Outcome of Voluntary vs Involuntary Admissions in Greece over 2 years after Discharge: A Cohort Study in the Psychiatric Hospital of Attica "Dafni"

The state of mental health in Greece: An international comparative analysis using data from the Global Mental Health Countdown 2030

BACKGROUND

Effective mental health systems depend on the functioning of a variety of factors that can be systematically monitored across countries. Macro-level assessments are needed to identify potential areas for improvement in the health sector, particularly in countries that face significant access barriers such as Greece.

AIM

To analyze Greece's mental health-related indicators in comparison to countries with similar socioeconomic contexts and geography and identify priority areas for the national mental health system.

METHODS

Data was sourced from the Global Mental Health Countdown 2030, an initiative gathering 48 indicators from 193 countries, classifying metrics into four domains: mental health system performance, determinants of mental health, factors influencing the demand for care, and wellbeing. We analyzed 39 indicators available for Greece to perform a comparative analysis with three groups of countries (27 European Union, 55 high-income, and 52 upper-middle income nations). We employed content analysis to organize mental health system indicators into a framework to inform policy and practice.

RESULTS

Greece exhibited low performance in several indicators related to mental health provision, with four metrics falling below the 12.5th centile for all comparative groups ('interventions in primary care', 'policy implementation', 'promotion and prevention', and 'frequency of collection of data'). A content-analysis framework grouped indicators into categories related to the mental health system, with low-scoring metrics clustering around 'policy and planning', 'affordability of care', 'coordination of services', and 'data collection and quality assessment'.

CONCLUSION

This analysis provides a contextualized overview of Greece's mental health system, identifying areas for improvement based on a panel of evidence-based indicators. Priority policy actions should focus on enhancing mental health insurance coverage and freely-available mental health services, organizing provision into a stepped-care and coordinated service network, and establishing systematic data monitoring mechanisms with unified electronic registers.

The mental health care system for children and adolescents in Greece: a review and structure assessment

Background

The mental health system in Greece faces challenges to complete its transition to a community-oriented model, having significant concerns for child and adolescent care due to lower coverage and service gaps. This component of the mental health system has not been comprehensively evaluated.

Methods

We conducted a review of the mental health care system for children and adolescents in Greece. For a field assessment, we directly collected data from mental health services to map availability and distribution. We analyzed the needs of human resources using professional register data and the national census.

Results

The National Health Care Service (ESY, Εθνικό Σύστημα Υγείας) is the public health system in Greece, characterized by public governance but significant private participation. Although ESY aims for universal care, gaps in population coverage and high user fees create barriers to access. Embedded within ESY, the mental health system is shifting towards a community-oriented structure since the psychiatric reform. For children and adolescents, there is a developing framework for regionalization and community services, including day centers, inpatient facilities, outpatient departments, and school-based psychoeducational facilities. However, services lack coordination in a stepped care model. Patient pathways are not established and primary care rarely involves child mental health, leading to direct access to specialists. Services operate in isolation due to the absence of online registers. There is no systematic performance monitoring, yet some assessments indicate that professional practices may lack evidence-based guidelines. Our mapping highlighted a scarcity of public structures, with an unbalanced regional distribution and many underserved areas. Child and adolescent psychiatrists are predominantly affiliated with the private sector, leading to professional gaps in the public system.

Conclusions

Our assessment identifies an established framework for a community-oriented, universally accessible mental health system, yet several barriers impede its full realization. These include an inconsistent primary healthcare system, a shortage of specialists in the public sector, imbalanced service distribution, lack of coordination among providers, underfunding, and absence of quality monitoring. We propose interventions to promote child and adolescent mental health in primary care, coordinate patient pathways, establish standards of care, and monitor performance.

Mental health professionals' beliefs and attitudes towards compulsory admission in Athens: a token of social stigma or good faith in psychiatry?-a cross-sectional study

BACKGROUND

Mental health professionals' (MHPs) attitudes towards involuntary admissions have not received adequate attention in efforts to curb their rates. Thus, the present study set out to (i) explore MHP attitudes regarding involuntary hospitalisation, (ii) describe their perceived dangerousness of people with severe mental illness (SMI) and their trust in psychiatry, (iii) identify the predictors of attitudes towards compulsory admissions and (iv) gauge the contribution of perceived dangerousness versus trust in psychiatry to explaining them.

METHODS

A random sample of 300 mental health professionals working in public mental health services located in the Northern part of Athens and in the two psychiatric hospitals of Attica participated in the study. Respondents had to complete a self-reported instrument garnering information about participants' attitudes towards involuntary hospitalisation (original scale), the perceived dangerousness of people with SMI (Perceived Dangerousness Scale) and their trust in psychiatry (based on the Attitudes to Mental Illness scale) as well as various socio-demographic and work-related variables.

RESULTS

Respondents largely accepted involuntary hospitalisations, considering them to be beneficial (72.96%) and disagreeing with the view that they adversely influence the course of illness (54.85%). Nonetheless, they believe that people with SMI should be treated in the community (89.93%), that compulsory admission should be the last therapeutic resort (84.01%) and that people with SMI should not be placed in psychiatric hospitals against their will in order to be under surveillance (90.64%). However, they acknowledge that involuntary admission is often the only treatment options(61.19%). Concomitantly, they report moderate levels of perceived dangerousness and high levels of trust in psychiatry. Trust in psychiatry had the strongest positive association with acceptance of involuntary hospitalisation among mental health professionals whereas postgraduate studies and working in outpatient settings were linked to less favourable attitudes. Interestingly, perceived dangerousness did not yield an independent effect; rather, it weakened the association between trust in psychiatry and acceptance of involuntary admissions.

CONCLUSIONS

Mental health professionals hold complex attitudes towards involuntary hospitalisation, which are largely explained by their trust in psychiatry. Efforts to reduce the rates of involuntary admissions should address both them and their determinants.

Involuntary psychiatric treatment during the COVID-19 pandemic. An international qualitative study

Background

During the COVID-19 pandemic, studies report that in the first few months of the lockdown there was a decrease in requests for mandatory psychiatric treatment, while, in contrast, following the second wave, the number of cases increased. This study investigates the use of compulsory psychiatric treatments internationally in the first and subsequent phases of the pandemic.

Methods

Sixteen key people were interviewed: eight mental health care professionals and eight scholars in Italy, Greece, China and Chile. Participants were asked to discuss their experience of the motivations, diagnoses and management of patients undergoing an involuntary psychiatric hospitalization.

Results

The analysis through Grounded Theory highlighted four themes: (a) the culture of psychiatric care services, (b) the effect of the pandemic on involuntary hospitalizations, (c) exceptional management of hospitalization, and (d) policies and suggestions for more inclusive mental health treatments.

Conclusion

During the first wave, respondents reported a decrease in the use of involuntary treatments, while a gradual increase was seen in the following months. Italy extended compulsory psychiatric treatment to a group of new users, including young people and adolescents with acute crises; in other contexts, the main users are chronic psychiatric patients.