Challenges for psychosocial rehabilitation services in the Lisbon Metropolitan Area: A qualitative approach

Abstract

In Portugal, a mental health reform process is in place aiming to redefine the model of service provision. In 2008, a National Mental Health Plan (NMHP) was approved to provide policy guidance over the transition period. The NMHP intended, among others, to develop community-based services, with a specific focus on rehabilitation and deinstitutionalization. This study aims to explore the perspectives of service managers of psychosocial rehabilitation services regarding the main challenges to support the community living of persons with severe mental illnesses (PWSMI) in the Lisbon Metropolitan Area (LMA). The paper also contextualises the provision of psychosocial services within the country's mental health reform process and characterises the profile of service users in socio-occupational units (SOUs) of the LMA.Semi-structured interviews were performed with all SOUs' managers of the LMA (n = 13). Information regarding service user characteristics was collected based on service records (n = 344). Interviews were analysed according to the framework methodology. The results of the interviews were triangulated using document analysis. Fieldwork took place between June and July 2016. The findings suggest that the development of the mental health reform ensured significant changes to service delivery. Community-based mental health organisations are an important actor for service provision. However, important asymmetries were identified in the provision of psychosocial care within the LMA. At the same time, family carers are perceived as responsible for ensuring a large part of the social needs of the PWSMI but there is an increasing concern with their own ageing processes. As a conclusion, it is highlighted the current inequality between services and the need to contemplate a life-course perspective that comprehends the ageing process of caregivers poses an emerging challenge for psychosocial rehabilitation. These findings are also important for other low-and middle-income countries passing through similar reforms.

Políticas e cuidados de saúde mental pós-alta da hospitalização psiquiátrica

“…There is also the implementation of the weak ICMHC Network due to heterogeneity in access and provision of psychosocial rehabilitation care. 16,27 This network is still in a pilot project phase and is therefore not available to all severely mentally ill patients with psychosocial disability. Continuity of care is therefore at risk due to the absence of a continuing care network that responds to LMHS needs.…”

“…There are 15 documents [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] that allow the definition of health care after discharge from psychiatric hospitalization in relation to what is foreseen in official documents, but also evidenced in practice.…”

Current Situation Of Supply And Demand Of Mental Health Services For Community Residents In D City And Suggestions On Countermeasures

“…Although D City has achieved certain results in community mental health services, there are still some weak links, such as incomplete construction of basic facilities for community mental health services, need to strengthen investment in mental health services, and the mismatch between "software" and "hardware" in mental health services; The management mechanism of community mental health services is not clear, and the demand and supply of residents' mental health services are imbalanced; The quality of community mental health service teams and professionals needs to be improved, and so on. Szabzon found that the development of mental health reform has ensured significant changes in service delivery, and community mental health organizations are important participants in providing services [4].A community is a place where residents live and engage in long-term activities. Providing mental health services in the community is faster and more convenient, especially in case of sudden crisis events.…”