The Policy Gap. Global Mental Health in a Semi-Peripheral Country (Portugal, 1998-2016)

Abstract

This paper analyzes the impact of the hegemonic paradigm of global mental health (GMH) on Portugal. We specifically argue that GMH in Portugal has effected a change of priorities in health policies, favoring the prevention and treatment of common mental disorders to the detriment of the deinstitutionalizing process. Diffused through the media, this model has negative effects, such as the medicalization of social suffering, the reorganization of mental health policy areas according to utilitarian criteria, and the risk of greater invisibility of users with serious psychiatric diagnoses. However, the GMH approach, bringing to the frontline the impact of all social policies on mental health, represents a new opportunity to politically address social suffering. Characterized as a semi-peripheral country, Portugal may be representative of observable trends in similar countries.

Against alienation treatment, we stand for!

“…Along with the Brazilian public health struggles, there were the Disabled people's social movements emerged in 1970 in countries such as USA and UK as a consequence of politicisation of the question of disability (Fontes, 2014). These principles closely followed the international standards handed down by the World Health Organization (WHO) and documents such as the Declaration of Alma-Ata of 1978 (which inspired Brazilian' public health system) established the ethical standards underlying the intended reform (MARQUES, 2017).…”

“…Today in Brazil this is called Participation and Social Control, which is the idea of creating national health conferences, and councils at the municipal, state, and national levels, in order for society to have effective participation channels in politics (BRASIL, 2013). Recently, in December 2015, it the 15th edition of the National Health Conference was held and the 16 th edition is scheduled to happen in 2019 4 .…”

Maladie et politique de la souffrance sociale: pour un agenda de recherche critique dans les études de la santé et de la science

“…This field registers a centre, located in the North Atlantic, a periphery incorporating middle and low -income countries of the Global South, as well as a semi -periphery (e.g. European contexts that are recipients of models from the centre) (Summerfield, 2012;Kirmayer and Pederson, 2014;Marques, 2017b). By actively promoting agendas of mental well--being, international agencies and institutions such as the United Nations, the World Health Organization (WHO) and the European Union, among others, have contributed to bringing mental health into the spotlight of political and public attention.…”

“…Besides their virtual impact on the classification of new mental disorders, especially in the case of Big Pharma, 7 these global actors also help shape the ways in which knowledge on so -called mental disorders is constructed. Indeed, they promote inquiries and epidemiological reports and provide guidelines to tackle the problems diagnosed (Marques, 2017b). In sum, Global Mental Health actors foster new institutional, epistemological and, by disseminating their concepts and values in societies, cultural environments, in which certain forms of social suffering are validated (or not) as mental diseases deemed to capture political attention.…”

“…Along these lines, some authors have argued that the models developed under the labels of "health democracy", "health governance", and "care" are neither ethically nor politically neutral (Castel, 2011;Paperman and Laugier, 2011;Marques, 2017aMarques, , 2017b. For example, the hegemonic discourse of governance, in some cases implemented in public hospitals in the form of clinical committees, implies the delegation of competences hitherto allocated to political entities (Orfali, 2003;Marques 2017a).…”