Reforming the Portuguese mental health system: an incentive-based approach

Abstract

BackgroundTo promote an effective mental health system, the World Health Organization recommends the involvement of primary care in prevention and treatment of mild diseases and community-based care for serious mental illnesses. Despite a prevalence of lifetime mental health disorders above 30%, Portugal is failing to achieve such recommendations. It was argued that this failure is partly due to inadequate financing mechanisms of mental health care providers. This study proposes an innovative payment model for mental health providers oriented toward incentivising best practices.MethodsWe performed a comprehensive review of healthcare providers’ payment schemes and their related incentives, and a narrative review of best practices in mental health prevention and care. We designed an alternative payment model, on the basis of the literature, and then we presented it individually, through face-to-face interviews, to a panel of 22 experts with different backgrounds and experience, and from southern and northern Portuguese regions, asking them to comment on the model and provide suggestions. Then, after a first round of interviews, we revised our model, which we presented to experts again for their approval, and provide new suggestions and comments, if deemed necessary. This approach is close to what is generally known as the Delphi technique, although it was not applied in a rigid way.ResultsWe designed a four-dimension model that focused on (i) the prevention of mental disorders early in life; (ii) the detection of mental disorders in childhood and adolescence; (iii) the implementation of a collaborative stepped care model for depression; and (iv) the integrated community-based care for patients with serious mental illnesses. First, we recommend a bundled payment to primary care practices for the follow-up of children with special needs or at risk under 2 years of age. Second, we propose a pay-for-performance scheme for all primary care practices, based on the number of users under 18 years old who are provided with check-up consultations. Third, we propose a pay-for-performance scheme for all primary care practices, based on the implementation of collaborative stepped care for depression. Finally, we propose a value-based risk-adjusted bundled payment for patients with serious mental illness.ConclusionsThe implementation of evidence-based best practices in mental health needs to be supported by adequate payment mechanisms. Our study shows that mental health experts, including decision makers, agree with using economic tools to support best practices, which were also consensual.

Translation and Validation for the Portuguese Adult Population of the Persistent and Intrusive Negative Thoughts Scale: Assessing Measurement Invariance

“…Previous research has shown that RNT is a transdiagnostic construct involved in emotional disorders such as generalized anxiety disorder, social anxiety, or major depression and is highly correlated with other transdiagnostic constructs such as worry and rumination (Arditte et al, 2016;Ehring & Watkins, 2008;Wahl, 2019). Furthermore, PINTS was significantly, negatively, and moderately correlated with life satisfaction, supporting the idea of an intrusive, repetitive, and negative thinking style as a burden on mental health and quality of life (Perelman et al, 2018). Interestingly, the current study found a stronger correlation between PINTS-PT and life satisfaction, by showing that Portuguese individuals who exhibited higher levels of persistent and repetitive negative thinking style, perceived greater impairment in their lives than individuals from the original study.…”

“…In the Portuguese context, emotional disorders are very widespread (Antunes et al, 2018;WHO, 2017), which negatively affects the public mental health system and the quality of life of the population, leading to a high prevalence of the use of psychotropic drugs use (Perelman et al, 2018). The PTQ was translated and validated for the Portuguese population (Azevedo et al, 2017;Chaves et al, 2013), but failed to replicate the three-factor model of the original version (Ehring et al, 2011), suggesting a two-factor model (i.e., repetitive thoughts; and cognitive interference and unproductivity; Azevedo et al, 2017;Chaves et al, 2013).…”

Self-perceived general health among community-dwelling Portuguese older adults: do men and women differ?

“…This suggests a different role of SPGH, other than the one investigated in this study, in the triad of SPGH, depression and functional status. These findings are relevant, given that depression is prevalent among older adults, being particularly high in Portugal in comparison with other European countries (Perelman et al, 2018). Further investigation in order to disentangle the contextual associations among these factors is of utmost importance and the results have the potential to inform decision makers with regards to healthy ageing.…”

“…Research in health inequalities among older adults have primarily focused on socio-economic determinants, such as educational level (Mackenbach et al, 2008;Campos-Matos et al, 2016;Uccheddu et al, 2019) and wealth (Ploubidis et al, 2012;Uccheddu et al, 2019), whereas gender differences and psycho-social determinants have been overlooked. This is surprising, because the role of psycho-social factors in reducing health inequalities irrespectively of age groups has been increasingly recognised (Stansfield and Bell, 2019).…”

Protocol for the Implementation and Assessment of “MoodUP”: A Stepped Care Model Assisted by a Digital Platform to Accelerate Access to Mental Health Care for Cancer Patients Amid the COVID-19 Pandemic

“…Possible barriers include inadequate screening, inability to tackle demand and/or insufficient collaborative care [ 28 ]. In Portugal, these may reflect conservative rates, since the country has one of the highest prevalence of CMD’s (23%) in Europe, representing the second largest cause of disability in the country, while access to mental health care is still below other European countries [ 29 , 30 ]. Furthermore, access to care is expected to decline due to the pandemic and its consequences on patients and services.…”