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Case report
Hard routes of mental health in Portugal: what can we offer to an adolescent with serious mental illness and multiple social risk factors?
  1. Rita Goncalves,
  2. Mafalda Marques,
  3. Teresa Cartaxo and
  4. Vera Santos
  1. Child and Adolescent Psychiatry Department, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  1. Correspondence to Dr Rita Goncalves; ritagoncalves14{at}


Worldwide, millions of children and adolescents are suffering due to a lack of efficient mental healthcare. Although some progress has been made to address the mental health problems in this age group, currently, even developed countries fail in providing psychiatric patients with the best practice care. We present a case of a Portuguese adolescent with a first episode of psychosis in whom multiple social and environmental risk factors were identified as triggers to his clinical presentation, as well as fundamental determinants of prognosis in the short and long term. In this case, we demonstrate how social determinants, including poverty, family dysfunction and difficulties in accessing appropriate mental healthcare, strongly influence the development, maintenance and prognosis in early psychosis during adolescence. Furthermore, we consider the implications of an absence of community-based mental healthcare and rehabilitation services and reasons for why this may complicate the management and limit opportunities to this patient population.

  • global Health
  • child and adolescent psychiatry
  • healthcare improvement and patient safety
  • psychotic disorders (incl schizophrenia)

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  • Contributors RG, TC and VS were involved in the patient’s care. RG, the corresponding author, had the initiative to write this article, explained the implications of it to the patient and obtained his consent. She was also responsible for patient information collection, analysis and interpretation, as well as the literature review and discussion of global health problems. MM and TC also collaborated in organising the information, in the literature review and discussion, in writing important parts of the manuscript and revising it extensively. TC and VS also wrote and edited the manuscript and critically reviewed the scientific and formal content. All the authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.