Spain

In Spain, three parallel processes have taken place during the last 20 years: decentralisation, a health reform and a mental health reform. These processes have produced an extremely complex situation in support and care for people with mental retardation. The decentralisation process was not accompanied by a clear definition of the co-ordination mechanisms among local authorities, and as a result many different health and social care systems have emerged at different times. This makes the description of the current care organisation difficult. An important characteristic of the Spanish system is the major role of NGOs in care and policy-making and planning in this area. A shift from institutional to community care has begun for both psychiatric patients and people with mental retardation, but compared with neighbouring countries and published standards, the provision of intermediate services and non-hospital residential care is very low, and the situation is worst for people with mental retardation and psychiatric problems.