Image by Noah Schmeling

Mental Health Relief in Lisbon: The Ins and Outs

The road towards a healthy mind and a happy heart is long and arduous enough. The last thing anyone needs is for the banality of paperwork and appointments to become another impassable struggle in a world of struggles.

Easy-to-understand information on finding and receiving serious, comprehensive mental healthcare in Lisbon is in short supply. A quick Google search will equip you with most of the information necessary to settle down in Lisbon, from setting up your tax number to buying property to receiving basic healthcare, but there is little available for newcomers who might need more than just a therapist to help navigate life.

While there are a few great general rundowns of the mental healthcare services offered in Lisbon and Portugal at large, they tend to gloss over one of the most important and urgent pillars of mental health treatment: hospitalization. Making the brave decision to seek help in a strange new city is complicated by difficulties like language gaps, labyrinthine bureaucracy, and often a painful lack of community support. It is, however, reassuring to know that the help is there. Without a road map, however, it can be hard to find.

Here, we’ll try to clear away some of the thick fog that surrounds Lisbon’s residential mental health services.

Image by Noah Schmeling

Comparing the public and private sectors, there are striking differences between the processes of receiving treatment and the treatment itself. Many of these factors are subjective and not necessarily better or worse but are important to grasp to ensure the right course of action, depending on your reason for seeking hospitalization — be it drug dependency, an acute crisis, or a long-held struggle.

The hospitalization services offered in the public healthcare system are limited, with Hospital Júlio de Matos in Alvalade serving as the primary public residential hospital for Lisbon proper. Internments in hospitals like Júlio de Matos are almost entirely focused on the psychiatric side of mental health, reflecting what appears to be the country’s enthusiasm towards medicinal and pharmaceutical treatment and its underemphasis on psychological treatments.

Psychologists are usually nowhere to be seen in Portugal’s residential hospitals, and activities such as talk or group therapy should not be expected. These hospitals are primarily concerned with the physical safety of patients, the development and administration of a psychiatric treatment plan, and establishing a sense of physical security, before discharging the patient.

Isolation in the name of safety plays a substantial role in compulsory stays in public psychiatric hospitals. Generally, no phones or computers are allowed, nor is television or sometimes even reading materials. These conditions, while certainly not very inviting, can be essential for people fighting drug addictions and those with high sensitivity to external stimuli.

If this brand of hospitalization sounds like too much or too little of the wrong type of treatment for you or someone you know, Hospital Júlio de Matos also offers a hospital de dia, or day hospital, program. This partial internment program consists of 35 hours of hospitalization per week from Monday to Friday, with patients returning to their homes each night.

From 9:00 am to 4:00 pm each day, patients participate in various forms of therapy, both one-on-one and in groups, based on individualized treatment plans developed by the doctors. The Júlio de Matos website describes the day hospital as a program fit for individuals already “recovering from an acute episode that required complete hospitalization, but still in need of daily care,” and those with “crises or episodes that are starting or that do not meet the criteria for full hospitalization.”

Note that the day hospital program is not intended for individuals with a “primary diagnosis” of drug addiction or dependency, but rather for those with mental health struggles and conditions who are “in need of intermediate care between full hospitalization and outpatient care.”

Admission into both the residential and day hospital programs is only attainable through referrals from outside professionals. As part of the National Health Service (SNS), referrals are obtained through emergency rooms or any of the city’s numerous centros de saúde. These public health centers can sometimes be maddeningly difficult to navigate, but making an appointment with a general practitioner or médico familiar at your local center is one of the less painful ordeals to be undertaken. Usually, an emergency room doctor or general practitioner will refer you to a psychiatrist who will in turn refer you to Hospital Júlio de Matos or a similar facility, based on your location.

Unfortunately, the efficiency of the public health system varies drastically depending on the location and time of year. The journey from that first visit to receiving actual help has the potential to be swift and painless, but may just as likely be mired by overcrowded schedules, administrative oversight, language confusion, and general banes of bureaucracy. Especially for those who need the help being sought, it’s important to prepare mentally and emotionally for the possibility of frustration and neglect.

The private health sector, as it usually does, offers far more streamlined services for a far higher cost. Private residential hospitals, such as Hospital Monsanto in Amadora, appear to be focused on psychiatry in the same way public residential hospitals are. Comprehensive psychological support is rarely offered alongside psychiatric treatment plans, although some may offer occasional group activities.

The primary differences, besides the price tag, are the quality of the facilities and the primary conditions treated. Hospital Monsanto, for example, treats everything from geropsychiatric conditions to acute mood or anxiety disorders, including suicide risks. Hospital Monsanto also provides support for individuals with developmental disabilities and drug dependencies of a certain level of affluence. The rules within the walls of private hospitals may also be more lenient than those of their public counterparts, allowing for phones, computers, and reading materials on a case-by-case basis. For those who are still learning Portuguese, there is also a generally higher chance of interacting with English-speaking doctors, nurses, and attendants in the private health sector.

Image by Noah Schmeling

While a stay in a private hospital might sound almost certainly superior to a stint in the public sector, there is of course the small issue of the bill. Rates in a private hospital like Hospital Monsanto can range from 150 euros to upwards of 350 euros per day, not to mention mandatory deposits that can soar into the thousands, making the private sector a non-option for a great deal of the immigrant and working-class communities of Portugal. While some health insurance plans offered by employers may cover a portion or perhaps the entirety of an internment, it is exceedingly important that someone looking to spend time in a private hospital checks, double-checks, and triple-checks with their insurance company and the hospital that the treatment will be covered before finding themselves with a bill they can’t pay.

Image by Noah Schmeling

The road towards a healthy mind and a happy heart is already long and arduous enough. The last thing anyone needs is for the banality of paperwork and appointments to become another impassable struggle in a world of struggles. With information, support, and a bit of fortitude, a more happy and more fulfilling life is possible, no matter how far from home we might be.

Various organizations and hotlines offer free and immediate 24-hour mental health support in Portuguese and in English.

Emergency services – 112

SNS 24 (mental health counseling hotline) – 808-24-24-24

SOS Voz Amiga (suicide hotline) – 213 544 545 // 912 802 669 // 963 524 660

Linha VIDA (drug abuse hotline) – 1414

Encontre uma Saída – Find a psychologist or psychiatrist in Lisbon

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