Over the last few weeks I have explored the health care system in and around Coimbra in Portugal and often visited departments that have been outside my general field of knowledge and expertise. This has not been a negative experience and in most cases has been doubly interesting because I learned so much more. So although I am still not an expert in radiotherapy and nuclear medicine I am certainly better informed from my multiple visits to these departments.
Today, however, I was looking forward to a visit to the acute mental health ward. Many years ago, as a newly qualified occupational therapist, I worked on an acute mental health ward and I was enthusiastically anticipating talking with professionals in this field and asking more informed questions.
On reflection of my visit I am sincerely hoping that I maintained an air of polite English interest and didn’t betray my inner turmoil. I should have done some homework! I was definitely not prepared for what I perceived to be an extreme biomedical approach to mental health. Everyone on the ward was in hospital pyjamas and dressing gowns except the doctors who wore 
white coats and all I could think about was the 1975 film “One flew over the cuckoo’s nest”. I don’t want to explore the pros and cons of this approach to mental health in this blog but what I do want to talk about is my reaction to a completely different and unexpected paradigm. Unlike my visits to nuclear medicine, I found I was unable to ask relevant questions. I was floundering to find an anchor on which to hook my thoughts and became completely silent when my guide suggested that as an Occupational Therapist I might want to see the pool table in the games room.
Eventually my training from the fabulous Kate Marlow kicked in and I was able to have a meaningful conversation about the merits of having psychiatrists in A&E for mental health emergencies and the success of the growing mental health community support programmes in Portugal. In A&E they have four psychiatrists and one nurse, as mental health emergencies require medical intervention. I did not criticise the biomedical approach at all during my visit but discussed the potential benefits of a biopsychosocial model to which my host felt there were few for an obvious biological disease. We didn’t discuss lobotomies directly but explored the benefits of electroconvulsive therapy and deep brain stimulation for some patient pathologies.
Today’s experience has caused me to think and reflect more than any other of my visits over the last few weeks. It motivated me to review some papers on the medical model versus the psychosocial model in mental health and made me think a lot more about how my views about health care are influenced.
This health care model will not be included in my presentation regarding innovation in the Portuguese health care system but for me it is definitely one of the most memorable.