About 300 Psychiatric Patients Are Still on Hospital Wards Because Portugal Has Nowhere to Discharge Them, as WHO Experts Review the Reform
The national mental health coordinator puts the number of patients kept in psychiatric hospitals for lack of community places at 300-odd, and the continuing-care network at 590 places. Intensive rehabilitation units for Lisbon, Coimbra and Porto are waiting on a government decision.
Some 300 people are still living on psychiatric hospital wards in Portugal not because they need to be there, but because there is nowhere for them to go. The estimate comes from Miguel Xavier, the national coordinator of mental health policy, who gave it to the Lusa news agency this week as experts from the World Health Organization (WHO) Europe began a four-day assessment of the country's mental health reform.
Asked whether patients remained institutionalised for lack of places in the community or in continuing care, Xavier put the figure at "around 300-odd". His explanation was capacity. The mental health strand of the continuing-care network has "only 590 places for an entire country. It is not much," he said, declining to say how many would be enough beyond "there would have to be more".
The patients who are better but cannot go home
Xavier described a second group the system does not yet serve: people admitted to an acute ward who stabilise but cannot go straight home. They need a period of rehabilitation that can last one or two years, and Portugal has no structures built for it.
The model he pointed to is the intensive rehabilitation unit used elsewhere in Europe, with a maximum of 16 residents and stays of up to two years. To start, he said, Portugal would need at least three, in Lisbon, Coimbra and Porto. Sites have been visited, staff have been sent to England for training through a collaboration with a specialist London service, but the process now needs a government decision to go ahead, and there is no date for the first unit.
What the WHO team is looking at
The WHO Europe visit, made at the invitation of the Portuguese state, runs to meetings with the national coordination, family associations, carer networks and non-governmental organisations. According to the government, the experts will assess the legislation, the governance model, the deinstitutionalisation model and the financing, and will finish with a set of priority recommendations. Their final report is meant to carry "direct weight" on the structural decisions of the next phase, including management, funding and staffing.
The government lists what it has done so far: the new Lei de Saúde Mental (Mental Health Law), in force since 20 August 2023; about 88 million euros from the Plano de Recuperação e Resiliência (Recovery and Resilience Plan) to expand community teams; the creation of Centros de Responsabilidade Integrada (Integrated Responsibility Centres, CRI); and a reorganisation of forensic services.
Xavier said the legislative goals of the reform, now about four years old, are essentially complete. The one organisational measure left, and in his view the most important, is rolling the CRI model out nationally. The pilot ran in 15 Unidades Locais de Saúde (Local Health Units) and, he said, cut readmission to inpatient care by 45 percent without staff leaving the services.
Three gaps the next phase has to close
Beyond the rehabilitation units, Xavier named three persistent problems:
- Long-term care. "Portugal has few responses for long-term care. Other European countries already have them. We do not."
- Depression and anxiety in primary care. Very common conditions that still find few answers in the Serviço Nacional de Saúde (National Health Service, SNS).
- Child and adolescent mental health, an area that "continues to worry us".
The capacity problem runs wider than the wards. In August we reported that 598 mental health residential places had been approved under the recovery plan, with building work at very different stages and the European money running out this year. In this morning's edition, providers said the general continuing-care network has lost 264 beds since January.
For families of the 300-odd patients still on the wards, the WHO report is the next milestone to watch. Xavier's own summary of what the reform needs was blunt: mental health does not need "big equipment", it needs teams "with trained people", and for decades Portugal "invested absolutely nothing" in it.
