In Portugal, the mental health problems have become more evident during the two long periods of a state of emergency, with severe restrictions and general confinement. The first one begun in March of 2020, the second one in the first five months of 2021. The emergency response measures in the area of mental health were taken, namely helplines, online platforms for appointments and referral, prevention and education of health. A task force of experts for comportamental issues has been set up in March 2021. According to one of the studies, “Youth for Health 20/30 “ from the Portuguese National School of Public Health (NSPH), mental health emerges as the main problem highlighted. With the closure of many health services not considered essential, face-to-face psychotherapeutic follow-ups were compromised, which began to be mostly done by phone or online. Increased risks for mental health were found by the ICS (Social Sciences Institute) and NSPH studies, carried out both in 2020 and in 2021. Young people and women were the most affected groups, as well as the unemployed and people with low incomes. The government members and the responsible for the public health department, at different times, indicated mental health as a priority, in the prospect of future decisions. Following this policy, the director of the National Mental Health Plan, Dr. Miguel Xavier, called for the urgent implementation of an important reform for the public services, which should include multidisciplinary and decentralized teams with psychotherapeutic and psycho-social support to the communities.
- 10.6 million Inhabitants (2011 approximation); 119 per square Kilometer
- Expenditure on Health (2009): 10 Billion Euros (Approximately).
- 6.7% gross domestic product.
Psychotherapy in the health care system
- It is normally not financed by the National System of Social Insurance, unless when prescribed by a psychiatrist. In general, private health insurance doesn’t cover psychotherapy sessions.
- The most common psychotherapeutic orientations are the cognitive-behavior- therapy, the psychodynamic psychotherapy inspired on psychoanalysis, the systemic familiar therapy and the humanistic psychotherapy.
- The public health care system includes a Psychological Service for diagnosis and consultation which is available in most Health Centers. There are hospitals that refer to mental health, although the number of Clinical Psychologists in the public service is quite limited.
- There are no laws regulating psychotherapy or psychotherapist activity.
- There are associations that provide specialized training in Psychotherapy, some for Psychologists. There are others for Psychiatrists, and some others open to other Professionals (Nurses, etc…)
- Otherwise, the title of psychologist is protected and the practice of psychologists is now regulated.
- Since 2010 all psychologists must be members of the Portuguese Psychologist Association (OPP).
Psychotherapy for Depression
- Although the prevalence of depression in Portugal is in the average of Europe, Portugal has the highest European rate of Antidepressant consumption. Besides this, in some regions we have the highest rate of suicide in Europe.
- A large number of Portuguese with psychological suffering don`t have adequate treatment.
•For most patients the option of Psychotherapy is not provided in the treatment for depression, outside of the principal health centers of Lisbon, Oporto, and Coimbra.
- The National Mental Health Service does not provide enough assistance neither in the medical perspective nor in the psychological perspective.
- There are lacks of psychiatrists in many regions of the country.
- There are only a few specialized Psychologists in the public service.
- The large majority of the psychologists and psychotherapists work exclusively in the private sector.
Desirable Changes to Health Policy
- The National Plan of Mental health Care was approved for the next few years (2008-2017) and officially published in 2008.
- This document mainly expresses a medical perspective.
- We must change the understanding of depression from the concept of mental illness (applicable for severe depression), and turn to the concept of psychological sufferance and give a central role to psychotherapy.
- The creation of reference centers with availability of the principal psychotherapeutic options needed to the treatment of various types of depressions.
- The Creation of a Work Task Force of experts with the following objectives:
- Study the principal risk-factors of depression, creation of prevention plans and therapeutic strategies.
- Look at the best practices for early psychological diagnosis and treatment.
- Promote a better integration of psychological knowledge with a stress on the psychotherapeutic approach on depression in the health care policy and improving the liaisons between psychologists specialized in psychotherapy, psychiatrists and medicals general practitioners.
- Improve the presence and qualification of Psychotherapy Services available in the National Health System, with the objective of getting the best treatment for the various cases of psychological sufferance, which in major situations include depression.
- Portugal has a compulsory registration regulated by law for the health professions (Medical Doctors, Psychologists, Nurses).
- The Psychotherapy in this context is a specialization of those professions.
- In Portugal to be an effective member of the Portuguese Psychologists Association (OPP), it is necessary to have the same requirements as those in EUROPSY.
- For psychologists specialized in psychotherapy the next step is to create a College in this field of Specialty, inside the OPP.
- The further specializing qualification which is required for membership of the College of Psychotherapy has not yet been agreed upon.
Dr. Jorge Gravanita, Psychologist Specialized in Psychotherapy, Founding Member of the Portuguese Society of Clinical Psychology (SPPC)
The text above is an excerpt from the paper "Psychotherapy in Europe – Disease Management Strategies for Depression. National Concepts of Psychotherapeutic Care".
You can download the paper here.