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By Dylan Ronald Tomlinson, John Carrier

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Deficiencies could be observed in relation to the composition of some of the community teams and the numbers of professionals working within them. In the case of 122 teams there was clearly an insufficient minimum of one psychiatrist, one psychologist ASYLUM AND THE COMMUNITY IN SPAIN 45 and one nurse, with some of these posts not even being filled. There were also manifest differences between the regions, as well as in the size of the population covered by each team. 3). Adopting Aparicio’s lucid method (Aparicio, 1993) it is possible to consider the Autonomous Communities as falling into five groups, each illustrative of a distinct model of mental health services development: 1 The institutional model This model obtains in the Balearic Islands, the Canary Islands, Extremadura, Galicia and Murcia (almost 20 per cent of Spain’s population).

In order better to uphold individual liberties, this code abolished the decree of 1931 and provided safeguards against involuntary confinement, for which judicial authorisation is required prior to any hospitalisation (unless it is considered an emergency and then twenty-four hours can be granted before a physician has to inform the judge). In the same way, every patient stay of more than six months has to be reviewed by a judge. Since its passing, however, this law has been shown to be ineffective in some respects, and the practical impossibility of guaranteeing judicial assistance in all cases of involuntary confinement has become apparent (Defensor del Pueblo, 1991; Ararteko, 1992).

The similarity of trends in both Asylum 1 and 2 in Scotland and Ireland could be seen as supporting such a hypothesis. Whatever the truth, those born before or after that period were very much less likely to receive such long-term institutional care, whatever their needs might have been. The degree to which those born later have benefited from more recent treatments, notably drug treatments as well as ambulatory health service contacts is also unclear, but some effect seems likely. A supply-side explanation is also worth considering.

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