Portugal's mental health patients left to cope alone

Five years ago Portugal switched to a ‘care in the community’ model for the care of its mental health patients, this allowed the ministry to close Portugal specialist mental health units.

The result has been that only one in five patients in need of treatment ‘in the community’ actually receives any care and support at all.

Portugal’s programme coordinator for mental health agrees with the conclusions of a new study that points out several flaws in the treatment of these patients.

The damning conclusions are based on evidence collected for a national and a European report on Portugal's move from mental health care in hospitals to community-based programmes. Currently only 20% of patients have access to care at home and throughout the crisis the numbers needing help steadily have been rising.

Álvaro de Carvalho, Portugal’s mental health controller, agrees with both reports’ conclusions and says that the community care network designed five years ago has not yet got off the ground.

The main aim of community care policy is to treat individuals in their own homes wherever possible, rather than provide long-stay care in institutions. This policy is seen as the best option from a humanitarian and moral perspective and has the advantage of being cheaper to operate.

For Portugal’s mentally ill, the closure of psychiatric hospitals went ahead but the expected support network has crashed on take off.

Reports coordinated by the Faculty of Medical Sciences of Lisbon clearly show that Portugal needs to help the mentally ill in the community but shortages of money and resistance to change by caregivers are hampering efforts.

The vast majority of people with mental illness in Portugal remain dependent on scarce specialist care in hospitals as there is scant care in the community despite this being the health ministry's original intention.

The closure of large hospitals such as Miguel Bombarda in Lisbon saved the government money but nothing has been spent on the promised care network. General hospitals have been forced to take up the slack in dealing with acute mental health patients.

The report authors comment that the Portuguese reality is that "the mental health teams in the community continue to exist in limited numbers only.

“Collaborative primary care programmes and integrated programmes for the severely mentally ill, mental health centres and residential intervention continue to have a very modest expression compared to the reality of other European countries and are far from the minimum acceptable."

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