Greece
Society for Social Psychiatry and Mental Health: services for the mentally ill
The Society for Social Psychiatry and Mental Health was set up in 1981 by professionals keen to reform the treatment and services for psychiatric patients by focussing on user empowerment and community involvement, particularly in rural areas. The service combines psychiatry and psychoanalysis to cover a range of mental health needs from prevention to therapy and rehabilitation, as well as community education and involvement.
- Voluntary/Community/NGO Sector
- Locally based quality improvement measures
- Coordinated/integrated services
- Staff involvement and participation in decision-making
The society runs mobile rural units which visit small towns and villages, mental health centres for adults, and child therapy centres. It also runs boarding houses and hostels in collaboration with the Manpower Agency - from which patients move on to sheltered housing; day centres, and therapeutic production co-ops which combine patients, staff and local community and foster social and financial independence. The Society operates in Phokida, a rural prefecture 200 kilometres north of Athens, formerly lacking any psychiatric services (covering Thrace, a poor region of north-east Greece, Lamia a town in central Greece, and Athens). It has a substantial teaching programme, coorganised with the University of Ioannina post-graduate programme, and it participates in European network and research programmes.
The society provides a service to an annual average of 2,500 people, including 1,000 regular clients, and 800 chronic psychotic patients in continuous care. Patients are regularly monitored, receive humane treatment, relapses are prevented and committals to hospital have significantly reduced. Funding comes from government grants and European structural funds e.g. Horizon and the Social Exclusion Programme of the Community Support Framework. The initial main source came from the Structural Funds through regulation 815/84.
Each regional facility has a manager, psychiatrist with substantial managerial and administrative authority. Service units within the facility have leaders who meet monthly with regional managers. Professional and administrative staff meet monthly. Every three months all staff participate in a three-day meeting - including workshops and plenary sessions - to exchange and share experience, make decisions and coordinate the service. These also function as informal training sessions. Patients are encouraged to be pro-active, to take responsibility for their lives, with a view to economic and social integration. Sheltered housing is provided for former hospital patients and young people unable to live at home. In Phokida patients now own and manage a house and land bought with income from their therapeutic co-operative.
Although there is no formal evaluation of the society the available evidence and monitoring data suggests a high quality level of service provision and effectiveness. The increase in self-referrals indicates that the society represents an accessible and credible service provider and has significantly lessened the social stigma of mental illness.
The society employs 46 mental health professionals, including 10 psychiatrists, 16 psychologists, 3 social workers, 9 nursing and training staff. Administrators are kept to a minimum to cut down on bureaucracy. There are 17 trainees, post-graduate students from the University of Ionnina and future professionals of the Greek mental health service. The administrators and some professionals are salaried, all other professionals have self-employed contracts. The low wage and lack of job security leads to frequent staff turnover. Regular staff are ideologically motivated and their commitment outweighs the lack of remuneration.
As psychiatric work is very demanding, stress is reduced by rotation of roles - dealing with adults/children, training, community linkage work with families, the police, the churches and staff meetings.
The society has a long established and close cooperation with the Directorate of Mental Health and the Ministry of Health, and Welfare. Recent mental health legislation reflects the approach of the society and the ten-year plan for psychiatric reform adopts, to a substantial extent, the model of service provision created by the society. However, in spite of its acknowledged role as an exemplary provider of services, the society has had substantial problems in ensuring continuity of service and staff employment because of uncertainties in funding.