Research Projects

MH Crisis Impact: Evaluating and improving the access to mental health services of people affected by the economic crisis in Portugal based on a new understanding of the effects of the crisis on mental health of the population

The main objective of this project funded by EEA Grants was to obtain a new understanding of the effects of the economic crisis in Portugal on mental-ill health of the populations, comparing epidemiological data on mental disorders, their determinants and use of services in a representative sample of the Portuguese population before and after the crisis. This information was used to propose new policies, programmes and interventions aimed at the reduction of health inequalities and mental health problems linked with the crisis.

The project contributed to the main objectives of the National Health Plan as it aimed at maximising health gains of vulnerable groups of the population through the participation and involvement of stakeholders in the health system with a focus on access, quality, and citizenship. It also contributed to the objectives of the National Mental Health Plan to the extent that it aimed to ensure equitable access to quality care to especially vulnerable groups and to reduce the impact of mental disorders in these groups.

You may access here the key documents produced by the MH Crisis Impact Project:

• Report 1 – Epidemiological study and qualitative study results
• Report 2 – Analysis of suicide rates and hospitalizations due to mental disorders
• Report 3 – Innovative mental health policies, plans and interventions to manage and prevent the consequences of economic crisis
• Fact sheet 1
• Fact sheet 2
• Fact sheet 3

Reassessing the Portuguese Mental Health System: evaluating its performance, and designing a new financial and organizational model aimed at enhancing its equity, efficiency, and quality

This Project, also funded by EEA Grants, was promoted by the National School of Public Health (Department of Economy and Health, PI: Prof. Julian Perelman), and involved the participation of the NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, the Department of Public Health and Community Medicine, Verona (Prof. Francesco Amaddeo), CHPL (Isabel Paixão), CHLO (Joaquim Gago), and Magalhães de Lemos Hospital (A. Leuschner).

The project aimed at (i) evaluating the performance of the Portuguese mental health system, through applying an innovative evaluation grid and qualitative survey methods; (ii) proposing an alternative model of organization and financing of health care providers, through a systematic literature review and a theoretical model based on microeconomic concepts; (iii) designing concrete financing schemes for mental health care providers, through cost data collected for this purpose.

You may access here the final report of this project:

• A critical evaluation of payment models of mental healthcare providers in Portugal – final report

SMAILE Project: Saúde Mental – Avaliação do Impacte das Condicionantes Locais e Económicas

This project, which began on 2013 and ran for two years, involved several Portuguese academic institutions and hospitals, and was funded by FCT (Fundação para a Ciência e a Tecnologia).

The project main aim was to assess the effect of environmental and territorial determinants on mental health and on the use of mental health services in times of social and economic crisis. It also intended 1) To study the associations between the evolution of contextual characteristics of some Portuguese municipalities in the last 10 years, and psychiatric morbidity and use of mental health services in these municipalities during the same period; 2) To understand how the mental health of individuals is affected by socioeconomic crises, depending on community support, social capital and urban planning; and 3) To propose changes to the physical and social environment that may promote mental health and reduce psychiatric morbidity of the populations during crises.

You may access here the final e-book produced by the SMAILE Project:

• Território e saúde mental em tempos de crise

PromQual Study: Rehabilitation and quality of life in the residential units for people with long-term mental illness: a cluster randomised controlled multicentre study

The main objectives of this Project were 1. To determine the characteristics of users of mental health residential facilities in Portugal and the quality of care provided, and to investigate associations between quality of care, service and service user characteristics; 2. To assess the effectiveness of a training intervention for the units staff to improve rehabilitation and quality of care of their users.

All the Portuguese residential units with at least 12-hour on-site staff support per day for the long-term mentally ill were assessed with the Quality Instrument for Rehabilitative Care (QuIRC) filled on-line by the managers. This instrument assesses the quality of care of longer-term units for people with complex mental health problems on seven domains of care (Living Environment; Therapeutic Environment; Treatments and Interventions; Self-Management and Autonomy; Recovery Based Practice; Social Inclusion; Human Rights). Additional descriptive data on the users’ sociodemographic characteristics, psychiatric diagnosis, psychotropic drugs taken, and length of stay (LOS) in the unit were provided by the unit staff. A random sample of service users was interviewed face-to-face using standardised instruments: the Residence Choice Scale (RCS) assessing Autonomy; the Manchester Short Assessment of Quality of Life (MANSA) for Quality of life; the Your Treatment and Care (YTC) questionnaire for the users’ Experiences of Care; the General Milieu Index (GMI) for service users’ views on the unit´s therapeutic milieu; Service user functioning was also assessed by the interviewer using the Global Assessment of Functioning (GAF). Randomisation was carried out after clustering of the units, using minimization. The intervention was designed using the information from the baseline results. It consisted of 1. A one-day workshop for the managers, and a two-day workshop for the remaining staff; 2. On-site hands-on 4-week intervention by an intervention team of one occupational therapist, one psychomotor expert, and one ex-user as consultant. The units were reassessed 8-month after the intervention ended, as well as the service users with the same instruments.