Mental health policy implementation assessment: 8 years after inception

Introduction In 2007, Portugal started the implementation of a new National Mental Health Plan (NMHP). The main objectives of the plan included: assure equal access, promote and protect human rights, reduce the impact of mental health disorders, promote the decentralisation of mental health services, and the integration of mental health in primary care, general hospitals and community networks. In the last years, the fulfilment of these objectives was hindered due to economical factors. Objectives To assess the degree of implementation of the main priorities included in the 2007–2016 NMHP, considering levels of low, medium and high implementation. Methods A full assessment of the NMHP was conducted by the National Mental Health Programme, by means of a cross-sectional evaluation, requested by the National Health Regulatory Agency. Results High degree of implementation: development of new services, continuing care law, workforce training, programme to fight stigma, programmes for vulnerable groups. Medium degree of implementation: reorganisation of emergency services, involvement of users and families, suicide prevention plan and grants for innovative services. Low degree of implementation: new models for budgeting and management, new continuing care network, workforce recruitment, inpatient services for children and adolescents, collaboration with the primary care, substance use and justice sectors. Conclusion The scarce degree of autonomy of the implementation team at the Ministry and the economical crisis hindered the fulfilment of key objectives. Dimensions including the mental health financial and management systems and the implementation of a continuing care network must be considered top priorities.