Barriers to mental health services utilisation in Portugal - results from the National Mental Health Survey

J Ment Health. 2022 Aug;31(4):453-461. doi: 10.1080/09638237.2020.1739249. Epub 2020 Mar 23.


Background: The treatment gap for mental disorders remains a challenge worldwide. Identifying reasons for nontreatment may contribute to reducing this gap.

Aims: To evaluate sociodemographic and clinical factors associated with use and barriers to treatment in Portugal.

Method: Data from the 2009 National Mental Health Survey were used. Participants reported 12-month treatment and reasons for nontreatment. Logistic regression models analysed the association between sociodemographic (education; employment; income; marital status) and clinical variables (mental disorder diagnosis; disability) with treatment and type of barriers (low perceived need; structural; attitudinal).

Results: The majority of participants with a mental disorder was not treated. Treatment was more common among participants with mood disorders (OR = 4.19; 95% CI: 2.72-6.46), and disability (OR = 2.43; 95% CI: 1.33-4.46), and less common among single participants (OR = 0.38; 95% CI: 0.20-0.70) and those with basic/secondary education (OR = 0.42; 95% CI: 0.24-0.73). Attitudinal barriers were more likely among participants with none/primary (OR = 2.90; 95% CI: 1.42-5.90) and basic/secondary education (OR = 1.70; 95% CI: 1.01-2.85), and less likely among those with substance use disorders (OR = 0.27; 95% CI: 0.10-0.70). Low perceived need was higher among single people (OR = 1.77; 95% CI: 1.01-3.08), and lower among those with anxiety (OR = 0.50; 95% CI: 0.28-0.90) and mood disorders (OR = 0.16; 95% CI: 0.09-0.30). Unemployed participants had higher odds of reporting structural barriers (OR = 3.76; 95% CI: 1.29-10.92).

Conclusions: This study identifies factors associated with nontreatment, providing useful evidence to develop policies and effective interventions.

Keywords: Mental healthcare; barriers to use; health policy; social inequalities; treatment seeking.

MeSH terms

  • Health Surveys
  • Humans
  • Mental Disorders* / epidemiology
  • Mental Disorders* / psychology
  • Mental Disorders* / therapy
  • Mental Health Services*
  • Patient Acceptance of Health Care
  • Portugal
  • Surveys and Questionnaires