The national coordinator of mental health policies argues that primary care needed twice as many psychologists as it currently has to guarantee, as in other countries, full-time professionals.

“We needed to have a number, in primary care, that was at least double. Because? To ensure that there can be full-time psychologists, as there are in other countries, because that is what is based on evidence, doing this type of approach, depression and anxiety ‘stepcare’ programs, ”he said in an interview. with Lusa. . .

Miguel Xavier recalls that primary care psychologists “have to respond to multiple needs and have difficulty, of course, in focusing on a single type of work.”

The coordinator defends that “there should be an exclusive template for primary care programs for common mental illness, as England did, as Australia did and as several countries are starting”

“It’s not something you do halfway through, but it’s something we have to start doing. For that we need to have people there,” she said.

underlines that psychologists are needed “in a very reasonable number” to respond to people with possible depression and anxiety: “20, or 30, or 40, or 50 psychologists are not enough for us.”

“We need to have many more people working together with primary health care. And this will have to be a bet for the future. One of two things: either we want primary care to be provided or not. (…) We cannot have both, have the attention paid and save at this level”, she insists.

Miguel Xavier praises the work of the health centers, highlighting: “Much of the impact of mental health related to Covid was not about serious mental illness, but about the so-called common mental illness.” And then, he continues, “the quilted mattress is in primary care. And a very important job was done.”

“If you ask me if primary health care was fully prepared for this, no. Because the whole aspect of psychological support is missing there, ”she says, considering that the country has to have non-pharmacological responses in primary care.

“We have to double our budget in a few years”

Miguel Xavier also defends that the investment in this area in the National Health Service, which today is around 5%, should double in a few years.

“We calculate, without being sure, because there is no certainty, that our investment in relation to the total ‘budget’ of the National Health System is around 5%. I believe that we have to arrive, at some point in our future, at twice that“, he said in an interview with Lusa.

Miguel Xavier gives the example of countries such as the United Kingdom, or the Nordic countries, where investment in mental health in the total weight of health is around 13% and 14%, explaining that this value does not arise by chance.

“It is because that is the percentage of the global burden of mental health on all diseases (…) The United Kingdom was already the first country in the world to arrive, others will arrive,” said Miguel Xavier.

He recognizes that you have to “be realistic and have your feet on the ground” and affirms: “If we are at 4% or 5%, we are talking about triple”.

However, he says that it is a positive aspect that mental health is currently considered “a priority across Portuguese society.”

“If we think we have to double our budget in a few years, I think it’s a goal and I hope it’s not too optimistic,” he said, stressing: “It’s a goal that the Portuguese deserve. And by the way, professionals [de saúde]who work there, and they work a lot,” he stressed.

Good mental health only with work policies, social support and education

Miguel Xavier considers that one of the biggest challenges in this area is human resources, but he stresses that results can only be achieved with measures linked to work, social support and education.

“We, without human resources, cannot go further. And trained human resources (…) Only good mental health services do not guarantee good mental health,” said Miguel Xavier, in an interview with Lusa, stressing that “they are an important part, but in no way do they guarantee this” and the importance determinants such as socioeconomic conditions.

The official says that putting “all the eggs” in the human resources basket is the wrong way to go, insisting: “The problem of mental health is much more transversal and is decided beforehand, not when people are sick.” “It is decided through policies that go beyond health and are fundamentally policies that have to do with work, social support and education. In short, it has to do with the economic and financial conditions of a country”, he considered.

He underlines that economic and social determinants have an enormous weight on mental health and that a country that only invests in health will not have good answers.

And he gives the example of the United States: “It is a country that invests massively in health services (…) However, the levels of inequality, as we know them, are enormous, the highest in the world. And when you look at mental health and other health indicators, you see that instead of having indicators similar to those that exist even in Western Europe, they have worse indicators than some third world countries.”

“Mental health problems are prevented before they appear. Through good parenting programs, good social programs, such as support programs in relation to vulnerable populations. If we are waiting for people to get sick and then we all want a lot of services, with a lot of people working and with thousands of professionals, we are not going there”, he says.

Regarding the impact of the Covid-19 pandemic on mental health services, Miguel Xavier points out that psychiatry and mental health services for adults and children and adolescents have had to adapt and considers that they “adapted well”.

“First because they managed to retain the space, that is, us at the time it started [a pandemia]In 2020, one of our concerns was that our space would not have an invasion. Because, although the transfer of patients between medical and surgical services, despite being difficult, and it was very difficult, but the patients are more similar, the transfer of individuals in the acute phase of mental illness to another service is very complicated” , exemplified.

He also recalls that, “unlike most European countries”, Portugal managed to ensure that “inpatient units remained only with patients in the field of psychiatry” and did not interrupt care, especially in cases of severe mental disorders.

“And this was carried out in such a way that adult and child-juvenile psychiatry were the only two medical specialties, of all medicine, that, during confinement, increased consultations, while we attended, in most of the specialties, to a decrease”, he added.

Asked about the fact that many of these consultations (in the mental health area) were teleconsultations, he replied: “But contact was not lost”

He also says that the impact of the pandemic on mental health was more at the level of situations of depression and anxiety, and not so much in cases of serious mental illness: “We could be in a situation in which the number of relapses and readmissions in severe mental illness had increased immensely and did not increase.