So, three days ago we celebrated World Mental Health Day. Or rather, it was pointed out, because from celebration, until I see it, it doesn't seem to me that there is enough yet. On the contrary. If we don't see, in a more microscopic lens, and looking only at Portugal.
Portugal is the European country where the most antidepressants are consumed. In January of this year, an Infarmed report reported that in the first nine months of 2021, almost 16 million packages of medication associated with mental health had been sold.
After all, we are talking about a State investment of 46M€. In the first six months of 2022, this value is already close to €33M, in a total of almost 11 million packages of anxiolytics, sedatives and antidepressants.
It is a case to say: it is too many pills.
Keeping an attitude of not underestimating the complementarity of the application of psychiatric medication, it would not be a case to scare me with these numbers and with such investment, not only by those who buy them, but also by the SNS, if I read testimonials such as those mentioned by the Minister of Health Manuel Pizarro different from what I read on World Mental Health Day.
Let's see, in the statements, the Minister mentioned, among several things, that "We cannot maintain a certain stigma about mental health as if the treatment of mental health disorders is exclusive to ultra-specialized professionals", referring in this case, would say to mental health professionals such as psychiatrists, child psychiatrists and psychologists. The Minister went on to say that “It makes no sense to imagine that anyone who has a mental health disorder always needs to be seen by a more qualified specialist”. In the media, there are also references that allude to illustrations by Manuel Pizarro, such as "no one would have thought" that a hypertensive patient had to be treated by a cardiologist or an internist, or that someone who had a stomachache , had to be seen by a surgeon”.
And here is where – pardon the popular expression – the pig twists its tail. Why? Well, because professionals who attend to this type of conditions, which will have been illustrated by the Minister of Health, are specialists, usually professionals in the field of medicine with a specialty, in this case General and Family Medicine. And those I know and am even friends with, they know very well what they are doing, and they often confide the impossibility of having more consultation time, the need to have more professionals – specialized – in the area of mental health with whom they can work in instead of referring their users in a given health center to a professional who practices his profession in a private context.
Three days have passed since World Mental Health Day. Seems like a short time. But 5 years have passed, that is, 1800 days (more or less) since the last contest to integrate professionals in the field of psychology into the SNS opened.
It is a case to say: it is too many days.
The wait for an appointment for psychology is on average above 3 to 4 months. The wait to buy a box of anxiolytics at the pharmacy is on average 3 to 4 minutes. It is easy to see that it is much simpler to opt for the second option than for the first as a client/user/patient/patient (whatever you want to call it), and this will not be due to a lack of willingness or investment in itself, but obviously because the symptomatology that is felt is extremely blocking, not to mention that it continues to be accompanied by social stigmatization, misunderstanding and not infrequently solutions provided by professionals with very good will but who are also in burnout - as observed in professionals in public institutions in several countries (Portugal here is just one more).
There doesn't seem to be a perfect solution. In fact, I would even say that strengthening the area of mental health will always be a work in progress that gained prominence after the covid-19 pandemic, namely for certain generations of our society. There are some things that can be thought of by the various stakeholders. I am not an expert in health policy, but I will give my opinion:
At the public level, I believe that other solutions should be found that not only strengthen the consumption of psychiatric medication for cases that may not need it as much, or for so long, it is fundamental. Note the values mentioned at the beginning of this text. The €33M that has already been spent this year would cover the expenses of almost 900 professionals with an average salary. Obviously, of these 30M€ that the SNS paid on psychiatric medication purchases, there will be a good percentage that must continue to happen, but do the math in order to think in the long term and not in the short term - this is the biggest The problem with thinking about public policies - is that the political community that takes credit is rarely the same one that designed it.
In the private sector, organizations need to listen to their People. Even if that means finding results that undermine ranking positions identified in the typical healthy workplaces ranks. One illustration is the typical mental health webinar. There are already jokes with this type of solution, which clearly wasn't designed with the people of a certain organization. There are no perfect solutions, but a good first step could be an assessment of certain risk and psychosocial factors that mental health professionals (with experience in occupational health/organizations) will be able to identify and assess. Bringing in external professionals at a given time may be a good solution, as issues associated with mental health vulnerabilities are often difficult to report internally.
In civil society it is important that everyone can give something back. At RUMO, in addition to free psychoeducational content, one of the ways we do this is through social and/or pro-bonos values that, at certain times, we are able to offer to people who are unable to purchase mental health services. in a private context and who are not able to wait months for a consultation in the public service.
There would be much more to say, but let's leave other topics for other occasions, after all, World Mental Health Day was just three days ago and we still have many more days to go.