Psychiatric Reform in Greece, after a period of struggles, nearly 30 years, is once again in a critical point. Its viability is under threat and so is the viability of all the mental health units that have been created during this period. Regrettably, despite the very important work that has been achieved, the crucial deficits and the dysfunctions of the political and the health system, have never been addressed properly and with a specific operational design. As a consequence of that we have witnessed that the efforts of the transition from institutional to community based care have been disputed or even annihilated. In addition to that, the unstable, fragmented and manipulative applied policies regarding mental health have resulted to serious problems in the organization and the operation and planning of the services. As a consequence, all the stakeholders (the service users, the families, the experts) are “locked and lost” in a totally fragmented mental health system.
The peculiarity of the Greek case is that a significant proportion (approximately 35%) of the Psychiatric Reform has been implemented by NGOs- legal entities operating under private law. The Ministry of Health has assigned the project of deinstitutionalization of patients from large psychiatric hospitals and of the creation of Mental Health Mobile Units, residential units and Day Centers in these scientific organizations (without though any special contract and any guarantee for the sustainability of the project), which meet the needs of approximately 30,000 patients. A correspondingly significant part of the Psychiatric Reform has been undertaken by public organizations and services.
Despite these aforementioned problems, there are currently about 2700 people who live and receive services in about 450 housing structures, which provide services also in the user’s families and in the communities where they are located. And over 30.000 in total all over Greece who are using these services.
There are 24 Mental Health Mobile Units, which cover hard to reach and inaccessible areas in the mainland and many small islands, the population (children, adults and over 65) of which without these services will not have any mental health service to turn to. There are also, nationwide, 41 Mental Health Centers and 69 Day Centers which also service the needs of the local communities where they reside. It is worth mentioning here, that the geographical complexity of Greece (many small islands and secluded villages), is a major factor that contributes to the difficulty of the people to have access to health services, especially since there is no actual operation of the planned and divided (only on paper) mental health sectors.
The harsh reality is that many of these mental health units, due to severe budget cuts, to the huge delays of their funding from the government, to being understaffed, in many cases poorly managed and planned and finally due to the complete absence of well-designed and operational mental health sectors, are dysfunctional or even worse not functioning at all.
The current situation oblige us to make the problem public, to formulate and open a discussion and also to act towards an un-negotiable goal: establishing the irrevocable of the Psychiatric Reform in Greece, for the benefit of all the mental health patients, people who will need some form of psychological support, their families and the communities in which they live and work.
For those of you who are not aware of the present reality in Greece, mental health is under attack and under threat, as a concept, us a function and us a system. Majorly due to the complete lack, on behalf of the policy makers (MPs and Prime Minister), to seriously discuss and implement solutions, and due to the will and inability of all the parts involved to work together and try together for this change. THIS HAS TO END, THERE IS NO TIME LEFT
Briefly we should mention that in Greece in the year 2013:
a.The unquestionable right, for all the citizens of all ages, to equal access to, at least adequate, health services, is questioned and infringed.
b.The rights of the mentally ill patients and their families are grossly violated in at least two levels: firstly because people are being negated the right to access or have functioning mental health services in the area that they live and secondly due to constructional deficiencies in their operation, co-operation and coordination. There have been recorded cases of patients burned alive strapped on their beds, deprived of their human rights, patients receiving very low quality care and so forth.
c.We have to underlie that, in these conditions where there is a breakdown of the social bonds and structures, where the welfare state is under huge crisis, where there are conditions of insecurity, of violent changes and deprivation, the first who are under major threat are the frail social groups. For example, due to the implemented policies, the mentally ill and their families are stripped of their basic welfare allowance, crucial to them, for living and covering their health care and medication. There is also a huge problem with the scarcity of certain cheap psychiatric medication which forces the patients to be burdened with the cost of other more expensive drugs.
d.The “difficult” and “demanding” patients (e.g. severely mentally retarded patients) stay for years or even decades to the psychiatric hospitals, due to the fact that the over-pressured and burned out system of mental health units cannot “cope” with them and properly treat them.
e.There is no integrated system of community care
f.Patients who are extremely vulnerable (unemployed, handicapped, poor and on well-fare) are excluded from some of these mental health services due to the fact that they have no insurance or their insurance partly covers the costs. They are also obliged, due to the aforementioned reality of the mental health system and policies dictated by the Government, to contribute from their penurious income for the living and functional costs of the residential units that they live in. At the same time their well-fare allowance has been stopped by the Government for over a year.
g.The 3000 people, who work at these NGOs (psychologists, psychiatrists, nurses, social workers etc.) and provide their services to the people and their communities for free, still remain unpaid for over a period of 9 months, due to the lack of political decision making and planning. They are not willing to properly support and sustain these mental health services, although the E.U., all these years, has many times intervened and saved the whole project with extra funding.
h.At the same time, people who work at the public sector and the mental health services which cover that field are also under threat, under budget cuts, threats of mergers with other mental health units, and closures of functional mental health units. Former and latter, are still providing their services, devalued and financially overburdened and they are asked to look after people who have enormous needs psychically and physically. In a reality which at best someone can characterize it as complete wretchedness. In conclusion we have to underlie the specific nature of the profession and the psychological burdens, which mental health professionals who treat severely mentally ill patients, have to withstand and endure. All these in a very hostile external reality, where there is no support from the well-fare state in any level and each person is trying to struggle for his/her own survival. It is easily assumed by everyone, that in these conditions both patients and mental health professional are at high risk.
PLEASE SUPPORT OUR EFFORTS FOR:
a.The survival of the psychiatric reform in Greece.
b.The safeguarding and the political confirmation of its irrevocable nature.
c.Sufficient funding for a comprehensive and integrated public mental health system, which will meet the needs of the Greek population and provide adequate services in a primary, secondary and tertiary level.
d.Complete restructuring and coordination of the mental health services (both NGOs and public sector) towards the community and gradual reformation of the psychiatric institutions. We need to preserve the existing services and create new out-patient units and mental health centers. All based on specific and scientific evaluating criteria.
e.Complete and immediate implementation of the sectoralization of the mental health services. It is of an outmost importance priority in order for everything else to function properly and effectively.
PLEASE INVESTIGATE AND PUBLICIZE THIS EXTREMELY IMPORTANT ISSUE, SINCE THE LOCAL MEDIA IN THEIR MAJORITY HAVE “DECIDED” TO UNDERMINE AND DEVALUE IT BY SILENCING AND BLOCKING OUR EFFORTS
For more information and data please contact:
Email: synskepsi@gmail.com (http://syn-skepsi.blogspot.gr/)
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