The reform of mental health care (MHC) systems is a key health policy target worldwide. To discuss the organisation, provision and financing of MHC in Spain. We draw upon existing literature, reports and empirical data from regional and national health plans, as well as European reports pertinent to Spain. In addition an expert panel has reviewed the features of MHC, namely its history, characteristics and determinants. Spain has moved to full de-institutionalisation alongside coverage expansion and policy innovation. There remains a lack of earmarked budgets for MHC , an imbalance in MHC reforms, and a lack of monitoring of the reform process. The new focus is on how to improve coordination within and across sectors, tackle socio-economic inequalities, monitoring trends including trans-institutionalisation, services to meet the needs of new migrants, as well as those of the rural population
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