Spain loses every year more than 430,000 people. Each of those deaths affects relatives and loved ones who must endure a grieving process. And they do so, in an increasing proportion, without the collective frameworks that for centuries helped manage that experience. This results in a cultural and social shift, but it also gives rise to a public health problem that action plans in mental health continue to address in an insufficient way.
Grief is a normal adaptive process. But when it becomes complicated — when the person fails to integrate it and is immersed in incapacitating symptoms — its consequences are serious and measurable. Systematic reviews on “complicated grief” in the Spanish adult population reveal a weighted average prevalence of 21.5%, with figures spanning 7.6% to 28.7% depending on the diagnostic tool used. These percentages, applied to the annual deaths recorded, imply tens of thousands of people at risk of developing depression, chronic anxiety, or suicidal thoughts. Moreover, the loss of a loved one is associated with an increase in health service use of up to 80% compared with the annual average of consultations at the health center. The cost, both human and systemic, is enormous. And yet, Spanish public policy does not have a specific grief care protocol integrated into primary care.
From the community to the funeral home
Spain has been characterized as a country with a dense and well-ritualized culture of grief. The wake at home, tolling bells, visible mourning, mourning meals, or prolonged visits fulfilled, as a symbolic device, a function that anthropology has studied intensely. Funeral rituals are not irrational premodernities, but social technologies for the collective elaboration of pain, mechanisms that allow externalizing suffering, sharing it, and giving it a temporal frame.
“Funeral rituals are not irrationalities of premodern times, but social technologies for the collective elaboration of pain”
The philosopher Ana Carrasco-Conde, author of La muerte en común, notes that Spain, until forty years ago, possessed communal wake rituals that organized grief collectively, but that contemporary societies consider those elements “no longer productive”. Today, many funeral homes close at night and reopen at ten in the morning. Grief has been normalized, sanitized, and accelerated. And furthermore, subcontracted, because it is no longer managed by the community but by the funeral sector, which in Spain bills more than 1.7 billion euros a year.
The change is not only about form. According to the III Report of the Funeral Services Observatory, 49.8% of Spanish funerals are now civil ceremonies, compared with 50.2% religious ceremonies, which reflects a gradual secularization of grieving. That secularization was inevitable and, in many respects, necessary. The problem is that it has occurred without secular frameworks for grief processing being built with the same solidity as those that have been abandoned. In other words, religious rituals have been emptied of their meaning without filling their space with equivalent civil rituals. The result is a functional vacuum, in which thousands of people go through their losses without a collective structure to support them.
The two-day leave and its consequences
There is an indicator that sums up the Spanish institutional stance toward grief. The paid leave for the death of a first-degree relative is, in most collective agreements, two natural days. In some cases, three if travel is required. Legislation sets this minimum and collective bargaining rarely expands it significantly.
Two days to bury a father, two days to organize a spouse’s death. And back to work.
“Grief has been normalized, sanitized and accelerated. And moreover, subcontracted, because it is no longer managed by the community, but by the funeral sector”
It is a broad implicit public policy statement in which grief is presented as a private matter that must not interfere with productivity. Other European countries —Belgium, France, Portugal— have recently expanded their grief leaves. The United Kingdom approved in 2020 a specific law on paid leave for the death of children. In Spain, however, the legislation has not been amended.
This decision has predictable consequences. People in mourning return to the workplace without having even begun the process of processing their grief. The current 2025-2027 Mental Health Action Plan recognizes grief as a risk factor for mental health, but it addresses it in a cross-cutting way and without specific detection and care protocols in primary care. Our health system treats the consequences —depression, anxiety, somatizations—, but does not address the cause.
A public policy gap
In 2022, Spain recorded 331 mental and behavioral disorders per 1,000 inhabitants, a 4.7% increase vs. 2019. Certainly, uncomplicated grief is not a mental disorder. But complicated grief is, and its entry point into the health system is, often, primary care, where its professionals — family doctors and nursing staff — do not receive formal, specific training for detection and support.
Half of people with mental health problems in Spain suffer from unwanted loneliness. The relationship between poorly managed grief, loneliness, and deterioration of mental health forms a triangle that public policies address separately — mental health plan, loneliness strategy, community interventions — without articulating an integrated response. And we need it urgently.
“It is a broad implicit public policy statement in which grief is presented as a private matter that should not interfere with productivity”
The nominal political will is present, as there exist plans, strategies and documents. Now, the recognition is missing that grief has a community dimension that the health system cannot resolve on its own and that requires investment in two areas that Spain has consistently neglected: training of primary care professionals in bereavement support and the reconstruction of secular ritual frameworks that allow communities — neighborhoods, schools, work environments — to collectively process losses.
Three concrete measures
The reform agenda is not unmanageable and involves at least three concrete lines of action.
The first is legislative. Extend the paid leave for the death of a first-degree relative to a minimum of five business days, aligning Spain with the most advanced European standards.
The second is health-related. Incorporate screening and care protocols for complicated grief into primary care, with specific training for family doctors and nursing teams, following the model that countries such as the United Kingdom and Australia have already implemented.
The third is community-based. Fund municipal grief support programs — support groups, spaces for collective processing, volunteer training — that do not replace clinical intervention, but fill the important in-between space between the health system and private grief.
Spain has learned to talk about mental health, but not yet about death. And while that conversation is postponed, the cost — health, human and economic — will continue to be paid, in silence and by those who lose someone.
