Rethinking Mental Health and Medication: An Open Call for Global Collaboration
Towards Safe, Person-Centered Best Practices: A Call to Rethink Drug Withdrawal and Deprescribing Policy in Spain and Beyond
Estimated reading time: 10–12 minutes
Topics covered: Mental health reform, psychiatric drug overuse, deprescribing policy, EU and WHO frameworks, systemic challenges in Spain and Europe, and a call for rights-based, person-centered care. This piece proposes a collaborative response to the rising human and economic cost of psychotropic medication dependence.
As mental health becomes an increasingly urgent concern around the world, debates around the appropriate use -and overuse- of psychiatric medication have reached a critical juncture. In light of these global developments, I recently proposed to the International Institute for Psychiatric Drug Withdrawal (IIPDW) the formation of a working group dedicated to exploring policy and supporting collective action on psychiatric drug withdrawal. IIPDW is a global network committed to promoting safe, person-centered withdrawal processes grounded in medical science, lived experience, and ethical care.
The purpose of this proposed initiative is not only to contribute to better-informed policy but to foster deeper transdisciplinary dialogue around a topic that too often remains marginalized in public health planning. I now share this reflection with my broader professional network, as I believe that this conversation must extend across sectors, geographies, and roles -including clinicians, researchers, policymakers, educators, and those with lived experience.
A Pivotal Moment in Spain
In Spain, a national debate on mental health reform is currently underway, as the government prepares to approve a new Plan de Acción de Salud Mental 2025-2027. A key component of this plan is the promotion of deprescribing and a significant reduction in psychotropic medication use nationwide. This initiative has garnered strong support from psychological associations, many psychiatric professionals, and the vast majority of user-led organizations and advocacy groups.
However, resistance remains. Some sectors of institutional psychiatry and their affiliated entities have voiced skepticism or opposition, raising concerns that the proposed reforms may be premature or misaligned with clinical realities. What this tension reveals is a deeper structural gap: without clearly defined, rights-based, and person-centered pathways for safe medication withdrawal, policy intentions remain vulnerable. Reforms risk becoming symbolic at best -and harmful at worst- if not implemented with precision, care, and accountability.
A fine line separates overprescription from self-medication, particularly in environments where mental health literacy remains uneven, safeguards are absent, and institutional pressures push both clinicians and users toward pharmacological shortcuts. Addressing this requires not only updated clinical training but also robust public health education -for service users, families, and policymakers alike.
An European Perspective
The rise in psychotropic drug consumption across the European Union cannot be understood solely as a response to increasing mental health distress. It is also a reflection of systemic shortcomings in how health systems interpret and manage that distress. In the EU, antidepressant use has increased by 147 percent over the past two decades. Countries like Spain, where nearly one in four individuals report having experienced a mental health condition, exhibit some of the highest psychotropic prescription rates in Europe -particularly for benzodiazepines and antidepressants.
Yet this pharmaceutical escalation has not been matched by a commensurate development of deprescribing protocols or clinical guidelines for safe, structured withdrawal. General practitioners and primary care providers -who are often the first point of contact- frequently lack adequate training, time, or institutional support to manage the tapering and discontinuation of psychiatric drugs. This deficit has fostered a pattern of chronic prescribing, wherein medications initially intended for short-term relief become long-term fixtures, often without re-evaluation.
This overreliance leads to a host of adverse effects, frequently unmonitored and inadequately acknowledged: emotional numbing, cognitive decline, sexual dysfunction, withdrawal syndromes, and in some cases, heightened suicide risk. These outcomes are rarely recognized as forms of iatrogenic harm, despite their considerable impact on individuals, families, and already overburdened care systems.
Economically, the implications are staggering. Mental health conditions cost the EU over €600 billion annually -more than 4 percent of GDP. In Spain alone, depression is estimated to generate costs exceeding €6 billion each year, encompassing healthcare expenditures, lost productivity, and the unpaid labor of informal carers. The absence of adequately resourced psychosocial alternatives -such as community-based services, supported housing, trauma-informed care, and recovery-oriented environments- has contributed to a pharmacological default. In many settings, medication substitutes for therapeutic engagement, perpetuating cycles of dependency rather than fostering recovery.
In such a context, coercive practices -including forced treatment and institutionalization -persist. These disproportionately affect vulnerable populations: women, migrants, survivors of violence, and individuals with intellectual or psychosocial disabilities. Framed as necessary for stabilization or risk mitigation, these interventions often exacerbate trauma and violate international human rights standards. Their prevalence signals not the presence of clinical necessity, but the absence of rights-based, person-centered alternatives. For clinicians, families, and service users alike, the emotional toll is significant.
Many professionals express moral distress at being complicit in a system that offers few viable options beyond long-term pharmacotherapy. Addressing this requires not only new competencies and institutional reforms but a fundamental cultural shift -one that redefines care as a participatory, relational, and life-affirming practice anchored in autonomy, dignity, and justice.
The pervasive use of psychotropics in Europe is symptomatic of a deeper systemic preference for pharmacological expediency over truly scientific and evidence-based, responsible, relational, community-grounded care. Societal expectations of rapid symptom relief -exacerbated by underfunded and overburdened services -have normalized the routine use of medications to manage grief, trauma, or social suffering. This tendency obscures the complex origins of distress, fosters long-term dependency, and often undermines recovery. Globally, the consequences are enormous: in the United States alone, the economic burden of substance misuse, including that related to prescribed psychotropics, is estimated at $442 billion annually. Within the EU, rates of lifetime misuse continue to rise, particularly among economically vulnerable groups.
Against this backdrop, the Joint Statement on Long-Term Care, issued on 26 March 2025 by Mental Health Europe and twenty civil society organizations, represents an important shift. It urges the incoming European Commission to move beyond its current focus on workforce shortages and commit to systemic, rights-based transformation of the care sector. Building on the foundations laid by the 2022 European Care Strategy, the statement emphasizes the need for care systems that are accessible, equitable, and grounded in human dignity.
Key priorities include investment in community-based services, expansion of social protection, support for informal carers, and improved working conditions for care professionals. The statement also raises concerns about the commodification of care and the threat posed by financial speculation in the sector -both of which risk eroding rights and shifting responsibility from public institutions to private households. The statement situates mental health within a broader web of structural inequalities -highlighting its intersections with poverty, gender, and systemic neglect. It is within this framework that psychotropic medication practices must be critically assessed. Overmedication often functions as a substitute for precisely the types of reforms that the EU now claims to promote: inclusive, sustainable, and person-centered models of care. Without confronting this disjuncture, efforts to improve long-term care risk entrenching the very harms they seek to overcome.
What is needed now is bold, coordinated action across clinical, policy, and cultural domains. This includes the development of clear withdrawal protocols, public education on medication risks and alternatives, legal safeguards for informed consent, and the redistribution of resources toward psychosocial and community-based interventions. The EU’s evolving care agenda provides a timely opportunity to reorient mental health systems around these priorities -placing lived experience, therapeutic relationships, and long-term well-being at the center, rather than pharmaceutical management alone.
WHO Guidance Reinforces the Need for Reform
Recent developments from the World Health Organization (WHO) add further urgency and legitimacy to these concerns. In March 2025, WHO released new guidance on mental health policy and strategic action plans, setting out a rights-based, person-centered, and recovery-oriented framework for transforming mental health systems worldwide.
The guidance emphasizes the importance of addressing social and structural determinants -such as poverty, education, housing, and employment- and calls for cross-sectoral, community-driven approaches. Crucially, it advocates for the involvement of people with lived experience in all stages of policy design and implementation, and for a shift away from narrow biomedical paradigms toward holistic systems that integrate psychological, social, economic, and physical health interventions.
This builds on WHO’s newly released policy guidelines on drug withdrawal management, which offer specific recommendations on withdrawal strategies for substances such as benzodiazepines, stimulants, and alcohol. For benzodiazepines, for instance, WHO advises a gradual tapering process over 8-12 weeks, often including substitution with longer-acting agents and psychosocial support throughout. These guidelines highlight the importance of structured, evidence-based, and ethically grounded withdrawal processes -exactly the kind of models we hope to amplify and build upon through the proposed working group.
Beyond Medication: Addressing Systemic Neglect
Today, we face a broader cultural problem: the normalization of using both legal and illegal substances -from ketamine and alcohol to prescription benzodiazepines and amphetamine-type stimulants- as perceived solutions to complex human suffering. In many cases, these are offered not as part of an integrated therapeutic framework but as quick fixes, perpetuating what some have called the "illusion of treatment." Meanwhile, slower, more relational and systemic approaches -often supported by strong evidence- remain underfunded or excluded from mainstream practice.
This is not merely a clinical or ethical issue. It is also social, economic, and deeply human. The cost of inaction is measured in lives lost, families strained, and public trust eroded. We must begin to ask not just whether a treatment is effective in symptom reduction, but whether it restores dignity, autonomy, and long-term well-being.
A Proposal for Collective Action
To help shift this conversation and support more grounded, sustainable reform, I’ve proposed the creation of a collaborative working group and international task force focused on psychiatric drug withdrawal policy. Its core objectives would include:
Collaboratively drafting evidence-informed policy briefs and supporting materials
Sharing international models of good practice, including user-led approaches and clinical guidelines for safe withdrawal
Building awareness through educational and legislative outreach that promotes meaningful, systemic change
Providing mutual support to individuals and organizations working to ethically influence national policy environments
This is an open invitation to all who are engaged in this space -clinicians, researchers, educators, activists, policymakers, and individuals with lived experience. If you are working in this field or wish to contribute your insight, experience, or expertise, I would welcome your collaboration. The challenges we face are shared, and so too must be the solutions, feel free to connect to me to collaborate.
Join the Conversation
To close, I am pleased to share an upcoming event that exemplifies the kind of informed, evidence-based dialogue we hope to foster. Professor John Read, chairperson of the IIPDW, invites you to join us for a presentation of the Maudsley Deprescribing Guidelines by Professor David Taylor and Dr. Mark Horowitz -two leading figures in this emerging field.
Event: Maudsley Deprescribing Guidelines - An Overview with Audience Q&A
Speakers: Professors John Read, David Taylor and Dr. Mark Horowitz
Online, registration via Eventbrite:
https://www.eventbrite.co.uk/e/maudsley-deprescribing-guidelines-an-overview-with-audience-qa-tickets-1248230724699?aff=oddtdtcreator
Let us use this moment to deepen our commitment to safe, person-centered care -one that listens to experience, values autonomy, and dares to reimagine what healing can truly mean. Please, repost and share this invitation as widely as possible.
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Henning Garcia Torrents
Medical Anthropologist | PhD Researcher | Professor in Training
research.enricgarcia.md