Mental Health Services in Portugal
Depressing truth...
Our friends Ajah and Rafa stayed in our home, dog-sitting Onix, when we went to Cascais earlier this month. Unfortunately, during their stay, a good friend of theirs attempted suicide by jumping out of a third-floor building in Lisbon. He is a Portuguese man in his twenties with a history of depression. He survived and remains in hospital as doctors tend to his many physical injuries. But what about his mental health…
Personal History
Before I tell you about what I have observed in Portugal as it relates to mental health services, I want to share a personal story. It was 2012. My parents had moved from Delaware to Florida, into a Brookdale Senior Living facility in The Villages. At the time my mother seemed to be in very good health for her age (85) but my father had Parkinson’s. His tremors had been well controlled by medication for nearly 20 years, but most of the time he was confined to a wheelchair. What I didn’t realize until a few weeks after they arrived, was my father was also suffering from Parkinson’s dementia…a not uncommon side-effect for someone who had had the disease for so many years.
This was before there were TV ads in the States showing an old, scared man seeing things that were not there. My father could keep it together during our short visits when we lived a thousand miles away. My mother did everything she could to keep it from us and from the doctors. But it didn’t take long until I heard my father ask, “Do you see that guy behind the tree? He is coming to kill me.” Or to get a pleading call from my mother, asking if I could rush over to stop my father from something or other.
I actually learned more about his disease, oddly enough, when I spoke to a neurologist at a pickleball tournament. He first provided me with the medical term and then some online resources. Shortly thereafter, during one of my father’s lucid moments, we had a discussion. He admitted that he was scared to death. He realized he was “losing it”. He wanted off the many medications (dopamine, anti-depressants, anti-anxiety, dopamine extenders), etc. he was on. But we couldn’t “adjust his medications” at home. He agreed the best thing was to go to an inpatient psychiatric facility.
I figured one could get an admission order from his doctor…but I was wrong. He had to be Baker Act’ed … so we got a lawyer, a psychiatrist, and a judge. Having jumped through those hoops, I assumed we would drive him to the hospital. I was told to stay with him until someone came by to pick him up. I assumed an ambulance would come. Instead, a few hours later 2 sheriffs and a squad car showed up. My father got into the back of the squad car knowing exactly where he was going and why. During the 30-minute drive to the facility, he forgot. He lost it. 4 days later he did leave the facility. He went directly into Brookdale’s memory care unit, while my mother remained in independent living. A few weeks later he died.
So when I share what I have observed about mental health care in Portugal, let me be clear. I am not suggesting that the US has gotten it right either.
First Impressions
Let me start by stating the obvious: I am not an expert. I am simply sharing a few observations and just a bit of online research. That said, my first impressions of Portuguese mental health care came from our housekeeper in Cascais. A lovely, caring, middle-aged woman that felt comfortable enough with us to share she was chronically depressed. Her depression had started 10 years earlier when her mother and her aunt died suddenly. She seemed unable to recover from the loss. I asked if she spoke with someone regularly. “No, but I see a doctor every 90 days and he adjusts my medication.” I learned that in the public health system, psychiatrists were available to prescribe medication. But the waiting list to see a psychologist on an ongoing basis, to talk with someone, was 24 months or more. That, in fact, few people in the public system rarely had “counseling”.
A few months later I met an American. He was also feeling blue. He wasn’t sure whether it was adjusting to retirement or adjusting to Portugal. He had private insurance, so he made an appointment to see a psychiatrist. After a brief visit, the physician prescribed medication. He asked about counseling. “Oh, I don’t do that,” was the response; and it turns out many private insurance do not cover psychologist visits. He ended up, utilizing online services originating in the States.
Most recently, I followed up with Ajah to see how her friend was doing. The doctors have done a great job of putting his body back together. They are confident he will walk out of the hospital. However, there seems to have been little, if any, attention paid to his mental health. “He told me he is going to try again,” Ajah reported. “It seems that no one wants to deal with his mental health in Portugal.”
The three experiences above, seem to be in line with my online research:
Although the prevalence of depression in Portugal is on par with the rest of Europe, Portugal has the highest European rate of Antidepressant consumption. Besides this, in some regions, Portugal has the highest rate of suicide in Europe.
The National Plan of Mental Health Care published in 2008 focuses on medical intervention (i.e. medications) rather than psychotherapy
More must be done to address the stigma of mental health issues.
No country is perfect…
Next Week: we are going on vacation…but there is still stuff for you to read.
It seems like mental health care is inadequate in so much of the world, and it makes me wonder how much of that is due to the fact that you can't "see" it the way you see a broken bone, or a lab value falling outside of the curve. Kind of the same way physical ailments that are hard to pin down like fibromyalgia or chronic pain are often un- or under-treated.
Thank you for writing about this, the more everyone discusses mental health, the more likely it is that discussing it and dealing with it becomes acceptable.
Have a great vacation!
Perhaps I could move to Portugal and hang out my therapist shingle.