Trends in the Organization of Mental Health Care in Portugal

Abstract

In the past 25 years, 3 periods can be identified in the organization of mental health care in Portugal: decentralization of hospital, institutionalized care (1963-1971), integration of mental health into the general health services (1971-1984), and the present situation. Before 1963 the needs of the Portuguese people for mental health care were very poorly met through uncoordinated subsystems generally oriented toward the provision of very specific types of care and benefiting only limited groups of the population. Outpatient psychiatric care was exclusively curative, complying with the demands of patients or families and based on the classic biological-medical approach to therapy. By 1963 the principal subsystems providing ambulatory care at the community level were: (i) psychiatric consultation within the network of the social security medicosocial services for workers and their families; (2) private psychiatric facilities, used mainly by the upper socioeconomic classes; (3) outpatient services (dispensaries) at state mental hospitals and mobile teams providing psychiatric consultation in the country's larger towns; and (4) special services by private psychiatrists for state employees, and psychiatric care within the medical services offered by several public enterprises or organizations. Psychiatric inpatient care was provided by 5 large state mental hospitals, with about 3,700 beds, located in the Portuguese cities of Lisbon, Oporto, and Coimbra, and 6 large private psychiatric clinics (owned mainly by religious orders) with a total of 3,100 beds. In general, these mental hospital facilities offered a very undifferentiated and traditional type of institutional care.