Child and teen mental health care in Spain, what parents should know

Terms used

• Empadronamiento — Empadronamiento is your registration at your town hall as a resident, usually needed to get a health card.
• Tarjeta sanitaria — The tarjeta sanitaria is the regional health card that gives access to public healthcare.
• Psicólogo sanitario — A psicólogo sanitario is a psychologist officially qualified to practise clinical health psychology.
• Orientación — Orientación is the school guidance department, staffed by counsellors who assess pupils' needs.

Key rules

• First stop: The paediatrician or GP at your health centre makes the referral to the child mental health unit.
• School: The school counsellor can assess and advise but cannot give therapy or a clinical diagnosis.
• Emergencies: If your child is in immediate danger, go to emergency services instead of waiting for a referral.
• Private care: You can see a private psychologist or psychiatrist directly, without a referral.

The route in short

Child mental health care in Spain runs from the paediatrician to your region's child and adolescent mental health unit. School support and private options sit alongside that route. Start with the paediatrician or GP at your health centre (centro de salud). They decide whether to refer your child.

Step 1: Get into the public system

Public specialist care needs the regional tarjeta sanitaria and a health centre with an assigned doctor. You normally need empadronamiento first. Children are covered. Uninsured adults have their own rules, which depend on how long they have been registered as residents.

Step 2: See the paediatrician or GP

Book an appointment and describe what you have noticed. The doctor can refer your child to the specialist unit. Referral is usually for suspected moderate to severe problems that primary care cannot manage. Examples are ADHD, autism, anxiety, depression, eating disorders and self-harm.

If your child is in immediate danger, go to emergency services. Do not wait for a referral.

Step 3: The regional unit

The unit's name and age limit differ by region. Ask your doctor what it is called where you live.

• Madrid: the child and youth section of the local mental health service, then hospital child psychiatry units and day hospitals.
• Cataluña: CSMIJ centres. Children aged 0-6 may go through CDIAP.
• Andalucía: USMIJ units within the regional health service.
• Comunitat Valenciana: USMI units in each health department.

Waiting times also vary by region. The what-if section below covers long waits.

School support

Schools can help, but they do not treat. Public and publicly subsidised (concertado) secondary schools have an orientador, usually a psychologist or educational psychologist. Primary schools are served by regional teams. They assess learning and behaviour needs, advise teachers and families, coordinate support plans and can refer to health services. They do not give ongoing therapy or diagnose mental disorders.

Ask the class tutor or head of studies for an evaluation by the orientación department, in writing if needed. A supporting report from the school can help when you see the doctor. Private schools have their own psychologists.

Private options

You can go private at any time, without a referral. Options include private child psychologists, child psychiatrists, multidisciplinary clinics and hospital private units. Some are covered by private health insurance (seguro de salud). Check that a psychologist is registered as a psicólogo sanitario.

Typical prices are estimates for around 2025. Madrid and Barcelona are at the higher end.

• Psychology session: 50-90 euros.
• Psychiatry consultation: 90-180 euros, and first visits cost more.
• Full neuropsychological or diagnostic assessment: often several hundred euros.

Use the checklist, timeline and FAQ below to work through the steps.

Timeline and deadlines

• Register at your town hall (empadronamiento): before you ask for a health card

• If you are an uninsured adult, wait until your registered residence reaches 90 days before requesting healthcare access; your child is covered without this wait: after 90 days of registered residence

• Get the regional tarjeta sanitaria and be assigned a health centre and a GP or paediatrician: once you are registered and covered

• See the paediatrician or GP, who refers your child to the child and adolescent mental health unit: after your child has a health centre and doctor

Checklist

• Book an appointment with your child's paediatrician or GP at the health centre and describe what you have noticed.

• Ask for a referral to the child and adolescent mental health unit of your regional health service.

• Ask what the unit is called in your region and what age limit it applies.

• Ask the school for a supporting report from its guidance team to show the doctor.

What if your child's mental health wait is too long?

You do not have to sit and wait. While you wait for a public child mental health unit, you can use the school, your paediatrician and private care at the same time.

Expect a wait, and ask about it

First appointments at public child and adolescent mental health units often take from several weeks to several months. The wait is longer in some areas and shorter for urgent or high-risk cases. Follow-up visits are often weeks apart. Ask your regional health service for the current wait in your area.

Start with your paediatrician

Go back to your paediatrician and say the wait is a problem. Describe what has changed since the referral, such as sleep, eating, school refusal, self-harm or talk of not wanting to live. A worse picture can move the referral up the list. The paediatrician can also see your child in the meantime and tell you what to watch for.

Use the school counsellor

In public and publicly subsidised (concertado) schools, ask the class tutor or the head of studies for an evaluation by the orientación department, in writing if needed. Secondary schools have an orientador, usually a psychologist or educational psychologist. Primary schools are served by regional support teams, and their names differ by region.

The counsellor can assess learning and behaviour, advise teachers and you, set up a support plan and refer your child to health services. The counsellor does not give ongoing therapy or diagnose mental disorders. Private schools have their own psychologists.

Consider private care while you wait

Many families pay for private care to bridge the gap. You can choose from:

• child psychologists (look for a psicólogo sanitario or a health psychology master's)
• child psychiatrists
• multidisciplinary clinics
• private hospital units

Typical prices are 50-90 euros per psychology session and 90-180 euros for a psychiatry consultation, with first visits costing more. Madrid and Barcelona are at the higher end. A full neuropsychological or diagnostic assessment often costs several hundred euros. Ask the price before booking, and keep any reports, since you can show them to the public unit.

If it becomes an emergency

If your child is at immediate risk (suicide attempt, self-harm, violence, psychosis), call 112 or go to hospital urgencias. Choose a hospital with paediatric emergency care if you can, because a psychiatric assessment is available there. Non-residents are also entitled to emergency care. Do not leave your child alone, and remove anything they could use to hurt themselves.

For advice and support, the free 24-hour line 024 is for crisis and suicide prevention. Children and young people can also call the ANAR Help Line on 900 20 20 10, which is free and confidential.

Frequently asked questions

Does my child need a health card before using a public child mental health unit?

Yes, your child needs the regional tarjeta sanitaria and a health centre with an assigned GP or paediatrician, because that doctor makes the referral. Registering at your town hall (empadronamiento) is generally the first step. Children are covered.

Can the school counsellor diagnose my child or give therapy?

No, the school counsellor (orientador) does not give ongoing therapy or clinical diagnosis of mental disorders.

How much does a private child psychologist or psychiatrist cost?

A private psychology session typically costs about 50-90 euros and a psychiatry consultation about 90-180 euros, with first visits costing more.

What is the public child mental health unit called in my region?

The unit's name depends on your region: Madrid uses the CSM infanto-juvenil, Cataluña the CSMIJ, Andalucía the USMIJ and Comunitat Valenciana the USMI. Your paediatrician or GP will refer you to the right one.