Mental healthcare in Portugal

In recent decades, the prevalence of mental health disorders has seen them become one of the major causes of morbidity around the globe. For expats, mental health concerns can be exacerbated by feelings of loneliness, isolation, and outside impacts, such as the COVID-19 pandemic.

When it comes to mental health issues in Portugal, anxiety, and mood disorders are the most prevalent (link in Portuguese). To help tackle these issues, increasing awareness about mental health and the available services is crucial. To help you understand your mental healthcare options in Portugal, this article includes the following:

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Mental health in Portugal

According to Eurostat, Portugal has the highest proportion of women reporting chronic depression in the EU, and the sixth-highest level of men. Furthermore, studies show that around 57% of the Portuguese population presents some psychological distress. Indeed, mental health disorders surpass oncological diseases in the country, accounting for 11.8% of identified disorders in Portugal.

According to the report Health at a Glance 2019 from the Organization for Economic Cooperation and Development (OECD), Portugal is the fifth country in the OECD with the highest consumption of antidepressants and anxiolytics (daily intake of 104 doses per 1,000 inhabitants). In 2019, the country’s suicide rate was 11.5 per 100,000 inhabitants.

Portuguese attitudes to mental health

Unfortunately, there’s still some mental health stigma (in Portuguese) and discrimination in Portugal. However, education and public awareness initiatives might help eradicate it in the future.

The stigma (in Portuguese) stems from preconceived ideas that don’t match reality, but which have been perpetuated given the lack of quality information available.

Presently, a few organizations have published online resources and developed webinars (in Portuguese) to promote mental health literacy and fight the stigma associated with mental illness.

Mental healthcare services in Portugal

In terms of mental healthcare, Portugal provides a range of services as part of its public healthcare system, Serviço Nacional de Saúde (SNS).

The National Mental Health Program (in Portuguese) aims to promote the integration of mental healthcare into the SNS, both in primary and long-term care. It focuses on mental health promotion, mental illness prevention, treatment, and rehabilitation. It’s also intended to decentralize mental health services and ensure general access.

Generally speaking, mental health care services in Portugal are provided through:

• Local services
• Regional services
• Psychiatric hospitals

Firstly, local services (in Portuguese) constitute the base of the mental healthcare system in Portugal, providing essential mental healthcare in primary care units and hospitals (both inpatient and outpatient settings).

Secondly, regional services (in Portuguese) should support the local mental health services of the five Regional Health Administrations (or RHA) of Continental Portugal.

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Lastly, psychiatric hospitals (in Portuguese) can also ensure mental health care services at the local and regional levels. Moreover, it offers long-term and specialist inpatient care to patients with serious mental health issues that have no family or social support.

The National Mental Health Program aims to improve patients’ life conditions, develop rehabilitation programs, promote home care, and support their reintegration into the community.

How to access mental health services in Portugal

If you’re an expat or foreigner registered as a resident in Portugal, you should have your healthcare user number (número de utente). It allows you to access health care services in any SNS institution, such as hospitals and local health centers (centros de saúde).

You need to schedule an appointment with your general practitioner (médico de família) to assess and refer you to a specialist or hospital if needed. During the ongoing COVID-19 pandemic, consultations are often made via telephone (in Portuguese).

Within the primary health care system, mental health consultations and all complementary diagnostic and therapeutic methods prescribed by an SNS doctor are exempt from the co-payment fee (taxa moderadora) (in Portuguese). This includes:

• Clinical follow-up psychiatric consultations (both for adults and children)
• All consultations and procedures carried out under the Mental Health Law

Alternatively, you can schedule a consultation at a private clinic with a psychologist (psicólogo) or a psychiatrist (psiquiatra) to assess your mental health needs, provide treatment and support. Costs associated with this private care will depend on your personal insurance situation.

Insurance for mental healthcare in Portugal

Expats living in Portugal can benefit from free basic healthcare, as the SNS provides subsidized healthcare for anyone that contributes to the Social Security System (Segurança Social de Saúde). It covers the mainland of Portugal.

If you’re in the autonomous regions of Madeira or Azores, you can access healthcare through Serviço de Saúde da RAM (in Portuguese) or Direção Regional de Saúde (in Portuguese), respectively.

For EU/EFTA citizens temporarily staying in Portugal, the European Health Insurance Card (EHIC) gives you healthcare access as you would enjoy in your home country. However, remember that this should only be used for urgent medical needs and should not replace your travel insurance.

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Whenever it’s possible, Portugal allows patients with severe mental illness to comply with their therapy in compulsory outpatient treatment (in Portuguese) instead of compulsory admission. In these cases, patients receive free antiepileptic and psychotropic drugs by the SNS.

Additionally, there are health subsystems that finance health care for certain professions. One of the largest subsystems is ADSE which finances psychological and neuropsychological tests, clinical psychological consultations, and psychiatric hospitalizations. The amounts covered vary depending on the type of treatment. Of course, access to these health services will depend on your profession.

You can avoid long waiting lists often associated with the SNS by having private health insurance. Private cover can give you access to a wide range of specialties without needing a referral from your GP. Here are some of the largest private health insurance companies in Portugal:

• Allianz Care
• Cigna Global

However, be sure to compare policies to ensure you find the right coverage for you and your family. For more information, read up on health insurance in Portugal.

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Psychologists, psychiatrists, and therapists

In 2020, there were approximately 2.5 psychologists per 100,000 inhabitants in Portugal, which translates into long waiting lists. However, the local healthcare system operates the SNS24 Line (in Portuguese), which provides a free 24/7 psychological counseling service (808 24 24 24).

Psychologists (in Portuguese) can perform assessments and interventions in the context of mental and psychological health issues. Unlike psychiatrists, they can’t prescribe any type of medication. Nonetheless, they can help you deal with difficult life experiences or situations. By law, they must register as members of the Ordem dos Psicólogos Portugueses (in Portuguese).

Psychiatrists differ from other therapists in that they make medical diagnoses and treatment plans, both pharmacological and psychological. They must register as members of the Ordem dos Médicos (in Portuguese).

On the Find a Way Out website (in Portuguese), you can search for a psychologist in your area to schedule an appointment. However, if you want to search specifically for English speakers, you may wish to check out this directory, too.

Some health subsystems and health insurance providers co-pay for psychology consultations. This means that a part of their cost is reimbursed by the insurance company, depending on your coverage plan.

In private practice, a one-hour consultation session costs between €45-60 (as of 2022), and you don’t need a referral from your GP. The psychologist can ask you to share what is going on in your life, specifically any difficulties you may be facing, or if you would like to discuss a particular subject. Generally, the sessions can last around 50 or 60 minutes.

Drug and alcohol services

The Portuguese Ministry of Health created the Intervention Service for Addictive Behaviors and Dependencies (SICAD) to reduce the consumption of psychoactive substances, as well as prevent addictive behaviors.

According to SICAD’s 2020 Report (in Portuguese) on alcohol abuse, 2.8% of the population (equating to 4.9% of all users) showed harmful alcohol consumption or dependence. Regarding drug use, there has been an increase in the rate per 1,000 inhabitants aged 15-64 years:

• 4.5 (per 1,000 inhabitants) are high-risk users of opiates
• 9.8 show cocaine dependence
• 2.1 inject drugs
• 9 have cannabis dependence

The SOS Drug Lifeline (in Portuguese) is a free, confidential counseling service that anyone can call (1414). It provides emotional support in crisis situations and clarifies doubts related to addictions and associated issues. Furthermore, it’s anonymous so that people feel comfortable to open up.

Generally, the treatment (in Portuguese) of a person with addictive behaviors is available in different types of settings, namely outpatient, inpatient, drug addiction centers or CAT, and day centers. Depending on the patient’s needs, it can involve different interventions, such as pharmacological, psychological, systemic interventions, and social rehabilitation.

If you have private health insurance, you should check your coverage plan, as some may not cover rehab centers or treatment for drug addiction.

Here are some support groups available in Portugal:

• Linha Vida SOS Droga – support hotline for drug addiction (in Portuguese)
• Grupo de Apoio aos Toxicodependentes (GRATO) – drug addiction support group (in Portuguese)
• Narcóticos Anónimos – support groups for those struggling with drug addiction (in Portuguese)
• Alcoólicos Anónimos – support groups for those struggling with alcohol dependence (in Portuguese)

Services dealing with eating disorders

There are a number of services available in Portugal for those facing challenges associated with eating disorders. These include anorexia, bulimia nervosa, and binge eating. If you are living with an eating disorder, speak to your family doctor, who can provide assistance. Usually, the treatment requires a multidisciplinary approach, and there can be long waiting lists in the public sector.

There is a lack of studies and data on eating disorders in Portugal, with the latest records being from 2014. According to this study, there was a total of 4,485 hospitalizations related to an eating disorder, with Anorexia being the most frequent.

For patients living with bulimia and binge eating disorders (in Portuguese), medication may be necessary, in association with psychotherapy. If you have private health insurance, it can cover some treatments, depending on your coverage plan.

There’s a support group for the families and friends of those dealing with eating disorders – Associação dos Familiares e Amigos dos Anorécticos e Bulímicos (in Portuguese).

Services for people with severe mental health problems

There are psychiatric institutions in which you can be admitted voluntarily in cases of severe mental health issues. You can search for the Mental Health Service of the Hospital in your region (in Portuguese).

A police officer can order you to go to one involuntarily if you constitute an imminent risk to yourself or society. A psychiatrist will assess your mental health status and decide on the best course of treatment, which might include compulsory hospitalization (in Portuguese).

If you disagree, health professionals can request any Portuguese court to keep you hospitalized based on a psychiatric assessment report. Afterward, the court has 48 hours to decide if there’s a legitimate reason for it. If so, you will be discharged as soon as the grounds for hospitalization cease to exist.

Portugal has been trying to transfer the long-term mental health care provided in psychiatric hospitals, into community-based services (in Portuguese). These community services will be integrated into the SNS, in order to make them more accessible to the population.

Mental health services for children and young people

In Portugal, the prevalence of mental health problems in children and adolescents is unknown, as there is a scarcity of data due to a lack of epidemiological studies.

The Pediatric Hospitals in Lisbon, Porto, and Coimbra have mental health centers for children and adolescents (in Portuguese). However, there is still a long way to go in optimizing the mental health care services for these age groups.

In 2021, Portugal created Children and Adolescents Community Mental Health Teams, as part of a pilot project. Basically, children and adolescent mental healthcare is provided through multidisciplinary teams involving nursing, psychological, social, and rehabilitation support.

Presently, these community interventions (in Portuguese) are developed in articulation with primary health care, GPs, and the respective preschool, primary, or secondary schools.

For example, ENCONTRAR+SE is a private non-profit institution that offers psychological counseling services to children and their parents or caregivers.

Services for special groups

There are several organizations (in Portuguese) that provide support to women, particularly those that are struggling with mental health issues, victims of sexual assault, victims of domestic violence, among other circumstances.

You can also find non-governmental organizations (list of resources in Portuguese) that support people with disabilities across the country.

Prevention and education

The Portuguese National Mental Health Program aims to increase by 30% the number of initiatives for mental health promotion and mental illness prevention.

The NGO ManifestaMente has created a free, online mini-course (in Portuguese) with essential information about mental health to increase awareness and provide resources.

Likewise, the initiative SER Mental – Serviço Especializado em Rede para a Promoção da Saúde Mental na Infância e Adolescência has created a community service that aims to prevent risky situations and promote mental health in childhood and adolescence (in Portuguese).

Levar a Saúde Mental onde ela não chega – KIDS is another project (in Portuguese) aimed specifically at promoting children’s mental health.

Additionally, the association ENCONTRAR+SE (in Portuguese) has developed a set of strategies and valuable resources for promoting wellness and mental health. This initiative intends to tackle the specific impact of the COVID-19 pandemic on mental health.

Emergency support and crisis lines

112 is Europe’s medical emergency number, and calls are free of charge (available 24/7).

You can find here the main emergency support lines:

• Linha Saúde 24 – you can call 808 24 24 24 in situations of illness -available 24/7 (in Portuguese)
• Linha Criança Desaparecida – call 116 000 in case of missing children – available 24/7 (in Portuguese)
• SOS Criança – children can call 116 111 to ask for help in urgent situations – available 24/7 (in Portuguese)

Find out more Portuguese emergency numbers with our list.

Useful resources

• National Health Service – provides information about mental health policy (in Portuguese)
• National Mental Health Program – provides information about the Portuguese mental health services and resources (in Portuguese)
• Association ENCONTRAR+SE – provides resources to improve and promote mental health (in Portuguese)
• Kit Básico de Saúde Mental – free online mini-course with essential information about mental health (in Portuguese)
• Portuguese Society of Psychiatry and Mental Health (SPPSM) – provides valuable information and guidance on mental health issues (in Portuguese)
• Levar a Saúde Mental onde ela não chega – Kids – provides mental health resources for children (in Portuguese)
• Support Line for Drug Addiction – provides information and resources for those struggling with drug addiction (in Portuguese)