Health Systems in Transition - Portugal

134 / 188

Health systems in transition Portugal 134
5.11 Mental health care
Subsequent to Decree-Law No. 2118/1963, of 3 April 1963, which approved the
principles of mental care provision, mental primary care centres were created
in 1964 in the different districts as well as in the larger cities: Lisbon, Coimbra
and Oporto. At the beginning of the 1970s, the need to integrate mental health
services in the general system of health care provision became obvious. As
such, in 1984 the Directorate-General for Primary Healthcare was created with
a Division of Mental Health Services. Later, Decree-Law No. 127/1992, of
3 July 1992 integrated the mental primary care centres into the general hospitals.
Considering the recommendations of the United Nations and the WHO with
respect to the emphasis on community services, it was necessary to change
this organization, with a focus on rehabilitation and social integration. Decree-
Law No. 36/1999, of 24 July 1999 regulated the organization of services in
this sector and created a clear referral system as well as a community care
network. In 2006, the Ministry of Health nominated a specialized Commission
for the Restructuring and Development of Mental Health Services. By 2007, the
Commission published the National Plan for Mental Health Services 2007–2016.
The National Plan highlights the advantages of a model of continued and family-
oriented mental care when compared with hospital-based therapy.
The current organization of services is characterized by the following:
• The referral model is that of community care.
• The local mental health services are the basis of the care system, linked
to primary care centres and hospitals.
• When local mental health services cannot be established, they are
organized regionally.
• The mental care teams are multidisciplinary, for a population of
approximately 80 000.
• Ambulatory services are based in primary care centres, and inpatient
admissions and emergencies are treated in hospitals.
• Care for children and adolescents is given by specific teams at the
local level.
• Social rehabilitation is carried out in conjunction with the state health
sector, social security and employment departments.
• Psychiatric hospitals support the local health teams, provide specialized
and inpatient care, and provide residential services for patients without
any family or social support system.