Two facts, and the tension between them.
First: Portugal is consistently among the European countries with the highest consumption of benzodiazepines and antidepressants, and it is a long-standing pattern rather than a recent fluctuation.
Second: access to psychotherapy in the public health service is limited. The number of psychologists per inhabitant has historically sat below what the World Health Organization recommends, and waiting times for psychology appointments are long across much of the country.
The simplest reading is the most uncomfortable: when a psychological response is not available in useful time, the pharmacological one is what remains — and it is frequently given by someone who did not want to be the only response available, in the short time of a general practice appointment.
The space this opens, and the risk it carries
Between "do nothing" and "medicate" there is a large space. It is where support groups, exercise, structured activity, psychoeducation, contact with nature — and technology — live.
It is a legitimate space. And precisely for that reason, it is the space where illusions are easiest to sell: someone suffering and without access buys hope, and plenty of people are selling.
Worth saying that a complementary response is not an alternative. A prescribed anxiolytic and a relaxation session are not in competition, and presenting the second as a way of avoiding the first is a clinical decision that does not belong to a supplier.
What RVer is, and is not, in this conversation
Being explicit, because imprecision does harm here:
- It is not mental health treatment. The base product is a Class I medical device registered with Infarmed, used as a non-pharmacological complement for comfort, distraction and relaxation, under health team supervision.
- It does not replace psychotherapy, consultation or medication.
- It does not assess, classify or diagnose emotional states. There is no wellbeing score.
- It is not for self-administration. The intended purpose requires supervision — which makes it, by design, unsuitable as an individual response for someone on a waiting list.
What exists: literature on immersive environments in anxiety and stress, mostly in concrete situations — the moment before a procedure, an inpatient stay, an institutional setting. We gathered it in the study library, where relaxation, stress and anxiety is among the best represented themes. And we have written about pre-operative anxiety, which is the best supported case.
There is one exception worth naming precisely: graded exposure in phobias and post-traumatic stress disorder has its own, older body of research, always conducted by professionals. In our case that is RVer Exposure — a module in development and not covered by the registration, in which the clinician picks the level and sets the pace, with no automatic progression, no score and no grading.
Where it makes sense, and where it does not
It makes sense inside a service already following the person: an inpatient stay, a day hospital, a unit, a care home. There is a professional, continuity and a record.
It does not make sense as a response for someone on a waiting list with no follow-up. Not because the equipment does not work — because that is not what it is, and because the absence of follow-up is precisely the problem no equipment solves.
If someone presents virtual reality to you as a way of reducing mental health waiting lists, that is the moment to ask which studies support it. We have none to give you.
In short
- High psychotropic consumption and limited access to psychotherapy are the same problem seen from two sides.
- The space for complementary responses is real — and it is where hope is most sold.
- Complementary is not alternative, and decisions about medication do not belong to a supplier.
- RVer does not treat, does not assess and does not replace consultation or psychotherapy.
- Where a team is following the person, it makes sense. On a waiting list, it does not.