Mental health access in Europe

Country/area: Spain

Organisation: Civio (main publishing org), El Confidencial, DW Deutsche Welle, VoxEurop, H-Alter, etc.

Organisation size: Small

Publication date: 09/03/2021

Credit: Eva Belmonte, Ángela Bernardo, María Álvarez del Vayo, Carmen Torrecillas, Antonio Hernández, David Cabo, Olalla Tuñas, Miguel Ángel Gavilanes, Lucas Laursen, Aspasia Daskalopoulou, Monica Georgescu


The Civio Foundation (Fundación Ciudadana Civio) is an independent, non-profit organization based in Spain which monitors public authorities, reports to all citizens and lobbies to achieve true and effective transparency within our institutions. We work for the following: to achieve free access to the information generated by them; to understand how they make decisions; to have public policies based on evidence; to succeed in the public sector being held accountable; and to facilitate action and public participation. The levers we use to achieve these changes are journalism and innovation. We are a multi-disciplinary team of 10 (journalists, computer programmers, and experts in communications and marketing, institutional relations and business development) with international patronage and an advisory board committed to improving democracy.

For this investigation, we have partnered with the European Data Journalism Network (EDJNet), a network of independent media organisations and data newsrooms producing and promoting data-driven coverage of European topics in several languages. The network brings together journalists, developers and policy experts. As in this occasion, we have the opportunity of working in collaboration with colleagues from several countries; a cross-border team of data journalists, graphic designers, developers and communicators all together.

Project description:

A 17-month investigation coordinated by Civio has led to the first in-depth journalistic publication on mental health access in Europe. We have investigated whether the public systems of each country provide this care, the cost for the patient of accessing through the private system, the effects of confinement for many of them, the violation of rights in psychiatric centers and the use (and abuse) of psychotropic drugs. A complete landscape that, in the absence of reliable official data, led us to create our own repository from scratch covering 28 countries, asking national governments, associations and patients in each of them.

Impact reached:

In theory, every European country has access to mental health services for its citizens. However, reality says otherwise. This investigation results in a series of three in-depth articles that enlightens the current situation. First, not all countries of the European Union grant access to mental health professionals in the national health system. But even countries that on paper do cover it have important gaps. The main piece, ‘Pay up or put it off: how Europe treats depression and anxiety’ shows that, although all countries claim to cover access to mental health in their public health system, the reality is very different. The existence of copayment, long waiting lists, a shortage of public psychologists or a limited number of consultations pushes patients to private care, if they can afford the prices -revealed for the first time in this investigation. 

We complete the coverage with a revision of the status of the model that ended the old psychiatric internships and discovered that there are still serious human rights violations in some countries in these dependencies. We performed an analysis of the abuse of psychotropic drugs such as anxiolytics and antidepressants in Europe, which can be explained by the lack of resources in mental health services, among other reasons.

Across Europe, at least 30 outlets have republished or echoed this research in 9 different languages, as Deutsche Welle, El Confidencial, VoxEurop and H-Alter, among others. A coverage that today is an international reference on the challenges of mental health in the present and in the coming years. As a result, the barriers that we bring to light have reached the legislative debate in the Spanish Congress, conditioning the future drafting of a national law of Mental Health.

Techniques/technologies used:

In the process of gathering the information, we have used several tools. One core tool in our work is the Information Act, key for accessing the information regarding the Spanish situation on mental health. Also, we carried out data analysis of our own databases, to which we used the traditional data driven investigation tools, such as Excel.

Nevertheless, most of our efforts were set to visualize the complex information in an easy way. The main infographic is a visual and interactive tour in which the reader can explore a large amount of data in an innovative way: ‘pulling the thread’ of their own country but also have an overall view of the main findings of the 26 countries at once. We have reinforced its narrative side technically via “scrollytelling”, a form of interactive experience that unfolds the visualization content as the user scrolls. Detection of the reader IP location was also implemented in order to highlight the user’s country along with the whole piece.

Plus, several static visualizations were included along with the articles for clarification purposes, adding context to the main piece. All of them are responsive, adapting to the different device sizes including small mobile displays, and are easily embeddable in multiple languages through Iframe HTML code. They are developed in JavaScript, combining D3.js, ai2html.js and scrollama.js libraries.

Also, at the end of the main article, the reader can use a search engine with all the data available for each country and every source of information in one place. Therefore, information is available as a public service where people who need help can look for resources and check their possibilities.

What was the hardest part of this project?

In the process of investigating the issue, we discovered that the official data did not tell the whole story. They remained on the surface. So, we decided to create our own database from scratch. This was, without a single doubt, the most difficult part of the investigation. We sent a questionnaire on access to psychological treatment to each of the national health systems in the European Union (including the United Kingdom). We sent the questions to professional organisations of psychiatrists and psychologists in all EU countries, to various mental health non-profit organisations, to mental health experts and to journalists from the European Data Journalism Network (EDJnet). We also sent them to the press offices of all EU health ministries, with the exception of Spain, where we made a public information request. 

In order to create our database and make it as up-to-date and rigorous as possible, we also asked all EU health ministries for the most recent data on psychologists per capita in their national health systems. Finally, we asked national organisations of psychology professionals to give us an estimate of the price ranges in private practices in their respective countries.

We worked tirelessly to have the most truthful data. When using other databases, such as the OCDE one on the use of antidepressants or anti-anxiety medication, we observed that numbers were abnormally low, so we sought confirmation from the Italian Pharmacy Agency. Their data differ from the OECD’s and we replaced it in our analysis. This is just one of many examples of the manual comprobation of the official data that the whole team had to carry out for months for this investigation.

What can others learn from this project?

This investigation has been a rollercoaster for the whole team. For instance, datasets that were available and ready to use ended up being not trustable, which added several months of work. Also, we learned a valid lesson: sometimes data makes things look good, but the barriers in reality are not shown. For example, one country can have free access to mental health treatments and data says plenty of people use these. However, data doesn’t show how long people had to wait until they received help in some cases. Or why antidepressants consumption is increasing in recent years. Data means nothing without context.

We talked and interviewed all the actors involved in these numbers: from patients to psychologists, psychiatrists, and health administrators. And they were the ones who told us the problems behind the data. Making them the center of the investigation was important for the team. Mental health is frequently a taboo conversation and people who suffer from it are stigmatized. By giving them a voice, we have gotten closer to the problems that matter for the people and we are proud of not sticking only to the data.

Finally, journalistic investigation on access to mental health care in Europe would not have been possible without the partnerships built within the European Data Journalism Network (EDJnet). Collaborations with journalists and local media have allowed us to get to know the social reality of each country, contextualising the data obtained, as well as interviewing sources of great interest to offer their vision of the national situation. This is a great lesson for the development of cross-border investigations that seek to address neglected issues such as mental health.

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