Half a Year to a First Psychologist Appointment in the SNS, With 1,200 Professionals for 11.5 Million People

A patient referred for psychological care inside Portugal's public health service can wait half a year for the first appointment, and the gaps between subsequent sessions can themselves run into months. That is the assessment given to the Lusa news agency on Friday by Sofia Ramalho, bastonária of the Ordem dos Psicólogos Portugueses (Portuguese Psychologists' Association), speaking to mark the national day of the psychologist.

Her objection is to what the delay does. "Often in six months the person's problem densifies, and instead of being a situation that could easily be resolved it is a situation that, over six months, evolves into a graver one," she said. That penalises the patient first, and then the health services and health financing after them.

1,200 psychologists for 11.5 million people

The Serviço Nacional de Saúde (National Health Service, SNS) employs about 1,200 psychologists. Roughly 500 work in primary care, meaning the centros de saúde where most first contacts happen; roughly 500 work in hospitals; the rest sit in public-sector projects.

After a meeting with Health Minister Ana Paula Martins, Ramalho says a reinforcement of 300 psychologists in primary care is due by December, taking that arm from about 500 to about 800. She does not think it is enough, calling the figure "clearly insufficient for a population of eleven and a half million".

The scale problem is familiar from the rest of primary care. Lisbon and the Tagus Valley added 49,000 people without a family doctor in a year, and an SNS psychology referral generally starts with a family doctor many patients do not have.

The schools, and a competition that closes in November

About 1,200 psychologists work in Portuguese schools, most on contracts renewed year after year. Ramalho argues it would be "adjusted and adequate" to bring them onto the permanent staff.

A route exists. The competition announced in April by the Ministério da Educação, Ciência e Inovação (Ministry of Education, Science and Innovation, MECI) covers 1,406 specialist technician posts, of which 758 are places for psychologists. School directors decide which technician is bound to the establishment, candidates may include people who have never worked there, and every school grouping is meant to end up with at least one established psychologist. The competition runs to November, and Ramalho says she does not yet know how many psychologists will actually be placed. Many of the same professionals are meanwhile facing demands to repay years of salary, a dispute the Ordem asked last week to have frozen.

The social sector, where the funding runs out

Outside the SNS and the schools sits the work reaching the most exposed: care homes, addiction treatment, victims of domestic violence, migrant communities. The "great barrier" there, Ramalho says, is the precariousness of the money. Most intervention projects with vulnerable groups are financed on short horizons, and a programme funded for three years is both unsustainable and unattractive to the professionals who would run it, because it offers no stability. A psychologist's salary in the social sector sits little above the minimum wage, put at 920 euros.

Her proposal is a reform of the financing model toward permanent funding, with the Orçamento do Estado (State Budget) carrying most of these projects rather than leaving them on rolling grants. Her warning otherwise is blunt: where resources are scarce, the incidence of mental health problems will worsen.

For anyone navigating the system now, our guide to mental health support in Portugal sets out the public and private routes and what each costs. One partial state answer already exists: the psychologist voucher was widened in July to everyone aged 12 to 35 and lifted to 40 euros, which buys a discounted private session rather than shortening the public queue.