Understanding the Mental Health Care Pathway — Where Psychiatry Fits
Mental healthcare in Portugal operates at three levels. Understanding where psychiatry fits helps you book the right service and get the level of care appropriate to your specific presentation.
Mental Health Consultation — first point of contact. Suitable for initial mental health assessment, safety advice, care planning, and management of common mental health presentations at GP level. Your doctor can refer to psychology or psychiatry when specialist support is needed.
Psychology Consultation — structured psychological therapy. Suitable for evidence-based psychological therapy — CBT, trauma-focused therapy, EMDR — delivered by a psychologist registered with the OPP. Psychological assessment for ADHD, specific learning difficulties, and other conditions.
Psychiatry Consultation — specialist psychiatric assessment and management. Suitable for complex mental health presentations requiring specialist diagnostic formulation, management of conditions not adequately controlled at GP level, specialist-level medication management, and presentations where psychiatric expertise is clinically necessary.
Not sure which level of care is right? Start with our Mental Health Consultation. Your doctor assesses your presentation and advises on the most appropriate pathway — including whether specialist psychiatric assessment is indicated.
What Remote Psychiatry Covers — And What Requires In-Person Assessment
Remote psychiatric consultation covers a substantial proportion of specialist psychiatric assessment and management — but not everything. Being clear about the scope ensures you receive the right care for your specific presentation.
What this specialist consultation covers:
- Complete psychiatric assessment and diagnostic formulation for presentations suitable for remote assessment
- Review and clarification of existing psychiatric diagnoses
- Assessment and management of mood disorders — depression and bipolar disorder at specialist level
- Assessment and management of ADHD at specialist psychiatric level
- Assessment and management of anxiety disorders at specialist level
- Assessment of trauma and PTSD and specialist management
- Specialist assessment and management of OCD
- Medication review and management recommendations at the specialist's professional discretion
- Second opinion on a psychiatric diagnosis or management plan
- Transition planning — from inpatient care to the community, from child and adolescent psychiatry to adult services
- Coordination with the family doctor, psychologist, and other members of the mental health care team
What requires in-person assessment:
- First episode of psychosis — assessment of psychotic symptoms requires in-person assessment in most clinical presentations
- Active suicidal ideation with significant risk — requires in-person risk assessment and may require emergency or inpatient intervention
- Acute mania — requires in-person assessment and often inpatient management
- Psychiatric assessment for the purposes of involuntary treatment under the Mental Health Act — cannot be conducted remotely
- Mental health conditions where a physical examination is needed — neurological assessment, metabolic screening — before formulation
Your psychiatrist advises you clearly if your presentation requires in-person assessment and coordinates the appropriate clinical pathway. Patient safety is always the clinical priority.
Situations Commonly Assessed and Managed
Mood Disorders
- Major depressive disorder — including treatment-resistant depression requiring specialist review
- Bipolar disorder — Type I and Type II — management review, mood stabilisation, and specialist medication management
- Persistent depressive disorder — chronic depression requiring specialist assessment
- Cyclothymia — assessment and management
- Perinatal mood disorders — depression and anxiety in pregnancy and postpartum at specialist level
- Seasonal affective disorder requiring specialist support
Anxiety Disorders at Specialist Level
- Generalised anxiety disorder not responsive to first-line management
- Panic disorder with significant functional impairment
- Social anxiety disorder — specialist assessment and management
- Health anxiety — severe presentations requiring specialist support
- Agoraphobia with significant functional impairment
- Specific phobias requiring specialist assessment
Trauma and PTSD
- Post-traumatic stress disorder — specialist assessment and management
- Complex PTSD — resulting from prolonged or repeated trauma
- Dissociative presentations — assessment and management
- Childhood trauma — specialist assessment of adult presentations
ADHD
- Adult ADHD — psychiatric assessment, diagnostic formulation, and specialist management
- ADHD with comorbid conditions — anxiety, depression, substance use
- Medication initiation and review at specialist psychiatric level
- Transition of ADHD management from child and adolescent to adult psychiatric services
OCD and Related Disorders
- Obsessive-compulsive disorder — specialist assessment and management
- Body dysmorphic disorder
- Trichotillomania and skin-picking disorder
- Hoarding disorder at specialist level
Personality Disorders
- Personality disorder assessment and formulation
- Borderline personality disorder — management support and specialist coordination
- Coordination with psychological therapy services for personality disorder treatment
Neurodevelopmental Conditions
- Autism spectrum disorder — assessment support and management coordination in adults
- Intellectual disability with comorbid psychiatric presentation
- Neurodevelopmental conditions with complex psychiatric comorbidity
Other
- Eating disorders — psychiatric assessment and coordination with specialist eating disorder services
- Substance use disorders — assessment of psychiatric comorbidity and management
- Sleep disorders with significant psychiatric dimension
- Psychiatric second opinion — independent specialist review of a diagnosis or management plan
- Transition planning — from child and adolescent psychiatry to adult services, from inpatient care to the community
What Your Consultation Includes
Complete Psychiatric Assessment. Your psychiatrist carries out a complete psychiatric assessment — covering your current concerns, psychiatric history, developmental history, family psychiatric history, medical history, current medication, substance use, risk assessment, and social and occupational functioning. This structured assessment is the foundation of your psychiatric formulation.
Psychiatric Formulation. Your psychiatrist develops a formulation — a specialist clinical explanation of your presentation that integrates biological, psychological, and social factors — providing the framework for your management plan. This is shared with you and, with your consent, with your family doctor and other members of your care team.
Diagnostic Review and Clarification. For patients with existing psychiatric diagnoses, your psychiatrist reviews the clinical basis for those diagnoses — confirming, refining, or reconsidering them in light of the complete assessment. This is particularly valuable for patients who have received diagnoses they don't fully understand or that haven't led to effective treatment.
Specialist Management Plan. Based on your assessment, your psychiatrist provides a specialist management plan — including medication review and recommendations at the specialist's professional discretion, psychological therapy recommendations, lifestyle guidance, and a clear follow-up pathway.
Risk Assessment. Every psychiatric consultation includes a structured risk assessment — covering risk to yourself and others, protective factors, and safety planning when relevant. This is conducted sensitively and as a standard clinical component of every consultation.
Coordination with Your Care Team. With your consent, your psychiatrist communicates with your family doctor, psychologist, and other members of your mental health care team — ensuring continuity and integration throughout your care pathway.
Second Opinion. For patients seeking an independent specialist review of a psychiatric diagnosis or management plan — including opinions received from other psychiatrists or in other countries — your psychiatrist carries out a complete assessment and provides a clear, independent, evidence-based perspective.
Medication Management in Remote Psychiatry
Medication is often a core component of psychiatric management — and medication decisions in psychiatry require careful specialist clinical judgement. Here is how this works in the context of a remote psychiatric consultation:
What is appropriate in a remote psychiatric consultation:
- Review of existing psychiatric medication — assessing effectiveness, tolerability, side effects, and appropriateness
- Medication adjustment recommendations when clinically indicated
- Medication initiation for conditions suitable for remote assessment — after a complete clinical assessment
- Medication education — mechanism, expected response, side effects, and monitoring requirements
What requires additional consideration:
- Controlled medications — including stimulants for ADHD and certain other medications — are subject to additional prescribing requirements in Portugal. Your psychiatrist advises on the appropriate clinical and regulatory pathway for these medications, based on your specific presentation
- Medication initiation for complex presentations — where the clinical picture requires further assessment before medication decisions are appropriate, your psychiatrist advises on the necessary next steps
All medication decisions are made exclusively at the psychiatrist's professional discretion, after a complete clinical assessment. No medication can be started or adjusted without a complete psychiatric assessment.
A Note on the Mental Health Act
The Mental Health Act (Law No. 36/98, of 24 July) regulates involuntary treatment and compulsory admission in Portugal. Remote psychiatric consultations cannot facilitate involuntary assessment or treatment — this requires in-person assessment and a judicial decision, in line with the law.
If your psychiatrist determines during a remote consultation that your presentation may require involuntary intervention, they advise you immediately and direct you to the appropriate service — which may include going to the nearest emergency department or contacting emergency services.
This limitation is stated clearly because patient safety requires transparency about what remote psychiatric care can and cannot do. If you are in crisis or believe you may need urgent in-person psychiatric assessment, contact emergency services or go to the nearest emergency department, instead of booking a remote consultation.
Support for Expats and International Residents
Accessing specialist psychiatric care as an expat or international resident in Portugal presents specific challenges — NHS (SNS) waiting lists, unfamiliarity with the Portuguese mental health system, language barriers, and the cultural dimension of discussing mental health across different clinical and cultural frameworks.
Our psychiatrists offer consultations in Portuguese, English, Spanish, Czech, and Romanian — and have experience with the specific challenges faced by international communities in Portugal. For expats managing psychiatric conditions diagnosed and managed in their home country, our psychiatrists can review existing diagnoses and management plans in the Portuguese clinical context — ensuring continuity of care across health systems.
Why Choose Our Care
Psychiatrists registered with the Psychiatry College of the Portuguese Medical Association. Our psychiatrists are registered with the Psychiatry College of the Portuguese Medical Association — the highest level of psychiatric qualification available in Portugal. You are speaking with a psychiatrist, not a GP with an interest in mental health.
Specialist diagnostic formulation. A psychiatrist provides a level of diagnostic formulation — integrating biological, psychological, and social factors — that isn't available at GP or psychology level. For patients with complex, treatment-resistant, or poorly understood presentations, specialist formulation is often clinically transformative.
Same-day and advance appointments. Available seven days a week, including evenings and weekends — because mental health crises and significant psychiatric concerns don't follow office hours.
Second-opinion experience. Our psychiatrists regularly provide independent second opinions on psychiatric diagnoses and management plans — including ones received from other psychiatrists or in other countries. This is particularly valuable for patients who have received diagnoses they don't understand or management plans that haven't produced the expected clinical response.
Integrated care coordination. Our psychiatrists communicate with your family doctor, psychologist, and other members of your care team — with your consent — ensuring your psychiatric care is integrated with your wider mental and physical health management.
Multilingual psychiatric care. Consultations available in Portuguese, English, Spanish, Czech, and Romanian — because discussing psychiatric history, trauma, and complex mental health in your native language is a clinical necessity, not a preference.
