Critical Reflection on Child and Adolescent Mental Health, in Portugal

Abstract

Child and Adolescence Mental Health is a clinical area in growing demand in care, resulting in increased health care needs, the response to which has not been accompanied by proportional investment and financing in this area, in Portugal. In addition to these problems, there is a great shortage of mental health professionals, along with a centralization of these professionals in large urban centers. This insufficient response has also repercussions at different levels of treatment, particularly in community instances and specialty consultancy work.
This is also the case in more differentiated outpatient, acute inpatient or residential inpatient regimes, such as in Training and Autonomy Residences, for teenagers, within the scope of continued care. Also in the social sector, the supply appears to be unresponsive and below the needs of young people, as we find a saturated system, with poorly specialized professionals and great turnover of technicians in institutions. This leads to perpetuation of cycles of greater psycho-affective instability and psychopathological worsening for more vulnerable young people. We are faced with a framework that is more conducive to the development and maintenance of mental disorders, and greater clinical severity, making preventive intervention increasingly important, although prevention and public health policies are still insufficient to meet national needs. Faced with a saturated system and a shortage of human resources, the use of coercive measures may become more common, particularly in children and adolescents, who must be monitored and integrated within the scope of quaternary prevention. Despite adversities across health and social systems, it is important to promote patients’ respect and autonomy, ensuring their integrity and informed consent, in light of the mental health law.