Getting therapy through the public system, the referral route

Terms used

• Centro de salud mental — The centro de salud mental (CSM) is the public outpatient mental health clinic for your area, with psychiatrists, psychologists and nurses.
• Tarjeta sanitaria — The tarjeta sanitaria is the card that proves you can use public healthcare in your region.
• Padrón — The padrón is the register of residents kept by your town hall, proving where you live.
• Médico de familia — The médico de familia is your assigned GP at the local health centre.
• INSS — The INSS is the national Social Security institute, which can recognise your right to public healthcare.
• Cita previa — The cita previa is the appointment booking system used by health services and public offices.

Key rules

• Referral: Public mental health care starts with your GP, who refers you to the CSM for your home area.
• Private care: Private therapists need no referral.
• Therapy intensity: Public follow-ups are often 3 to 6 weeks apart, so weekly therapy is rare.
• Urgent cases: In a crisis, go to hospital emergency, which can refer you to psychiatry.
• Region: Rules and waits depend on your region's health service.

The short route

To enter the free system, you see your GP, and your GP refers you to the centro de salud mental (CSM) for your home area. Expect a team led by psychiatrists, limited psychotherapy and big differences between regions. Private care needs no referral. The decision block below helps you compare routes.

Before you can see a GP

You need a tarjeta sanitaria and an assigned GP (médico de familia). Register on the padrón at your town hall first. Then ask for the tarjeta sanitaria at your regional health service or your centro de salud. The documents list and checklist below show what to bring.

Public care is open to legal residents, including those without insurance. Undocumented people can qualify with conditions: they must show registration and 90 days' presence in Spain. If you are not affiliated to Social Security, you may need to apply through the INSS to have your right to care recognised. EU citizens usually use the EHIC or an S1 form. Documents and the online or in-person process differ by region.

Step 1: the GP appointment

Book with your assigned GP and explain what you are going through. The GP assesses you and may start treatment if that suits. The GP then sends a referral to the CSM for your catchment area. That area is set by your home address.

Mild to moderate problems are often managed by the GP with medication. Some areas have a psychologist at the centro de salud, who sees mild to moderate anxiety or depression and can refer you on to the CSM. This is still rare and coverage varies even inside one region, so ask whether your centro has one.

In an urgent situation, go to a hospital emergency department. It can refer you to psychiatry. Children and teenagers are referred to child and youth mental health units, not the adult CSM.

Step 2: waiting for the CSM

The CSM gives you your first appointment, usually by phone or letter. Make sure it has your current phone number and address. Your centro de salud can tell you which CSM covers your address.

Step 3: the first visit and what follows

A CSM team includes psychiatrists, clinical psychologists, mental health nurses and social workers. The first appointment is an assessment with a psychiatrist or clinical psychologist. Expect 30 to 60 minutes on your reason for coming, history, symptoms, risk, medication and social situation. It ends with a plan: medication, psychotherapy, follow-up with the team, or a return to your GP.

What public therapy is really like

Public care leans on medication, because psychiatrist appointments are short and psychology capacity is limited. Psychotherapy with a clinical psychologist is mainly for more severe or complex conditions. Sessions often last 30 to 45 minutes, and follow-ups are commonly 3 to 6 weeks apart, sometimes longer. Weekly therapy is rare. Some areas offer group therapy or brief programmes. No national session limit exists, but capacity restricts how often you are seen.

If you want weekly sessions, the private or online routes in the decision block may fit better.

Regional differences

Each autonomous community runs its own health service, with its own website, appointment system (cita previa) and mental health section. Ceuta and Melilla are run by INGESA. Some regions allow direct access in specific programmes, so check your regional health service's website.

Public, private or online therapy: which route fits you?

Which route fits you: public, private or online therapy?

• Public system through your GP: Choose this if cost matters most, you speak Spanish or the regional co-official language, and you can wait weeks to a few months for a first appointment. Your GP refers you to the centro de salud mental for your home area, and waits vary a lot by region.

• Private therapist in person: Choose this if you need to start soon, want sessions in English or another language, or want to pick your therapist. Cost is the trade-off: the price of a first psychiatrist visit and of a session is set out in the cost article. Big cities cost more, especially for English-speaking clinicians.

• Online therapist: Choose this if you want a language that local clinics rarely offer, live far from a good clinic, or need flexible hours. Online sessions are often slightly cheaper than in-person ones, and some therapists offer sliding scales or packs of sessions.

If you are in crisis, do not wait for any route: call 112 or the free, confidential 024 line, open 24 hours a day. Otherwise, start with your GP if you speak Spanish or the regional language and can wait. Go private or online if you need a quicker start or therapy in English. You can also combine them: see your GP for a referral and a psychiatrist, and a private or online therapist for talking therapy while you wait.

Waits, language support and prices vary by region and clinic. Check current figures with your regional health service and with the therapist directly.

Timeline and deadlines

• Register on the padrón at your town hall, then ask for your tarjeta sanitaria: first, before you can use the public system

• If you are undocumented, show registration and presence in Spain to qualify for care: after 90 days of presence in Spain

• See your GP, who refers you to the centro de salud mental: once you have your tarjeta sanitaria and an assigned GP

• Wait for the centro de salud mental to give your first appointment by phone or letter: after the GP sends the referral

• Attend follow-up sessions with the team: commonly every 3 to 6 weeks or even longer

Documents you need

• Passport, or your NIE or residence card, to prove who you are and that you live in Spain.

• Padrón certificate from your town hall, proving you are registered at your address (empadronamiento). Register first, then ask for your health card.

• Social Security number, which you get from the TGSS (Social Security office) or through your employer.

• Proof of address or a form declaring you have no other health coverage, which some regions also ask for.

Checklist

• Ask for your tarjeta sanitaria at your regional health service or centro de salud, with your passport or NIE, padrón certificate and Social Security number.

• Ask for your assigned GP (médico de familia) and book an appointment.

• Ask your GP for a referral to the centro de salud mental for your home area.

• Ask whether a psychologist works at your centro de salud, since some areas refer mild to moderate anxiety or depression there first.

• Check that the centro de salud mental has your phone number and address so it can send your appointment.

Frequently asked questions

Who will I see at the centro de salud mental?

You will see a team that includes psychiatrists, clinical psychologists, mental health nurses and social workers. The first appointment is usually an assessment with a psychiatrist or clinical psychologist, often 30 to 60 minutes.

How often will I get therapy sessions in the public system?

Follow-up sessions are commonly spaced every 3 to 6 weeks or even longer, not weekly. Care is mostly medication-led, and psychotherapy is mainly offered for more severe or complex conditions. There is no fixed national session limit, but local capacity decides how often you are seen.

Can a psychologist at my health centre see me before the centro de salud mental?

Only in some areas, where a psychologist is assigned to your centro de salud. Your GP refers you to that psychologist, usually for mild to moderate anxiety or depression, and the psychologist can refer you on to the centro de salud mental if needed.

How do I find which mental health services cover my region?

Ask your centro de salud which centro de salud mental covers your address. Your region's health service website also has a centre directory, a mental health section and online appointment booking (cita previa).