Mental Health Services: Call for Ιmmediate Αction

It is well known that in Greece, up until the decade of the 1980s, mental health services were provided exclusively in institutions, under unacceptable conditions of patient care, a situation which stigmatised the country in the international view.

From the end of the decade of the 1980s, with the economic support of the European Union (Regulation 815/84 concerning psychiatric reform in Greece), the Psychiatric Reform programme was started, and it has continued to be in effect up to the present day.

The principles of the Psychiatric Reform were legislated by the Hellenic State under the legal act L. 2716/1999 "concerning the development and modernization of the Mental Health Services" (Government Gazette 96/A/17.5.1999), and the related Ministerial Decrees which have been issued under its authorization. According to the above provisions, the State has the responsibility for the provision of mental health services with the purpose of the prevention, diagnosis and treatment of mental illness, and the care and psychosocial rehabilitation of individuals with psychosocial problems.

The above legislation and the goals towards the realization of the Public Psychiatric Reform constitute the System of Mental Health Services, which is under state supervision and funding, and to which the Mental Health Units belong, operating according to the ordinance of the legislation, within the framework of the public services and the private non-profit sector (N.G.Os).

Already in Greece, with the continuing assistance of the European Union within the context of the successive Community Frameworks of Support, a substantial contraction of the large psychiatric institutions has been achieved, along with the development of satisfactory numbers of psychiatric units in General Hospitals and of Mental Health Centres. Moreover, the operation of a large number of Psychosocial Rehabilitation Units and Specialized Care Centres (sheltered homes, hostels, protected apartments, day centres, etc.) under the management -in the majority of them- of the non-profit sector (N.G.Os).

These Mental Health Units, which are in operation throughout Greece, offer high quality services to hundreds of people with psychosocial problems who formerly lived under institutionalised conditions of social exclusion, and have assured them, to a large extent, their social reincorporation.

It should be pointed out that the work accomplished in the Psychosocial Rehabilitation Units and Community Specialised Care Centres mentioned above is of a multifaceted nature:

A. They provide high level psychosocial rehabilitation services to their patients-residents.

B. They constitute the venue for the development of research and educational activities, providing training of undergraduate and postgraduate students in mental health sciences.

C. They organize mental health education activities for the wider community, aimed at mental health promotion and eradication of the stigmatisation of mental illness.

D. They develop actions directed towards society in general, aimed at the promotion and reinforcement of the idea of voluntary work in the field of mental health.

However, recently from January 2005, the continuing operation of the Psychosocial Rehabilitation Units and the Community Specialised Care Centres, which are funded by the state health budget, has come under threat, due to the payment of only the 50% of the required budget of the state funding (reduction by 50%). It should be pointed out that the greatest proportion of the expenses of the Units is related to fixed expenditure, such as living expenses, costs of care and psychosocial rehabilitation of the residents, salaries of the mental health specialists who comprise the therapeutic team of each Unit, and running expenses of the premises where the patients-residents are housed (rent, etc.). The payment of only 50% creates conditions of inability to operate the Units according to the mandate of the relevant Legislative Framework on Mental Health passed by the State.

The same threat is already faced by the large number of Psychosocial Rehabilitation Units and Community Specialised Care Centres which were recently founded in the context of the Action Programme "HEALTH-WELFARE" 2000-2006, incorporated in the 3rd Community Framework of Support, with co-funding to the extent of 75% from the EC Monetary Fund, which was authorized by the Decision E(2001)583/4.4.2001 of the Commission of the European Communities. Following the expiry of the contractual period of co-funding, the Hellenic State undertook to the European Union the continuation of their operation under the regular State budget.

The financial situation of the Units described above has placed the mentally ill residents in a state of severe insecurity. In the event of continued non-payment of the required budget by the state funding, these people are in danger of being returned to psychiatric institutions, with the following direct consequences: a) deterioration in their mental health status, b) violation of their rights, c) stress in their families, and d) retrogression of the Psychiatric Reform, which has been sustained continuously since 1984 by the European Union with the above-mentioned Regulations, and by the relevant legislative regulations of all the Hellenic Governments.

In parallel with the above, a whole range of complex legal, administrative, ethical and deontological concerns are created, related to issues arising from compensation for the employees-mental health specialists, compensation for theowners of the premises housing the Units, unemployment of the employees and the non-utilization of the especially skilled highly trained human resources.

It should be pointed out that the administrations - non-salaried - of scientific non­profit agencies, to whom the State, according to the legal act L. 2716/1999 cited above, entrusted the responsibility of the operation of the Psychosocial Rehabilitation Units and the Community Specialised Care Centres, will become involved in complex legal processes, in order to deal with, although they are not obliged to, the persisting consequences of the inability to continue operation of the Units.

The above demonstrates the necessity for immediate action on the part of the Hellenic State, to take the necessary measures to meet its commitments as described above.