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Abstract
The delivery of psychiatric rehabilitation interventions has been recognised as fundamental to facilitate recovery of people with severe mental illness. Although Portugal has developed a plan to restructure mental health services between 2007 and 2016, multiple barriers are hindering its effective implementation. We aim to describe a Portuguese psychiatric rehabilitation institution and analyse barriers in the mental health paradigm change. With our experience, we intend to help countries that are planning or passing through a change of paradigm in mental health care to anticipate and avoid similar obstacles. Sources used were research literature, government policy documents and legislation, in loco experience and experiential knowledge. The case study was carried out using interactive (participant observation and non-structured interviews) and non-interactive techniques (document analysis, namely the target institution reports, projects and dossiers). Barriers found include not complying with the most recent available evidence and the use of outdated and non-evidence and values-based models. Moreover, a deficient monitoring and evaluation of services' quality, resistance to change, lack of appropriate training of professionals, lack of involvement of users in their care planning and funding issues are also contributors for the perpetuation of this scenario.
Acknowledgements
The authors are grateful to Professor Julian Leff for proofreading the article and providing invaluable advice and expertise, to the Board of the institution for allowing us to carry out the case study and to the staff of the institution for the collaboration.
Funding
This work was supported by the Portuguese Foundation for Science and Techonology [Grant number SFRH/BD/47097/2008].
Notes on contributors
Carina Teixeira is a PhD candidate at the University of Coimbra and an effective member of the Order of Portuguese Psychologists (Ordem dos Psicólogos Portugueses). She is a research collaborator at the Institute for Cognitive Psychology, Vocational and Social Development, University of Coimbra. She was a founding member of ReCriar Caminhos, a nonprofit Association to support the vocational development, training and social inclusion of people with schizophrenia and is currently a member of the Board of the Association. Her research interests are psychiatric rehabilitation, community integration and recovery.
Eduardo Santos is Associate Professor with Aggregation at the Faculty of Psychology of the University of Coimbra. He is the Scientific Coordinator of the R&D Unit Institute for Cognitive Psychology, Vocational and Social Development (IPCDVS/FPCE), University of Coimbra, III/Portuguese Foundation for Science and Technology (FCT). He is also Adjunct Professor at the State University of New York, USA and Emeritus Professor at Universidade Santa Cecília, Santos, SP, Brasil. He is Associated Researcher of Laboratório Interdisciplinar de Pesquisa e Intervenção Social, Pontifícia Universidade Catílica do Rio de Janeiro, Brasil. He is Director of the Journal ‘Revista Ibero-Americana de Gerontologia’. He was also a founding member and member of the Board of the nonprofit Association ReCriar Caminhos, an Association to support the vocational development, training and social inclusion of people with schizophrenia.
Manuel Viegas Abreu is Emeritus Full Professor of Psychology at the University of Coimbra; Member of The National Academy of Sciences at Lisbon; Honorary member of the Order of Portuguese Psychologists (Ordem dos Psicsólogos Portugueses); and First Honorary Member of the Portuguese Association of Experimental Psychology. He founded the Institute for Cognitive Psychology, Vocational and Social Development, University of Coimbra and is currently a researcher at this Institute. He was also a founding member of the Association ReCriar Caminhos, a nonprofit Association to support the vocational development, training and social inclusion of people with schizophrenia. He is the current President of the Board of ReCriar Caminhos.