Psychiatric rehabilitation and social inclusion of people with mental illness: a Portuguese experience and a critical analysis of current barriers

摘要

The delivery of psychiatric rehabilitation interventions has been recognised as fundamental to facilitate recovery of people with severe mental illness. Although Portugal has developed a plan to restructure mental health services between 2007 and 2016, multiple barriers are hindering its effective implementation. We aim to describe a Portuguese psychiatric rehabilitation institution and analyse barriers in the mental health paradigm change. With our experience, we intend to help countries that are planning or passing through a change of paradigm in mental health care to anticipate and avoid similar obstacles. Sources used were research literature, government policy documents and legislation, in loco experience and experiential knowledge. The case study was carried out using interactive (participant observation and non-structured interviews) and non-interactive techniques (document analysis, namely the target institution reports, projects and dossiers). Barriers found include not complying with the most recent available evidence and the use of outdated and non-evidence and values-based models. Moreover, a deficient monitoring and evaluation of services’ quality, resistance to change, lack of appropriate training of professionals, lack of involvement of users in their care planning and funding issues are also contributors for the perpetuation of this scenario.