fertility clinics in Spain, people come from all over Europe and even further afield. A recent study by the American Society for Reproductive Medicine found that five percent of European fertility care involves patients cross border travel and that the most popular European destinations are Spain, the Czech Republic, Denmark and Belgium.

In 2019, Spanish fertility clinics carried out 18,457 treatment cycles for foreigners, the majority from France and Italy. According to Barcelona IVF, the French, English and Italian are the ones who travel the most to Spain to undergo fertility treatments.

So what are the rules on IVF and other assisted reproductive techniques in Spain? 

The In Vitro Fertilisation Law in Spain states that any woman over 18 years old can undergo reproductive techniques in Spain regardless of marital status and sexual orientation. Egg freezing for future use is also allowed.

This legal framework establishes that assisted reproductive techniques can only be used when there are possibilities of success and when they do not pose a serious risk to the health of the patient.

The IVF law in Spain does not allow for uterus transplants or the use of surrogates or gestational carriers.  

While the law has not yet incorporated any mention of ROPA techniques, this is also offered in Spain. The ROPA method is used when women in a same-sex relationship want to share parenthood, whereby one provides the egg and the other one carries the baby.

What is the law on PGD and PGS testing?

Preimplantation Genetic Diagnosis or PGD is when the embryos are tested for specific inherited genetic issues such as cystic fibrosis. PGS also referred to as PGT-A is Preimplantation Genetic Screening or Testing and tests to see whether the embryo is genetically normal. The second one is typically used for women over the age of 35 or for those who have had multiple implantation failures or miscarriages.

Both types of tests are legal in Spain, however, the IVF law prohibits these tests to allow for selecting the sex of the baby or for physical characteristics. In some countries, such as the US for example, it’s very common to find out the sex of the embryo when these tests are carried out.

What are the rules for IVF in public health care?

Assisted reproduction techniques such as IVF and artificial semination are available through the public health care system in Spain, however, out of the more than 400 fertility centres in Spain only between 10 and 20 percent are public centres.

READ ALSO: Spain restores free IVF to singles, lesbians and now trans people

This means that there are also long waitlists for reproductive techniques through the public system, as well as stricter rules. According to the latest data available, wait lists for IVF are just over one year, however, in many regions, this can go up to two years or longer. In fact, waiting much longer than this is not uncommon.

The government laws establish that the maximum age to undergo these treatments in the public health system is 40 years in the case of women and 55 years for men. This age limit drops to 38 in the case of insemination with a partner’s semen.

The state guarantees a maximum of three rounds of IVF, six if it is by artificial insemination with donor sperm and four if it is with a partner’s sperm. 

Some regions in Spain, have their own rules however such as Madrid which raised the age to 45 and increased the number of rounds from two to four. 

READ ALSO: Madrid raises age limit for women to have free IVF up to 45

What are the laws on egg and sperm donations?

The In Vitro Fertilisation Law in Spain also regulates egg and sperm donation. Egg and sperm donation in Spain is anonymous, voluntary and altruistic.  

The choice of the donor will only be made by a medical team and cannot be selected by the patients, however, doctors will try to match certain physical characteristics. 

Is embryo donation/ embryo adoption legal in Spain?

Yes, according to Article 11 of the law 14/2006 embryo donation or embryo adoption as it is commonly referred to is legal in Spain. Donations must be anonymous and altruistic. 

A couple may wish to donate their embryos if they have a surplus and have already completed their family, while a couple or single woman may want to adopt an embryo if there have issues with their eggs or sperm.

What are the costs of IVF in Spain? 

IVF is a costly process when you go privately, but prices in Spain can be almost half of those you would pay in the US for example. According to the IVF Abroad Patient’s Guide 2022 for IVF using your own eggs, the costs range from €3,600 to €6,700. 

If using an egg donor, it can range from €5,900 to €8,500. For IVF using embryo donation, the costs range from €3,000 to €5,000 and for IVF involving egg freezing, the costs range from €3,500 to €4,700.

Medications for the injections are typically not included in these prices and can cost an extra €1,000 on top.