EEA Grants Portugal Mental Health Programme Pedro Mateus National Mental Health Programme

Summary Context Programme development Mental Health in Portugal National Mental Health Plan Programme Areas for Mental Health

Indicators - Portugal Unesco 2011

Real GDP per capita (2013) € Eurostat 2013

Gross domestic expenditure as a percentage of GDP 1.50 Unesco 2011

Gross domestic expenditure by field of science Social Sciences: 12.9% Medical Sciences: 11.3%

Programme Development

Key points Link national priorities with EEA Grants framework. Strengthen bilateral collaboration and cross fertilisation between donors and beneficiaries. Define priority areas giving degrees of freedom to creativity and innovation from candidates. Raise the odds for good implementation… …and subsequently improve care.

Find balance Portugal MH needs and priorities EEA Grants scope

“Reduced inequalities between user groups” “Strengthened financing systems” “Improved mental health services” Programme Development Grants expected outcomes EEA Grants, Programme Areas, Public Health Initiatives

Mental Health in Portugal

12 MONTH PREVALENCE AND SEVERITY COMPARISON OF THE RESULTS IN PORTUGAL, OTHER EUROPEAN COUNTRIES AND USA % PAÍSMILDMODERATESERIOUSALL PORTUGAL 7,715,56,322,9 BÉLGIUM 6,43,32,4 12,0 FRANCE 9,76,12,7 18,4 GERMANY 4,53,31,2 9,1 ITALY 4,32,91,0 8,2 NETHERLANDS 8,83,72,3 14,8 SPAIN 5,32,91,0 9,2 UKRAINE 8,27,44,8 20,4 USA 9,29,47,7 26,3 (Caldas de Almeida & Xavier, 2013)

% people with severe MI without treatment 33.6% % people with mild MI without treatment 64.9% Median delay for the beginning of Depression treatment 5 years (Caldas de Almeida & Xavier, 2013) Treatment Gap

Eurobarometer 2010

Data Annual prevalence of MH problems: 22,9% Untreated severe mental illness: 33% Median of delay for depression treatment: 5 years Antidepressants use: 15% (EU average = 7%) 40% of the territory (10% of pop.) have 4% of the HR

National Mental Health Plan

Mental Health Plan Main objectives Assure equity in the access to MH quality care Decentralize services and increase proximity care Reduce impact and promote mental health Integrate MH in PHC Make the prevention of depression and suicide Promote and protect human rights

Mental Health Plan Main results Closed psychiatric hospitals Opened 15 MH services/units for adults, children and adolescents Trained more than 600 MH professionals in EB practices Financed 46 innovation/community MH projects Launched the basis to a residential and supported care network, gathering Health and Social Affairs Ministries.

Mental Health Plan Partnerships EC - European Pact for Mental Health (2008) WHO - Mental Health Plan evaluation (2010) WHO - Human Rights (2011) EC - Joint action for Mental Health leadership (2012) Participation in the planning of the European and Global Mental Health Plans (2013).

However… In 2012 we had to refit the National Mental Health Plan into a reality influenced by the economic crisis Maintaining priority areas running… …with increased challenges

That’s why We welcome the support of the grants. We understand it as an opportunity to improve care and develop cooperation with out partners.

Programme Areas for Mental Health (EEA Grants)

MH programme areas (what we know) 1.“The financing system has created unintentional disincentives to establish community based services.“ (Portuguese MH Plan evaluation - WHO 2010) 2.“Action is needed to tackle the steady increase in work absenteeism and incapacity linked to stress and mental disorders.” (European Commission ) 3.“Integrating mental health services into primary care is the most viable way of closing the treatment gap.” (WONCA ) 4.The importance of schools in the provision of mental health related services for children and adolescents is crucial. (WHO ) 5.“Portugal is one of the more severely affected countries in Europe by the global economic crisis in the last years.”

MH programme outcomes 1.Mental health financing system improved. 2.Mental health at work and for population groups mostly affected by the economic crisis promoted. 3.Treatment of depression in primary healthcare improved. 4.Mental health problems prevention and mental health promotion in schools for children and adolescents improved. 5.Access to mental services for population groups affected by the economic crisis improved.

MH programme outputs 1.Reports evaluating the current mental health financing and management systems. Pilot implementation. 2.Intervention programmes on the promotion of mental health at the workplace and support programmes to those unemployed due to the economic crisis

MH programme outputs 3.Regional training programmes for depression treatment in primary healthcare. 4.Regional professional training sessions in primary health care and schools. Promotion and prevention programmes running.

MH programme outputs 5.Reports on the impact of the economic crisis on the population mental health and plans developed to reduce health inequalities

Challenges Implementation History of implementation challenges: legislation implementation policy implementation evidence based practices implementation (all are crucial to improve care)

Expectations Innovation and creativity. Cooperation between countries will become stronger and go beyond the end of the projects. Projects itself will be sustainable after the grants. The Grants will help the implementation of the MH Plan.