New challenges in the policies of mental health care - Comparing the situation of Portugal and Poland

The history of the institutionalization of the mentally ill overlaps their social exclusion. Portugal and Poland have followed (with delay) the evolution of European policies, defined the closure of psychiatric hospitals and the de-institutionalization of their patients during the second half of the twentieth century. The focus of this paper is on the history of mental illness in Portugal and Poland, giving special emphasis to the period between the XIX - XXI century. We try to reveal and discuss the socio-cultural processes underlying the impacts of the confrontation and coexistence of plural models to explain and deal with madness, between tradition and modernity. What is the role of psychiatry and science? What is the role of the state? What is the role of the civil society and the families? How lay people incorporate those different models in everyday live and deal with mental suffering?

In Portugal and in Poland, the de-institucionalization in practice never occured while successively fully legislated. This contradiction is based on the role of the welfare society as compensation for deficiencies of the state intervention that penalized families in the Portuguese case. Indeed, although civil society embodied some social responsibilities (more in Poland than in Portugal), namely the organization of social facilities, only at a very partial level of those incipient responses corresponds to the needs identified as gaps in social policy. In fact, what it means in both countries talk about community integration of people with mental illness?