John Henderson obituary

Psychiatrist, reformer and adviser to Greece on mental health

Henderson was an early pioneer of social psychiatry

John Henderson, who has died aged 80, was an influential figure in psychiatry, mental health and human rights around the world. Long after official retirement, he continued his work with startling energy through a vast array of voluntary and non-governmental organisations right across Europe – especially Mental Health Europe, which he helped to found in the late 1990s.

In particular, he supported colleagues and activists working for the reform of the Greek mental health system. The appalling institutions for mentally ill people and those with learning disabilities on the Greek island of Leros, in the south-east Aegean, became more widely known from the early 1980s. When full, the institutions had housed around 3,000 people. During John's tenure at the World Health Organisation (WHO) in Europe, and as part of its accession to the European Union, Greece made a request for special assistance to reform and modernise its mental health system away from institutional care.

Controversially, a special programme was agreed in 1984. However, by 1987 nothing had happened to change conditions in Leros, very little money had been spent and there were moves in the European parliament to end the programme. Then an Observer journalist, John Merritt, and an independent film- maker, Jane Gabriel, decided simultaneously to draw the world's attention to Leros with dramatic press coverage swiftly followed by two powerful documentaries broadcast on Channel 4.

Such was the public outrage that a compromise was agreed by the European commission for the assistance programme to be renewed and extended for five years from 1990. John was asked, as part of this deal, to lead an independent team of experts working for the European commission to monitor and evaluate the progress of the reforms. For five years the European Commission Independent Team of Experts (ECITE) spent six to eight weeks a year in Greece reviewing progress in Leros and – just as importantly – reviewing the changes to the mental health system that would make the institutions on Leros and elsewhere in Greece redundant. It was a challenging assignment.

The outside experts were not always welcome or popular, and it required all of John's diplomatic skills and firmness to win the trust and co-operation of politicians, bureaucrats, officials, the medical profession, the staff and the patients of the institutions. The work that led to the eventual closure of the worst parts of the institutions in Leros and at other sites involved many people from Greece and elsewhere who came to change the terrible conditions. The contribution of ECITE under John's leadership was to keep the show on the road when it seemed that the political and administrative blockages would bring the reforms grinding to a halt.

The work of ECITE ended in 1995, with the worst abuses, at least, on the way to being dealt with. However, John and other team members were regularly invited back by the Greek government and by the organisations running the new services to monitor progress – especially when momentum was in danger of being lost. As recently as last June, John spoke at a memorable meeting in Brussels in front of EC commissioners, MEPs and officials as, once again, the reform programme was brought back from the brink of collapse.

Gabriel summed up John's contribution in Greece and more generally: "I remember some remarkable times with him and how he managed to maintain a cheerful equilibrium when all around was either as grim as it gets – or worse.

"He was a man who inspired a quiet optimism, and more than once kept me going in the Leros days, by insisting that improvement would come, and in that case, of course, he was right."

Born in the town of Galashiels, Borders, John attended Central secondary school in Aberdeen and Melville College, Edinburgh. He studied medicine at Aberdeen University, graduating in 1954, and undertook national service with the Royal Army Medical Corps, in Kenya (1955-57). He then trained as a psychiatrist at Kingseat and Cornhill hospitals in Aberdeen.

After becoming a consultant in 1963, John took up the post of physician superintendent, first at Bilbohall hospital, in Elgin, and then at Bangour, in West Lothian. In 1976, after two years at the Scottish Office, he took up his first international posting as a regional adviser in mental health for WHO in south-east Asia, and then moved to the European regional office in 1980.

The thread that ran through John's life's work was his belief that psychiatry should be about helping people with mental heath problems to have the possibility of a better life. That meant caring about the whole person and the circumstances in which they lived. He was one of the early pioneers of social psychiatry, a firm believer in the abilities and capacities of people living with and recovering from mental illness, and always a fierce critic of the discrimination and human rights abuses that were – and unfortunately still are – rife across many parts of Europe and the rest of the world.

John was kind, supportive and encouraging to those who were trying to do the right thing in challenging circumstances. It was this combination of stern authority, compassion and an in-depth knowledge of psychiatry and mental health as practised throughout the world that made him such a potent force for change.

He is survived by Toshie, his wife of 52 years, four sons – two of whom work in mental health – and 10 grandchildren.

Two weeks before his death John finally agreed to the wishes of his sons and colleagues to establish a foundation in his name to help continue the mental health work he so passionately believed in across Europe.

• John Henderson, psychiatrist and reformer, born 29 November 1929; died 4 January 2010

Bob Grove, guardian.co.uk

Mental Health Europe’s Message

Mental Health Europe’s Message for the European Year 2010 for

Combating Poverty and Social Exclusion 

Research has shown clear bidirectional links between mental health and poverty. People experiencing poverty are particularly vulnerable towards developing mental health problems. Conversely people with existing mental health problems are more likely to experience poverty. Uncertainties about the future dominate their daily lives.In the context of the European Year 2010 for Combating Poverty and Social Exclusion, Mental Health Europe therefore calls on policy-makers and other stakeholders to:

1. Implement the European Pact for Mental Health and Wellbeing, which was launched in 2008, into all policy areas (health, social policies, housing, employment, training, justice, fundamental rights etc.).

2. Foster measures for mental health promotion and prevention of mental health problems through adequate social protection and inclusion policies.

3. Reduce stigma and discrimination against people with mental health problems, also with the support of the media.

4. Ensure a minimum level of income which allows all people to live a life in dignity.

5. Make labour markets truly inclusive, support flexible working schemes and ensure decent pay. Keeping people in their jobs is the best way to prevent poverty and social exclusion.

6. Ensure access to quality health care and social services.

7. Invest in human resources and skills development in order to apply an effective lifelong learning strategy.

8. Place the fight against mental health problems and homelessness high on the political agenda.

9. Protect the most vulnerable members of society by promoting social justice as well as the mental health and wellbeing of the population – a decisive factor for social cohesion in Europe!

Mental Health Europe

BBC: Greek mental care failures exposed

                 

BBC news: Greek mental care failures exposed

By Chloe Hadjimatheou
BBC World Service, Athens

Twenty years after a scandal erupted over the appalling conditions in which psychiatric patients were kept in Greece, the BBC has seen evidence that in some parts of the system little has changed.

The European Commission has warned Greece that if it does not come up with roadmap for psychiatric reform by next month, EU funding will be cut from social projects across the board.

As I approach the women's clinic at the Dromokraitio Psychiatric Hospital in Athens I assume it is a disused building, with its crumbling walls and broken shutters hanging from windows.

But inside I see patients in bare rooms, lying in their beds staring into space, as the minutes tick by.

Dromokraitio is home to around 300 patients, and is one of the two main psychiatric hospitals in Athens.

"If I had a dirty room in my house I might want to hide it from visitors," says Dr Yiorgos Astrinakis, a resident psychiatrist at the hospital.

"But this hospital belongs to the public and they have the right to know where they might end up if they get sick."

As we walk through the women's clinic I notice wide leather straps and buckles lying beside the beds.

"We have to keep some patients tied at night to prevent them wandering around and waking the other patients," Head Nurse Maria Makraki explains.

Dr Astrinakis interrupts her: "Just like a dog you tie up to stop it wandering off… this could be considered the veterinary approach to psychiatry."

He points to buckets below the beds that act as make-shift toilets.

A woman sits with her head in her hands. Around her leg I see a belt tying her to her bed.

"Whenever she's left loose she becomes aggressive towards the other patients," says Nurse Makraki.

"She needs constant supervision and so we're forced to keep her tied all the time because we simply don't have the resources to look after her properly."

Nurse Makraki tells me that staff shortages mean that there are usually only two nurses caring for around 30 patients.

That is half of what is required to provide basic care.

Stella Galianos, a psychologist, estimates that in every clinic at Dromokraitio hospital there are around three to four people tied to their beds.

I ask her if the woman I saw could end up tied to her bed for years.

"Yes definitely."

'Island of the damned'

In 1989, the world was shocked by pictures of patients chained up and naked in a Greek psychiatric hospital on the island of Leros.

Dubbed the "island of the damned" it was regarded as the worst mental institution in the whole of Europe.

Shamed into action, Greece enacted numerous reforms, helped by EU funding and an army of foreign mental health experts.

But that progress seems to have slowed and even begun to reverse itself in recent years.

The European Commissioner for Social Affairs, Vladimir Spidla warns that Greece can not let its progress continue to decline.

"The system is in a state of reform, but I have to say that if patients are attached to their beds for hours or days, that's totally unacceptable. For me it's sad that this exists in the European Union."

Dr Pavlos Theodorakis, who represents the Greek ministry of health at the World Health Organization, admits that there are many doctors who do not follow the guidelines set out by the European Commission on restraining psychiatric patients.

"There are huge problems in terms of culture and mentality among health care professionals," he told me.

"But it's important to remember how far Greece has come in the last 20 years."

Athina Residential Home is just one example of those changes.

Here there are 25 members of staff looking after just 15 residents.

The director of the residential unit, Petroula Dimitropoulou, tells me that they never tie patients under any circumstances.

"There are other approaches. If a patient becomes violent you can ask them to sit in their room and discuss their feelings with a member of staff."

But according to the non-governmental organisations that run these projects, the ministry of health funding meets less than half their necessary costs.

Last year Athina came in danger of closing when the staff went unpaid for six months.

Dr Theodorakis admits that there have been unacceptable delays in paying professionals working for NGOs like Athina.

But he says the government has been struggling to provide full financial support since European Union funds ended last year.

"It makes me very angry," say Jimmy, one of the residents at Athina Residential Home.

"The government doesn't care about us. It's not right."

Radio Broadcast

ARE YOU CLOSING DOWN THE PSYCHOSOCIAL REHABILITATION UNITS MR. MINISTER OF HEALTH ?

                        

Till the 80’s, in Greece, thousands of people with mental health problems were confined to large psychiatric institutions. When the horrific living conditions at the Leros Asylum became known to the public, there was an international outcry, and the European Union forced our country to reform its psychiatric services.

Nowadays, thanks to the efforts of the mental health professionals in our country and EU funding, substantial progress has been made in the field of psychiatric services. Some psychiatric institutions have been closed down, while the creation of community-based structures (hostels, sheltered apartments, day centers) has ensured accommodation, support and human living conditions to thousands of former inpatients.

However, over the past three years, problems regarding the funding (in 2008 funding was down by 50%) of the Psychosocial Rehabilitation Units operated by Non-Governmental Organizations (Scientific Associations), lead psychiatric reform to a dead end. The unjustifiable and systematic refusal of the Minister of Health to fulfill the financial obligations towards the Psychosocial Rehabilitation Units, despite the recommendations of the European Union, puts thousands of people with mental health problems at direct risk.

The mental health professionals are left unpaid over the past five months while still working. The Units are unable to cover even their daily operating expenses, with consequences on the quality of care. If this situation goes on, the Rehabilitation Units risk terminating their operation in the near future and the people with mental health problems risk to be transferred back to the psychiatric institutions.

As humans who cannot disregard our fellow human beings; as citizens of this country that has thrown its mentally ill patients into the institutional “gorge of Kaiadas”, and finally as mental health professionals who have strived to get Greece out of the psychiatric dark ages: We denounce the negligence and hypocritical attitude of the Ministry of Health and we call:

• Every competent authority to act immediately in order to solve the problem

• Every Greek citizen to support our efforts

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.

Mental Health Europe calls on the Greek government to put an end to the dramatic situation in the Mental Health sector !

MENTAL HEALTH EUROPE – SANTE MENTALE EUROPE aisbl

Boulevard Clovis 7, B-1000 Brussels

Tel +32 2 280 04 68 - Fax +32 2 280 16 04

Email: info@mhe-sme.org

www.mhe-sme.org

PRESS RELEASE

For immediate release

Brussels, 27 November 2008

Mental Health Europe calls on the Greek government to put an end to the dramatic situation 

in the Mental Health sector!

The Greek Mental Health sector is facing dramatic times. Mental Health Europe is deeply concerned about the future of the public (community) mental health services system in Greece and calls upon national policy and decision makers to take urgent actions.

During the last 20 years thousands of people across Europe have walked the long way from the psychiatric asylums back to community, to social support and effective treatment, to life. The guidelines of the World Health Organization and the European Commission are quite clear: letting back the old institutional care, transforming the services into a community network which should offer a wide range of psychiatric and medical care, social support, training opportunities, right’s advocacy. There have been great examples of significant experiences all over Europe where inspired professionals, mobilized patients and relatives, persistent decision makers at the political level and all the community stakeholders transformed into everyday reality what seemed impossible: they exchanged the gloom of logic with the optimism of action.

After the scandal involving the Leros State Mental Health Hospital (1988-89) the coordinate efforts of the Greek psychiatric community, the European Commission, international experts and European mental health teams financed by the EU under a special measure (Regulation 815/84) from 1990-5, also Greece initiated the deinstitutionalisation procedures and the long term planning (2000-2010) regarding the psychiatric services under the title “Psychargos”

This Greek National Mental Health Plan has created a large consensus between mental health professionals, political and local authorities, mass media, associations of families and users as a continuity of the psychiatric reform started with the deinstitutionalisation of the Leros asylum. The country used to offer many an example of good practice.
 

That is, until recently!

For the last 3 years, the state has systematically failed to maintain the values and momentum of the reforms. This has caused a series of problems and roadblocks regarding the transition from institutional to community care. The community mental health sector fears a unparalleled regression: return of long-term patients to psychiatric hospitals that should have been closed down and generalised incapacity of the psychiatric system to cover the needs.

The problems are presented as administrative but at root they are mainly about the ethical values concerning the rights of people with mental health problems, about the attitude towards provision of care, and finally, an issue of political determination!

Mental Health Europe shares the deep concern of a growing number of service users, relatives professionals as well as representatives of the European Parliament for the future of the public (community) mental health services system in Greece.

MENTAL HEALTH EUROPE – SANTE MENTALE EUROPE aisbl

Mental Health Europe (MHE) is a European non-governmental organisation committed to the promotion of positive mental health, the prevention of mental distress, the improvement of care, advocacy for social inclusion and the protection of human rights for (ex-) users of mental health services, their families and carers. For more information: www.mhe-sme.org