7.5 Mental health
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National strategy(ies)
Under the National Health Plan, Priority Health Programmes were developed, among which the National Mental Health Plan 2007-2016 (PNSM).
PNSM was approved in 24th January 2008 and revised in 2012, in which the National Coordination for Mental Health was established, under the High Commissariat of Health, which is responsible for coordinating its implementation.
The goal of PNSM is to ensure access to the entire Portuguese population to qualified services to promote the population’s mental health, provide quality care and facilitate the reintegration and recovery of people with mental illness.
There is no Plan directly aimed at young people, but the PNSM provides a group of goals and initiatives for this age group.
However, there is a document with Recommendations for the clinical practice of child and youth mental health in the primary healthcare. This document was developed in 2009 by the National Coordination for Mental Health.
Under the Action Plan for Mental Health 2013-2020 of the World Health Organisation, and the goals defined under the Health in 2020, PNSM intends to support the creation of 1500 spots for adults and 500 for children/teenagers in Continuing Mental Health Care.
In the context of childhood and adolescence, PNSM intends to promote the training of 5 health regions in order to qualify professionals of the primary healthcare in the evaluation of the development and emotional risk in childhood/adolescence. This measure was developed in coordination with the National Child and Youth Health Plan from the DGS.
PNSM still underlines the need of developing services, programmes and projects that promote early intervention and that are properly articulated with the national health policy, especially in schools.
In this sense, it is also essential to promote the articulation between mental health services and social security services, including Commissions for the Protection of Children and Young People at risk (CPCJ).
Also, it should be stressed that under the National Mental Health Programme, the National Suicide Prevention Plan 2013/2017 was developed, which defines the need to develop preventive strategies at the level of specific populations, particularly Teenagers - especially those who are identified as showing risk factors of suicidal tendencies and self-harm behaviours - and at the individual, demographic, age, gender and sexual orientation level.
Improving the mental health of young people
Mental Health in School Health
According to the National School Health Programme (PNSE), the mental health is one of most important aspects in the training of children and young people in health education and promotion, being a priority area of intervention in school.
Health education
Under the extracurricular unit Education for Citizenship, the theme Health Education provides for the promotion of Mental Health and Prevention of Violence.
Mental health and prevention of violence are considered priority areas as they are cross-cutting to all other priority areas of health education.
Framed in the guidelines of the National Mental Health Plan (2007-2016), the educational establishments must be concerned about the implementation of validated prevention programmes, targeted at more vulnerable areas and groups, with the objective of supporting awareness-raising actions and promoting mental health and consequent promotion of continuous intervention and based on knowledge, in partnership with competent institutions in the topic.
Manual for the Promotion of Socio-emotional skills in School
Under the intervention model proposed for School Health and Mental Health, The Directorate-General of Health created a manual for education professionals and school health teams involved in projects to promote socio-emotional skills aimed at children of preschool education and students of basic and secondary education.
It is a pedagogical resource that offers guidance to the promotion of fields of health and well-being as a whole, as well as the development of interpersonal relationships, with the goal of qualifying education professionals for the implementation of projects that promote Mental Health in School. The approach of this resource is based on the typology of the SEL Learning programmes (Social and Emotional Learning) and provides for the involvement of professional school health teams, guardians, school bodies and other partners.
Happy Mind
Happy Mind - Education and Awareness-Raising for Mental Health is an online platform developed by a team of mental healthcare professionals and researchers. It is a part of a wider project - "Education and Awareness-Raising for Mental Health: a programme of school-based intervention for Teenagers and Young People", implemented in schools in the Regional Directorate of Education of the Central region, and developed by the Health Sciences Research Unit. Nursing of the Higher Education Nursing School of Coimbra.
The project intends to promote health and the prevention of mental disorders and behaviour in teenagers and young people, by improving mental health literacy. The project offers a set of tools and information targeted at young people, professionals in the field of education and parents, in order to qualify them to notice and understand the first signs and symptoms of mental disorders, as well as the types of help and treatments that are available.
It provides information on the following areas of mental health:
It presents a group of ANIPI actions - a first help in mental health, whose goals is not to make a diagnosis, but raising awareness for the importance of self-help, reinforcing the need and resort to a specialized professional. ANIPI establishes 5 aid strategies:
- Approaching the person, observe and help (in a crisis);
- Do not judge and listen carefully;
- Inform and support;
- Seek specialized professional help by encouraging the person to get it;
- Encourage the use of other support.
The Nucleus of Suicide Studies (NES)
NES is a non-profit scientific association with the status of a public utility entity, and was founded in the Psychiatric Service of the Santa Maria Hospital (H.S.M) of the National Health Service.
It is dedicated to the study of suicide and suicidal behaviour in adolescence, through a triple approach - individual, family and social - having in mind the dissemination, training and prevention of adolescent suicide.
NES consists of a multi-disciplinary team comprised of multiple agents in the field of health, education and social intervention: psychiatrists; child psychiatrist; clinical psychologists; paediatricians; family physicians; sociologists; social service technicians and teachers.
It provides adequate therapy and develops a diversified set of activities, including:
Clinical Activity
- Daily triage - fast and urgent care;
- Therapeutic intervention to young people at risk of suicide or strong suicidal ideation – individual or family.
Training Activity
- Continuous training to various technicians and social agents - Teachers and education agents, health professionals, sociologists;
- Training in secondary schools - in 4 levels (suicidal crisis intervention; information seminars about adolescence; meeting of conflict management; actions of postgraduate training for school technicians).
Scientific Activity
- Youth suicide attempt;
- Risk behaviour in teenagers;
- Social representations of teen suicide;
Dissemination Activity
- Events and dissemination in the field of youth suicide.
Mental health services for children and teenagers
Regarding public services targeted at young people, there is a specialized help offer in the primary healthcare, in particular through Psychology appointments integrated in the URAP of the ACES of the National Health Service, even though this feature is not always directly targeted at young people (except, for example, the "Show Up (Aparece)" appointment currently headquartered at the Health Centre of Sete Rios and other one-off projects resulting from the partnership between the SNS and, for example, local authorities, such as Oeiras and Cascais).
Under the National Mental Health Plan and the objective of development and improvement of services, Psychiatric and Mental Health in childhood and adolescence services were reorganised in order to enable the provision of care at three levels:
- Primary Healthcare: ensured by Groups or Nuclei of Support to Children's Mental Health, comprised of professionals of the health centres and family health units, with a consulting Psychiatrist of Childhood and Adolescence from the local specialized service. These structures must carry out the triage, evaluation and consequent articulation with other structures of the community, including social services, schools, Commissions for Protection of Children and Young People at Risk, Early Intervention Teams, foster care institutions for children at risk, Drug Treatment Centres (CAT), local psychosocial intervention projects;
- Local specialized services: local healthcare, provided by the specialized services/units of Psychiatry and Mental Health in Childhood and Adolescence integrated in general hospitals;
- Regional specialized services: through the departments of Psychiatry and Mental Health in Childhood and Adolescence at the regional level, , located in Lisbon, Oporto and Coimbra, endowed with a diversity of valences: Emergency Service, inpatient services unit; intervention centres in specific areas for more complex pathologies; Research field, in connection with Universities;
There are technically more differentiated departments of Mental Health in Childhood and Adolescence, present in 3 Paediatric Hospitals, in Lisbon, Oporto and Coimbra, that succeed the old Mental Health Centres for Children and Youth.
In 2016, the capacity of the paediatric hospital in Oporto and Coimbra was increased and a new unit was opened in Psychiatric Hospital of Lisbon, sharing the service with the department of child psychiatry of the D. Estefânica Hospital.
Video about mental health in young people
The video "young people and mental health" is a resource to be used in training contexts or reflection/action that describes the passage from childhood to adolescence, highlighting the importance of mental health, the conflicting character of self-growth and appealing young people to ask for help to a family member of a professional, in case of demand or need. The video is aimed at children and teenagers, being a tool to promote debate and to be used by teachers in a school environment.
The Portuguese Institute for Sport and Youth, the National Youth Council, the PNSM of the Directorate-General of Health and the National Association of Nutrition Students are responsible for the video, which was produced within the context of the International Youth Day of 2014 and highlighted the "Young People and Mental Health" theme.
WhySchool - Why Youth Mental Health Care School-Based with Primary Care Liaison
The WhySchool project was implemented between April 2015 and 2016 and aimed to promote access to young people to mental health services through the empowerment of professionals that work with young people.
This project intends to develop a multi-stage care strategy, from school to hospitals, involving teachers and other actors in the education system to primary health care professionals. In addition to specialized training, it intends to provide a set of information and support materials, namely through an e-learning platform.
At the same time, it aims to provide individual and direct support to young people at risk.
The main objectives are to reduce the incidence of suicide. In the primary healthcare, models of intervention and identification of chronic depression are included.
The project provides for a monitoring and evaluation of its impact through the regular analysis of a set of indicators.
The programme, which is funded by the European Economic Area (EEA) Agreement, Iceland, Liechtenstein and Norway, involves a group of differentiated entities, since the Institute of Public Health of the University of Oporto (ISPUP) and the University of Oslo, training centres, Portuguese municipalities and universities.