Portugal at the Forefront of Child and Adolescent Mental Health Promotion

In May 2013, the 66^th session of the World Health Assembly constituted by the Ministries of Health of 194 Member States adopted the WHO Comprehensive Mental Health Action Plan 2013-2020, which recognized the essential role of mental health to achieve health for all persons over the life cycle.⁽¹⁾ The need to include mental health as one of the first priorities in the public health agenda has become more recognized internationally in the last decades, and was incorporated in Europe in 2016 via the European Framework for Action on Mental Health and Wellbeing.⁽²⁾ This recognition is justified essentially by three types of reasons: the growing evidence and awareness about the magnitude of mental health problems in European countries (mental disorders are highly prevalent in Europe, result in a great number of implications for individuals, society and the economy, and represent an impressive translation in terms of disability adjusted life years - DALYs); because the burden of mental disorders is linked to the high prevalence of mental health problems, in most cases in an early life stage (usually before adulthood) and the realization that about half of the population with mental health problems does not receive evidence-based clinical orientation; and finally, because of the circumstances of mental health problems are considered one of the main causes of productive human capital and are a reality with significant financial implications, estimating global financial costs of mental disorders, including direct and indirect medical costs, with healthcare and loss in productivity, more than 450,000 million Euros per year, in the European Union alone.⁽²⁾

Considering this framework in Portugal, which became part of the present European Economic Community on January 1, 1986, the current state of mental health, as outlined in the most recent report by the Directorate-General of Health, is disheartening.⁽³⁾ In concrete terms, mental and behavioral disorders weigh significantly on total healthy life years lost by Portuguese citizens, with a rate of 11.75% versus 13.74% for cerebrovascular diseases and 10.38% for oncological diseases. Furthermore, mental disorders represent 20.55% of total years lived with disability, followed by respiratory diseases (5.06%) and diabetes (4.07%). Considering the data about child and adolescent mental health, epidemiological studies report that, although most children and adolescents live their childhood and adolescence without significant difficulties, approximately 20% present psychiatric disorders.^(4,5) Regarding the consumption of psychotropic substances (medications, alcoholic beverages, and illegal drugs), the situation remains is just as alarming, especially when considering the use of benzodiazepines and nonspecific central nervous system stimulants, respectively, among adolescents and children, data corroborated by the report “The Health of the Portuguese - 2016 Panomara”.⁽⁶⁾ Suicide rates among adolescents have been decreasing over the last few decades, even though it is still one of the leading causes of death among Portuguese youths between 15 and 24 years old.⁽⁷⁾

Based on this diagnosis, the field of child and adolescent mental health in Portugal has been recognized as an emerging priority area for intervention. To support this recognition, numerous epidemiological, retrospective and prospective studies have been produced, which have confirmed the empirical observation that the onset of many adult psychiatric disorders occurs before the age of 18, and that early diagnosis of these disorders is decisive to good progression.^(5,8) Furthermore, such high prevalence of mental disorders in childhood and adolescence associated with a high rate of comorbidity and the frequent continuity of severe psychopathology into adult life justifies addressing the economic and social burden of these disorders, which extend far beyond the economic cost for health services.^(4,5) In fact, it was the sheer dimension of these needs in the practical field of mental health that led Portugal, within the scope of a clear, dynamic and up-to-date national policy, to give priority to the implementation of the National Mental Health Plan - PNSM,⁽⁴⁾ which has brought the country much recognition. This prestige lies not only in the plan's set of objectives that have the potential to structure a paradigm shift in Portuguese society, but in the responsibility it takes upon itself to address a short-term framework of priority proposals.⁽⁵⁾

Among the many recommendations set forth in the Portuguese PNSM, the following priorities for 2020⁽⁷⁾ have been established in the field of child and adolescent mental health (focus of the present editorial):⁽⁷⁾ 1) to consider child and adolescent mental health a priority health action, defending the urgent need to create and reinforce multidisciplinary child and adolescent mental health teams at the national level, focusing mainly on peripheral geographical areas; 2) to prioritize the implementation of mental health promotion and prevention programs, based on ecological intervention models and intersectorial coordination; 3) to create a national epidemiological database about mental disease in childhood and adolescence, which allows for services to adjust to their different needs; and 4) to develop valid and reliable indicators that are sensitive to change, which enable not only longitudinal monitoring of healthcare quality, but also cross-sectional evaluations, thus enabling a global assessment of the performance of services and compliance with the PNSM.

Within the scope of these four recommendations, a group of researchers from the Higher School of Health of the Polytechnic Institute of Viseu, in collaboration with other institutions from central Portugal, developed a research project called “Monitoring and Assessing Child and Adolescent Mental Health Indicators: From Research to Practice”. Funded by European resources (reference: CENTRO-01-0145-FEDER-023293), the aim of the study is the prevention of mental disorders and promotion of mental health in schools. It supports the implementation of professional training and informational programs based on ecological models of intervention aimed at teachers/educators, teaching assistants, health professionals, authorities/security agents, i.e., professionals who are in direct contact with and participate in the education of future citizens.

In this context, and within the scope of many of the project's activities, in the coming year, on June 21 and 22/2019 - the World Conference “Quality of Life and Mental Health: Perspectives, Trends, and Challenges,” will occur on June 21 and 22/2019 in the city of Viseu, Portugal, at the School of Health, part of the Polytechnic Institute of Viseu (http://www.essv.ipv.pt). The overarching goal of the conference, which will also serve to foster Portugal at the Forefront of Child and Adolescent Mental Health Promotion, is to present the “state of the art” in Portugal and the world regarding the interface between mental health and the quality of life of children and youth.

Preference will be given to the paper presentations (oral or poster presentations) that address the topic and context of the conference, that can foster discussions and the exchange of opinions and experiences among participants. In sum, we will strive to organize a conference with active and determined participants, with the will to share best experiences and scientific evidence with the community. To this end, we have entered into partnership with the Paulista School of Nursing of the Federal University of São Paulo - Brazil, which will participate in the conference's organizing and scientific committee. Furthermore, such interinstitutional collaboration will allow for full articles submitted to analysis and evaluation by the scientific committee be published in an edition of the conference's official organization, the Acta Paulista de Enfermagem journal, in accordance with its editorial policy.

With this aspiration, I am pleased to invite you to participate in this conference, whether by proposing and presenting an oral or poster presentation or even by organizing a seminar. With the certainty that everyone will have something to contribute to the promotion of child and adolescent mental health, I hope that we can all meet, in 2019, in the beautiful city of Viseu. Until then, enjoy all the information available at http://projects.essv.ipv.pt/msmental.

Referências

• ¹
  World Health Organization (WHO). Mental health action plan 2013-2020. Geneve: WHO; 2013. [citado 17 de setembro de 2018]. Disponível em: http://www.who.int/mental_health/publications/action_plan/en/
  » http://www.who.int/mental_health/publications/action_plan/en/
• ²
  Portugal. Ministério da Saúde. Alto Comissariado da Saúde. Coordenação Nacional para a Saúde Mental. Plano Nacional de Saúde Mental: 2007-2016 [Internet]. Lisboa: Coordenação Nacional para a Saúde Mental; 2008. [citado 17 de setembro de 2018] http://www.dge.mec.pt/plano-nacional-de-saudemental-2007-2016
  » http://www.dge.mec.pt/plano-nacional-de-saudemental-2007-2016
• ³
  European Framework for Action on Mental Health and Wellbeing. EU joint action on mental health and wellbeing: final conference [Internet]. Brussels: EU; 2016. [citado 17 de setembro de 2018]. Disponível em: http://ec.europa.eu/research/participants/data/ref/h2020/other/guides_for_applicants/h2020-SC1BHC-22-2019-framework-for-action_en.pdf
  » http://ec.europa.eu/research/participants/data/ref/h2020/other/guides_for_applicants/h2020-SC1BHC-22-2019-framework-for-action_en.pdf
• ⁴
  Portugal. Ministério da Saúde. Comissão Técnica de Acompanhamento da Reforma da Saúde Mental. Relatório da Avaliação do Plano Nacional de Saúde Mental 2007-2016 e Propostas Prioritárias para a Extensão a 2020 [Internet]. Lisboa: Comissão Técnica de Acompanhamento da Reforma da Saúde Mental; 2017. [citado 17 de setembro de 2018] Disponível em: https://www.sns.gov.pt/wp-content/uploads/2017/08/RelAvPNSM2017.pdf
  » https://www.sns.gov.pt/wp-content/uploads/2017/08/RelAvPNSM2017.pdf
• ⁵
  Caldas de Almeida JM, Xavier M (2009). Estudo Epidemiológico Nacional de Saúde Mental: 1° relatório. Lisboa: Universidade Nova de Lisboa; 2009. [citado 17 de setembro de 2018]. Disponível em: http://www.fcm.unl.pt/main/alldoc/galeria_imagens/Relatorio_Estudo_Saude-Mental_2.pdf
  » http://www.fcm.unl.pt/main/alldoc/galeria_imagens/Relatorio_Estudo_Saude-Mental_2.pdf
• ⁶
  Direção-Geral da Saúde (DGS). Plano Nacional de Prevenção do Suicídio 2013-2017. Lisboa: DGS; 2013. [citado 17 de setembro de 2018]. Disponível em: https://www.dgs.pt/documentos-e-publicacoes/plano-nacional-de-prevencao-do-suicido-20132017-pdf.aspx
  » https://www.dgs.pt/documentos-e-publicacoes/plano-nacional-de-prevencao-do-suicido-20132017-pdf.aspx
• ⁷
  Direção-Geral da Saúde (DGS). PORTUGAL Saúde Mental em Números - 2015. Lisboa: DGS; 2016. [citado 17 de setembro de 2018]. Disponível em: https://www.dgs.pt/em-destaque/portugal-saude-mental-em-numeros-201511.aspx
  » https://www.dgs.pt/em-destaque/portugal-saude-mental-em-numeros-201511.aspx
• ⁸
  Direção-Geral da Saúde (DGS). A Saúde dos Portugueses. Perspetiva 2016. Lisboa: DGS; 2017. [citado 17 de setembro de 2018]. Disponível em: https://comum.rcaap.pt/bitstream/10400.26/18278/1/A%20Sa%C3%BAde%20dos%20Portugueses%202016.pdf
  » https://comum.rcaap.pt/bitstream/10400.26/18278/1/A%20Sa%C3%BAde%20dos%20Portugueses%202016.pdf

Publication Dates

• Publication in this collection
  2018