What Can Portugal Teach Us With Its New Mental Health Law?

Portugal has taken a major step forward with its new mental health law that transforms how mental health care is approached. Instead of the traditional institutional model, it focuses on community-based treatment that keeps people connected to their support systems.

 

Mental Health Statistics in Portugal

Portugal is facing a major mental health crisis, with alarming statistics highlighting the severity of the situation:

 

1. Limited Access to Services

Only 1.7% of those with mental health issues in Portugal have access to public specialized services, despite an estimated 5-8% of the population suffering from moderate to severe psychiatric disorders annually.

 

2. High Prevalence of Mental Disorders

Portugal has the second-highest prevalence of psychiatric diseases in Europe at 22.9%, surpassed only by Northern Ireland. Around 22.9% of Portuguese people suffer from a psychiatric disorder, with anxiety disorders being the most prevalent at 16.5%, followed by mood disorders at 7.9%.

 

3. Significant Disease Burden

Mental and behavioral disorders account for 11.8% of the overall disease burden in Portugal, more than oncological diseases (10.4%).

 

4. Chronic Depression and Psychological Distress

Portugal has the highest proportion of women reporting chronic depression in the European Union (EU), and the sixth-highest level for men. Around 57% of the Portuguese population experiences some form of psychological distress.
 

5. High Consumption of Psychiatric Medications

Portugal is the 5th country in the Organization for Economic Co-operation and Development (OECD) with the highest consumption of antidepressants and anti-anxiety medications, with a consumption rate of 104 daily doses per 1,000 inhabitants.

 

6. Alarming Suicide Rates

The suicide rate in Portugal was 11.5 per 100,000 inhabitants, with rates increasing between 1993-1999 and 2008-2012 in mainland Portugal. Some regions like Alentejo (21.4), Algarve (14.4), and Azores (13.2) had rates above the European average in 2011-2013. The Azores has a suicide rate of over 25 per 100,000 for the 15-24 age group, the highest in Portugal. 

 

Older age groups generally have higher suicide mortality rates, with rates increasing for those over 75 between 1994-2014, except for ages 15-29. The 45-59 age group saw the highest increase in suicide rates from 2001-2014. Males have significantly higher suicide rates than females, averaging 14.1 vs 4.2 deaths per 100,000 inhabitants.
 

7. Rising E-Cigarette Use

Electronic cigarette use increased from 11.6% to 16.9% over the same period.
 

These alarming statistics emphasize the urgent need for thorough mental health policies, increased access to services, and effective prevention and intervention strategies in Portugal.

Portuguese New Health Reform

 

The Portuguese mental health reform has indeed put a strong emphasis on patient-centered care and promoting the recovery and reintegration of individuals with mental health conditions into the community. Here are some key points about the patient-focused approach under the new law:

 

1. It shifts away from the traditional paternalistic model where decisions were made solely by health professionals, towards a collaborative approach that empowers patients to be active participants in their treatment plans and decisions affecting their care.

2. There is a focus on respecting patient autonomy, human rights, and informed consent in mental healthcare. Patients are seen as independent individuals capable of making informed choices about their treatment when properly supported.

3. Community-based services aim to provide care in the least restrictive environment possible, facilitating patients' social inclusion and participation in community life.

4. Integrated case management programs for those with severe mental illness involve the patient and their family/caregivers in developing an individualized recovery plan.

5. Psychosocial rehabilitation programs in community settings help patients develop skills for independent living and social reintegration.

6. The principles of the reform emphasize continuity of care, accessibility, and fighting stigma - all aimed towards empowering patients on their recovery journey.

 

End of Forced Commitments and Protecting Human Rights 

A big change in the new law is that forced commitments are now banned, except in extreme cases and with strict legal protections. This practice was common in the past and was a clear violation of human rights, often causing more harm to patients. By stopping forced commitments, the mental health law acknowledges that freedom is a basic right that shouldn’t be taken away without good reason. This change helps build trust and cooperation between patients and health professionals, which is better for recovery.

 

Investing in Local Mental Health Services

The law aims to shift mental health care from large psychiatric hospitals to local services integrated into the community. This involves:

 

1. Developing a nationwide network of local mental health services (LMHS) to provide care closer to people's homes and communities.

2. Improving the quality and capacity of existing LMHS to deliver comprehensive outpatient and community-based programs.

3. Transferring long-term care for severe mental illness from psychiatric hospitals to community services integrated into the public health system.

Improving Access to Mental Health Care

By expanding local and community-based services, the law aims to increase accessibility of mental health care across Portugal. Some ways it aims to improve access include:

 

1. Integrating mental health services into primary care units and general hospitals to reduce barriers to treatment.

2. Developing regional mental health services to support and complement local services.

3. Enabling early intervention by making services available at the community level.

4. Considering social, economic, and cultural factors that impact mental health through community-based approaches.

Promoting Recovery and Social Reintegration

The law emphasizes rehabilitation programs and reintegrating those with mental illness into society through community services. Key aspects include:

 

1. Developing psychosocial rehabilitation programs, supported housing, and employment support.

2. Transitioning long-term psychiatric patients into community living with proper support.

3. Involving patients and families in treatment and recovery through community-based care.

4. Reducing stigma and facilitating social inclusion by providing services locally.

Challenges and Opportunities in Making it Work

 

While the new mental health law is a big step forward, there will be challenges in making it work. It will be important to train health professionals so they understand the new principles and practices. It will also be important to overcome stigmas and prejudices in society, and to promote a better understanding of mental health. But the opportunities are huge. By changing the way we think about psychiatry, Portugal is leading the way towards a more respectful and dignified future in mental health treatment. This new approach could inspire other countries to do the same, leading to a worldwide change in how we deal with mental health challenges.

 

References:

https://www.portugalresident.com/almost-1-in-5-portuguese-suffer-mental-health-problems/
https://www.expatica.com/pt/healthcare/healthcare-services/mental-health-portugal-104327/
https://www.mdpi.com/1660-4601/19/18/11153
https://www.sppsm.org/en/informemente-en/mental-disorder-in-numbers/
https://www.oecd.org/health/health-at-a-glance-europe-23056088.htm
https://www.sns.gov.pt/recursos-humanos/formacao/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873880/
https://hbsc.org/portuguese-adolescents-mental-health-and-well-being-decline-hbsc-study-reveals/
https://www.sppsm.org/en/informemente-en/mental-disorder-in-numbers/
Organização Mundial da Saúde, "Mental Health: Strengthening Our Response" (https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response)
Comissão Europeia, "Estudo sobre Internações Compulsórias na União Europeia" (https://ec.europa.eu/health/non_communicable_diseases/mental_health_en)
Ministério da Saúde de Portugal, "Relatório sobre Serviços de Saúde Mental" (https://www.sns.gov.pt/monitorizacao-do-sns/relatorios/)
Ministério da Saúde de Portugal, "Formação de Profissionais de Saúde Mental" (https://www.sns.gov.pt/recursos-humanos/formacao/)
OCDE, "Atitudes em Relação à Saúde Mental em Portugal" (https://www.oecd.org/portugal/health-data.htm)