Action Plan for the Reform of the Mental Health Sector · epidemiological reality in the Mental Health sector over the last twenty years have made it necessary to expand and enrich

Action Plan for the Reform of the Mental Health Sector

CONTENTS

1 OBJECTIVE AND PURPOSE OF THE ACTION PLAN FOR MENTAL HEALTH ..........3

1.1 BRIEF PRESENTATION OF THE PSYCHIATRIC REFORM IN GREECE ................................................3

1.2 METHODOLOGY AND STRUCTURE FOR THE IMPLEMENTATION OF THE ACTION PLAN..................4

2 ANALYSIS OF CURRENT SITUATION ...................................................................................3

2.1 INTERNAL ENVIRONMENT ............................................................................................................5

2.1.1 Agencies providing Mental Health services (recorded by type and prefecture) .....................5 2.1.2 Table of existing Mental Health agencies by type and prefecture ..........................................7 2.1.3 Actions during the 1983-1993 decade .................................................................................11 2.1.4. Detailed presentation of Mental Health actions - PSYCHARGOS I Programme ..............17 2.1.5 Projects under way and degree of completion......................................................................24

2.2 BROADER ACTIVITY ENVIRONMENT ..........................................................................................27

2.2.1 Greek institutional framework for Mental Health ...............................................................28 2.2.2 International trends in Mental Health .................................................................................29 2.2.3 Philosophy of transformation from a "Closed" Care Model to an "Open" Care Model .................................................................................................................31 2.2.4 Necessity of provision of community-based Mental Health Services....................................32 2.2.5 Transformation process ........................................................................................................32

2.3 CONCLUSIONS AND REMARKS....................................................................................................34

Minimum actions required for Mental Health. ..............................................................................35

3 OBJECTIVES AND PRIORITIES.............................................................................................37

3.1 STRATEGIC OBJECTIVES.............................................................................................................37

3.1.1 Strategic objectives for de-institutionalisation .....................................................................37 3.1.2 Strategic objectives for community infrastructures ..............................................................37 3.1.3 Strategic objectives for training............................................................................................37

3.2 PSYCHARGOS 2001-2010 TEN-YEAR PLAN................................................................................39

3.2.1 Introduction ..........................................................................................................................39 3.2.2 Sectorization of Mental Health Services...............................................................................39 3.2.3 Improvement of patients' living conditions during the 2001-2010 period and comprehensive preparation for their exit into the community. ...............................................................................48 3.2.4. Operational upgrading of Mental Health Services..............................................................48 3.2.5 Development of primary and secondary Mental Health care community-based structures and programmes and interconnection of services within integrated networks in the framework of Mental Health Sectors ...................................................................................................................50 3.2.6 Continuation of care for target-populations at community level ..........................................51 3.2.7 Promotion of prevention .......................................................................................................52 3.2.8 Actions that promote social solidarity and enhance actions for the re-integration of target mental patients into the labour market ..........................................................................................52 3.2.9 Actions subject to the Information Technology sector ..........................................................52

3.3 ACTIONS SCHEDULED FOR THE 2001-2010 DECADE ..................................................................56

3.3.2 Special actions ......................................................................................................................56 3.3.2.1 Special de-institutionalisation actions ...............................................................................56

3.4 SCHEDULED ACTIONS FOR 2002-2004........................................................................................57

1ST PART (2002-2004) ...................................................................................................................58 2ND PART (2003-2006) ..................................................................................................................75

4 DETAILED PLANNING PER REGION ...................................................................................86

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4.1 DE-INSTITUTIONALISATION STRUCTURES ..................................................................................86

DE-INSTITUTIONALISATION OF THE MENTALLY ILL ............................................... 87 4.2 AIMS AND EXPECTED RESULTS ................................................................................................108

R.H.S. OF EASTERN MACEDONIA & THRACE .......................................................................108 1ST R.H.S. OF CENTRAL MACEDONIA.....................................................................................109 2ND R.H.S.OF CENTRAL MACEDONIA .....................................................................................110 R.H.S. OF WESTERN MACEDONIA ..........................................................................................111 R.H.S. OF EPIRUS ......................................................................................................................112 R.H.S. OF THESSALY .................................................................................................................113 R.H.S. OF THE IONIAN ISLANDS .............................................................................................113 R.H.S. OF WESTERN GREECE..................................................................................................114 R.H.S. OF STEREA ELLADA ......................................................................................................115 PREFECTURE OF ATTICA (1ST - 2ND- 3RD R.H.S. OF ATTICA) ...............................................116 R.H.S. OF THE PELOPONNESE................................................................................................117 R.H.S. OF NORTHERN AEGEAN...............................................................................................118 R.H.S. OF SOUTHERN AEGEAN ...............................................................................................119 2ND R.H.S. OF SOUTHERN AEGEAN.........................................................................................120 R.H.S. OF CRETE .......................................................................................................................121

4.3 TABLE OF ACTIONS OVER THE DECADE FOR EACH PREFECTURE AND AGENCY 122

5 PROGRAMME FUNDING .......................................................................................................197

6 MANAGEMENT AND EVALUATION MECHANISMS ......................................................199

6.1 MANAGEMENT MECHANISMS.........................................................................................199

6.2 EVALUATION MECHANISMS............................................................................................200

7 ANTICIPATED RESULTS.......................................................................................................202

7.1 INTRODUCTION...................................................................................................................202

7.2 RESULTS FOR EACH CATEGORY OF ACTION ...............................................................202

7.3 RESULTS OF OPERATION OF SUPPORT MECHANISMS ...............................................203

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1 OBJE CTI VE AN D PURP OS E OF TH E ACTION PLAN FOR ME NTAL HEALTH

1.1 BRIEF PRESENTATION OF PSYCHIATRIC REFORM IN GREECE

Rapid changes in the social, economic and cultural model and the new epidemiological reality in the Mental Health sector over the last twenty years have made it necessary to expand and enrich the policies implemented in Greece.

Following this rationale, the model of the modernization policy currently applied in the Mental Health sector was provided for in the Psychiatric Reform and has already started being implemented.

The term “Psychiatric Reform” refers to all interventions that allow mental patients to remain active citizens within their community and family environment, enjoying autonomy, economic activity and social inclusion, i.e. leading a life that is completely different from that of a long-term inpatient committed to a mental hospital.

The implementation of Psychiatric Reform in Greece began on the basis of the legislation concerning the National Health System (Law No. 1397/83), within the framework of Regulation 815/84 (European Community Programme which laid the foundations for Psychiatric Reform). The 1983 law was expanded through Law No. 2071/92 and consolidated through Law No. 2716/99 “Development and Modernisation of Health Services and other provisions”.

Its central axis is the de-institutionalisation and socio-economic (re)inclusion of the mentally ill in the community through the creation of suitable community-based structures and services and the mobilization of excellently trained personnel to support such actions.

This new conception has brought changes to the attitude and approaches of Mental Health professionals, on the one hand, and to the structure and types of services provided to patients and citizens in general, on the other.

It has also underlined the necessity to develop a network of services at sectoral level. Thus, the regions of the country have been divided into Mental Health Sectors, with each prefecture forming a sector (except for some sparsely inhabited prefectures which are included in the same sector with an adjacent prefecture with a larger population. Another exception is made for the Prefectures of Attica and Thessaloniki, which are divided into more than one sector and into special sectors for children and adolescents).

At the level of structures and services, the objective is to develop a comprehensive network of services for the community that safeguards operational sufficiency at the level of health regions with regard to the needs of the local population, an objective that is far broader than the mere treatment of illnesses.

According to the Psychiatric Reform, there are three main prerequisites for the successful operation of the network of services at sectoral level, which will also serve as a guide for the planning, understanding and implementation of actions during the 2001-2006 period:

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• The first prerequisite concerns the development of an adequate number of Mental Health units and actions in each sector. This means development of Mental Health services at General Hospitals, as well as phasing out of psychiatric hospitals. At the same time, other units and Mental Health centres for the support of the mentally ill are being developed.

• The second prerequisite concerns the staffing of the new structures with suitably specialized Mental Health professionals (psychiatrists, psychiatric nurses, psychologists, social workers, occupational therapists, speech therapists, educators, etc.).

• The third prerequisite concerns the humanistic understanding that permeates any intervention addressing mental illness. In other words, the development and dissemination among all those wishing to contribute to the Mental Health sector and to society of the fundamental realization that society has a unique capability to activate and revive even its weakest members and to render them entities with a right to life, to being different, to social protection, to human living conditions, to happiness and to the joy of social life – and all this can only be offered through social solidarity, thanks to which patients, after having received the therapeutic interventions that are suitable for them, can lead a life as part of the community and avoid the segregation, confinement and unhappiness of the socially excluded.

Psychiatric reform can be implemented through the following actions:

• “De-institutionalisation and socio-economic (re)integration of the mentally ill”.

• “Development-Complementing-Expansion of community-based structures for the integrated implementation of psychiatric reform”

• “Prevention actions and actions enhancing social solidarity and socio-economic (re)integration”.

• “Training of staff to support the de-institutionalisation, socio-economic (re)integration and on-going support of the mentally ill”.

1.2 METHODOLOGY AND STRUCTURE FOR THE IMPLEMENTATION OF THE ACTION PLAN

The methodological approach to the implementation of the Action Plan will be developed in three stages:

• The first stage includes a brief description of the current situation in the Greece’s Mental Health sector, the institutional framework, as well as the implementation measures and actions and crucial agencies that have an impact thereon.

• The second stage defines the strategic goals and priorities of the Psychiatric Reform.

• The third stage defines the detailed planning by region, as well as the expected results.

Action Plan for Reform of the Mental Health Sector

2 ANALY SI S OF C U RRENT S ITUATION

2.1 INTERNAL ENVIRONMENT

The analysis of the internal environment of Psychiatric Reform will help understand the objectives reached during the previous period and plan the strategic attainment of objectives during the new period.

The analysis of the internal environment includes:

• Presentation of the institutional framework of operation of the basic functions and competences

• Analysis of services provided

• Recording of the elements of organisation, procedures, technologies and general infrastructure

• Identification of areas where major changes are expected to take place

• Quantification of the current situation

• Description and method of implementation of Mental Health interventions in the past

2.1.1 AGENCIES PROVIDING MENTAL HEALTH SERVICES (RECORDED BY TYPE AND PREFECTURE)

The central agency for Mental Health services in Greece is the Ministry of Health and Welfare and, specifically, the Directorate for Mental Health of the Directorate General for Health. The country’s Health Regions are divided into Mental Health Sectors (MHS), according to geographic and population criteria, and include Mental Health Units (MHU) that are organized in accordance with the provisions of Law 2716/99.

Mental Health Units (MHU) belong to hospitals, non-profit legal entities under private law, Limited Liability Social Cooperatives, University Mental Health Hospitals and legal entities under public law or local administration agencies.

Specifically, Mental Health Units include:

• Mental Health Centres.

• Medical-pedagogical Centres.

• Mobile Mental Health Units: these units provide preventive, hospitalization and special mental health care services at home within a specific Mental Health Sector and can serve more than one Mental Health Sector within the same or different Health Region.

• Psychiatric wards for adults or children in General Prefectural or Regional Hospitals.

• University Psychiatric Clinics for adults or children and adolescents.

• University Psychiatric Hospitals.

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• University Mental Health Institutes.

• University units working on mental health.

• Psychiatric Hospitals or Children’s Psychiatric Hospitals.

• Private Clinics.

• Specialised Care Centres: these may be Day Centres, Day Hospitals, Crisis Intervention Centres for adults, children or adolescents.

• Psycho-social Rehabilitation Units: These are boarding houses, hostels, sheltered apartments and host families. They aim at placement and psychiatric monitoring in spaces providing accommodation, therapy and support for long or short-term stay of persons suffering from mental disorders and serious psycho-social problems, who do not have a home or suitable family environment, at their own request and with the agreement of the treating psychiatrist or treating psychiatric team.

Specifically:

Boarding houses and hostels carry out psycho-social rehabilitation activities and jointly participate, together with other legal entities of the region, in cultural and educational activities as well as social and vocational re-integration activities.

Host families may belong to the patient’s circle of friends or family, provided that they are not first degree relatives of the patient.

Special Social Re-integration Centres or Special Rehabilitation and Vocational Re-integration Units: these are rehabilitation and socio-vocational re-integration services provided by one or more divisions or units of psychiatric hospitals, university psychiatric hospitals and hospitals of Legislative Decree 2592/53 and Law 1397/1983.

The Special Social Re-Integration Centres may be:

Therapeutic Rehabilitation Units and Social Re-integration Centres for adults, children or adolescents.

Pre-Vocational Education and Vocational Training Centres for adults and adolescents.

The Special Rehabilitation and Vocational Re-integration Units are:

Sheltered Workshops.

Vocational Education Workshops for adults or adolescents aged 15 or older with chronic mental disorders and serious psycho-social problems.

Sheltered Workshops and Vocational Education Workshops provide services to people suffering from chronic mental disorders and serious psycho-social problems towards the acquisition, with the help of suitable staff, of functional, learning and vocational skills aiming at treatment, social re-integration and placement in the free or sheltered labour market or in Limited Liability Social Cooperatives or other forms of social or municipal enterprises.

Limited Liability Social Cooperatives (Koi.S.P.E.): these cooperatives aim at the socio-economic integration and vocational inclusion of persons suffering from serious psycho-social problems and contribute to their treatment and financial independence, to the greatest degree possible. KoiSPEs are legal entities under private law with limited liability of their members and have a commercial

6


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character. They can be production, consumer, trading, procurement, transport, tourism, construction, credit, development, social, educational and cultural units and can carry out any financial activity.

2.1.2 TABLE OF EXISTING MENTAL HEALTH AGENCIES BY TYPE AND PREFECTURE

The following table records present day mental health agencies by type and prefecture. Each column of the table corresponds to one of the country’s prefectures. Column groups belong to the corresponding health regions. Each line of the table corresponds to one mental health agency.


RHS EASTERN MACEDONIA

& THRACE

1ST OF CENTRAL

MACEDONIA

2ND OF CENTRAL

MACEDONIA

WESTERN

MACEDONIA EPIRUS THESSALY IONIAN ISLANDS

WESTERN

GREECE STEREA ELLADA

1ST O

F ATTICA

2N

D OF ATTIC

A

3R

D OF A

TTICA

AGEN

CIE

S

PELOPONNESE

NORTHERN

AEGEAN

AEGEAN

2N

D OF S

OU

THE

RN

AEGEAN

Mental Health

Structures

EVRO

S

RH

OD

OP

E

XANTH

E

DR

AM

A

KAVA

LLA

KILKIS

SERR

ES

HA

LKIDIKI

THES

SALO

NIK

I

THES

SALO

NIK

I

PELLA

IMATH

IA

PIERIA

FLOR

INA

KASTO

RIA

KOZAN

I

GR

EVEN

A

IOA

NN

INA

THES

PRO

TIA

ARTA

PRE

VEZA

LARISS

A

TRIKA

LA

MAG

NESIA

KARD

ITSA

CO

RFU

LEFKA

S

CE

PH

ALO

NIA

ZAK

YNTH

OS

AE

TOLO

ACA

RN

AN

IA

ACH

AIA

ILIA

PHTH

IOTIS

EVRYTA

NIA

PHO

CIS

BOEO

TIA

EUBO

EA

ATTICA

CO

RIN

TH

ARG

OLIS

ARC

ADIA

LAC

ON

IA

ME

SSEN

IA

LESBO

S

CH

IOS

SAM

OS

CYC

LADES

DO

DE

CAN

ES

E

HA

NIA

Psychiatric Hospitals 1 1 1 1 2 1 1 1

Comprehensive

Psychiatric – Children’s

Psychiatric Divisions of

General Hospitals

Hospitalisation Units for

Adults 2 1 1 1 1 1 1 1 2 1 3 2

Short Hospitalisation

Units for Adult s

s

s

3

s 2

s

Acute Case Units for

Adult

Crisis Intervention

Centres for Adult

Satellite Hostels for

Adults


Adolescent

Short Hospitalisation

Units for Adolescents


Adolescent

Crisis Intervention

Centres for Adolescents

8


Satellite Hostels for

Adolescent s

n 1 1

n

s 2 1 1 1

s

s


Childre

Short-stay


Children


Children

Crisis Intervention

Centres for Childre

Mental Health Centres 2 1 1 1 1 1 1 4 1 1 1 1 1 1 1 1 4 1 1 1

Medical-Educational

Centres 2 1 1 1 1 1 1 1 1 1 3 2 4 1

Mobile Unit

Day Centres 3 3 3 1 2 2 2 1 1

Units and Programmes

for Psycho-Social

Rehabilitation 6 0 0 0 1 0 0 1 0 30 0 0 5 0 0 0 0 5 1 1 1 3 1 1 1 3 0 0 0 3 2 1 0 0 4 1 3 0 2 55 4 1 1 5 1 1 0 1 0 0 42 5

Hostels 1 1 1 4 3 4 1 1 1 2 1 1 1 2 3 2 1 1 2 1 23 2 1 1 2 1 1 1 23 2

Boarding houses 4 1 1 7 1 1 1

Sheltered Apartments 5 22 2 1 1 3 1 1 25 2 19 2

Centres / Units for

Social – Vocational Re-

Integration 1 1 1 1 9 2 2 1 1 1 2 1 2 1 2 1 3 3 1 1 5 1 3 2 2 15 9 1 1 3 1 1 1 13 4

Integrated Centres for

persons suffering from

autism spectrum

disorder

Day Centre

Crisis Intervention

Centres

Hostels / Boarding

houses

9


10

Research & Education

Centre s

s

s

Centres for Alzheimer’s

disease patient

Crisis stabilization

centres for drug addicts

Crisis stabilization

centres for alcoholic


2.1.3 ACTIONS DURING THE 1983-1993 DECADE

Psychiatric Reform in Greece essentially began in 1983. During the 1983-1993 decade, the actions that took place for the reform of the health sector were based on the “requirements” of the European Union (then the EEC), as expressed through European Council Regulation (EEC) 815/84.

Regulation 815/84, which was approved on 26 March 1984, provided for emergency financial assistance for:

• The creation of new training facilities in the broader region of Athens (Programme A).

• Reform of the psychiatric care system throughout Greece (Programme B).

Within the framework of Programme A, action focused on the creation of training infrastructure in the broader region of Athens that would fill in any gaps due to the exclusion of the region from ERDF intervention. The objective was to build, expand, configure and equip vocational training centres.

The action undertaken within the framework of Programme B focused on the development of new structures and services throughout the country, aiming at the social and vocational rehabilitation of persons suffering from intellectual and mental illnesses and disabilities, as well as the improvement of conditions of care given to patients in state mental hospitals. In this way, the serious inadequacies of the Greek psychiatric care system would be addressed.

The same regulation provided for the granting of Community assistance amounting to a total of 120 million ECU, distributed equally between the two programmes. Community funding covered 55% of the costs and, in the case of technical assistance, up to 100% of public expenditure.

This funding would cover:

• The construction of new centres and the expansion and re-configuration of existing buildings (Programmes A and B).

• Equipment of centres (Programmes A and B).

• Pilot plans in order to find the most efficient methods for the implementation of Programme B.

• Training plans (in Greece and abroad) for the adjustment of the professional qualifications of the medical, nursing and paramedical personnel and social workers (Programme B).

Community financial assistance was to be granted on the basis of:

• The submittal by Greek authorities of global action plans that would correspond to parts A and B for the duration of validity of the Regulation.

• The annual submittal by Greek authorities of specific requests for financial assistance within the framework of these plans, which would then be approved by the Commission.

Despite the fact that the actions within the framework of the two programmes might seem similar, the objectives of Programme B aimed at supporting the creation of an entirely new system of social and vocational rehabilitation for persons suffering from mental and intellectual disorders and disabilities. The core of this new system was

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the replacement of psychiatric care based on the passive confinement of patients in psychiatric hospitals with a system based on an entirely different approach, i.e. active rehabilitation of patients.

Initially, the execution of programmes within the framework of Regulation 815/84 was to last until end 1988. However, the difficulties of the Greek administrative system to respond to the necessary tasks -mostly due to the rigid procedures that were in place with regard to public projects and, in part, particularly in the case of psychiatric reform, to the fundamental nature of the change- dictated the expansion of funding.

For these reasons, the period was extended for three additional years, until 31 December 1991, with Regulation 4130/88, which amended Regulation 815/84 and expanded the field of application of the intervention. Specifically, Regulation 4130/88:

• Extended the granting of Community assistance until 31 December 1991.

• Extended Community assistance for expenditures that covered the acquisitions of buildings and lots, exclusively for Programme B.

• Extended Community assistance, within the framework of a limit of 2% of the total estimated assistance and up to 100% of relevant expenditures for technical assistance, evaluation and monitoring actions.

• Provided for the establishment of a Monitoring Committee by the Greek authorities, in agreement with the European Commission.

• Provided for the establishment of a monitoring system by the Greek authorities, in agreement with the European Commission, for the systematic collection, processing and dissemination of information on the implementation of the programmes.

In 1989, the European Commission came to the conclusion that while the implementation of the action within the framework of Programme A recorded steady progress, the implementation of the action within the framework of Programme B was showing significant delays. Specifically, the following ascertainments were made and corresponding amendments followed:

Programme A maintained a steady rate of progress during the 1984-1994 period, as mentioned above. Overall, Programme A included the implementation of 104 projects for the construction/re-configuration/expansion and equipment of vocational training centres in the broader region of Athens. The projects included:

• Construction and equipment of 10 new vocational training centres.

• Re-configuration and/or expansion and equipment of 16 existing centres.

• Procurement of modern training equipment for 11 training centres.

Approximately 10,000 training positions were created and 1,400 trainers and 800 administrative employees worked at the training centres. All the actions carried out within the framework of Programme A reached their effective conclusion in December 1994.

Programme B mainly aimed at reducing the number of new admissions to major psychiatric hospitals, at not making patients chronic and institutionalized and at promoting the social re-integration of long-term inpatients.

The main objectives of Programme B were:

• The gradual replacement of an institutionalized psychiatric care system by a decentralized network of flexible preventive and therapeutic psychiatric services and structures in the community or in General Hospitals.

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• De-institutionalisation and reduction of the number of long-term inpatients in

psychiatric hospitals through the provision of vocational and social rehabilitation services, including community-based training and accommodation facilities.

• The execution of training programmes for mental health professionals.

During the first stage of implementation of Programme B (1984-1988), it was ascertained that the relatively limited action scheduled for the improvement of the inexcusable conditions at the Psychiatric Hospital of Leros had not been implemented as planned and that the conditions at the Hospital continued to be unacceptable.

In order to address this situation, the Commission decided in 1989 to postpone the approval of new actions within the framework of Programme B until the terms set by the Commission and the European Parliament had been satisfied, including specific actions to resolve the problem in Leros.

To this end, the Greek authorities submitted a new action for Leros in the form of a special two-year programme (1991-1992) aiming at the rehabilitation, de-institutionalisation and upgrading of the living conditions of a large number of inpatients at the Psychiatric Hospital of Leros. This special programme was approved by the Commission in December 1990. By autumn of 1991, there were clear indications, confirmed by a group of independent experts, that the implementation of the scheduled action on Leros had very positive results for the situation of patients residing there.

Therefore, after the submittal of a revised programme for Psychiatric Reform by the Greek authorities and the creation of a monitoring and evaluation system, the Commission decided in 1991 to continue Community funding within the framework of Programme B of the Regulation.

From 1991 onwards, the implementation of Programme B greatly accelerated. This was partly due to the experience acquired by the Greek authorities during the first implementation period and to the systemization of the monitoring, evaluation and control work organized by the Commission. This work included the establishment of a monitoring and evaluation system that was a determinant progress factor.

Programme B was effectively concluded in June 1995, excluding the monitoring and evaluation action, which ended in March 1996. Despite the need to extend initial funding for an additional three-year period (1988-1991), Regulation 815/84, as well as its amendment by Regulation 4130/88, decisively contributed towards the development of a network of preventive, therapeutic and psychiatric services and structures within the community or in General Hospitals, as well as a reduction in the number of long-term inpatients in public psychiatric hospitals.

The following Table presents changes that took place during the 1980-2000 twenty-year period.

Table 2.1.3.1: Brief presentation of changes during the 1980-2000 twenty-year period

Psychiatric Hospitals

Hostels / Apartments Regional Health System

(PESY) 1983 2001 1983 2001

Eastern Macedonia & Thrace 0 1 0 7

1st RHS of Central 0 0 0 1

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Macedonia

2nd RHS of Central Macedonia 0

2 0 35

Western Macedonia 0 0 0 0

Epirus 0 0 0 8

Thessaly 0 0 0 6

Ionian Islands 0 1 0 3

Western Greece 0 0 0 6

Sterea Ellada 0 0 0 8

1st – 2nd – 3rd RHSs of Attica 0 3 15 57

Peloponnese 0 1 0 9

Northern Aegean 0 0 0 1

Southern Aegean 0 1 0 42

Crete 0 1 0 9

The situation changed radically during the 1981-2001 period. In 1981, there was only one psychiatric unit at a General Hospital (with 16 beds) and 6 Mental Health Centres. In 2000, there were 30 units at General Hospitals (365 beds) and 28 Mental Health Centres. Furthermore, an additional 10 psychiatric units at General Hospitals (without in-patient facilities) provided counselling and outpatient services.

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Table 2.1.3.2: Qualitative and quantitative data on the provision of Mental Health services in the years 1980 and 2000

Provision of Mental Health Services

1980 2000

Chronic inpatients in public psychiatric hospitals (beds available)

5,677 2,922

Psychiatric wards in General Hospitals (beds) 16 361

Mental Health Centres 6 28

Medical-Pedagogical Centres 8 36

Day Centres/

Workshops/ Cooperatives/

Hostels/ Boarding houses

40 4,317


16

2000 1981

0 9

6

28

8

0

22

166

40

5,677


361

Medical-pedagogical

4,317


2.1.4. DETAILED PRESENTATION OF MENTAL HEALTH ACTIONS – PSYCHARGOS I PROGRAMME

The PSYCHARGOS National Action Programme is an on-going, ten-year programme within the framework of Psychiatric Reform in Greece that pertains to the development of mental health units and actions throughout the country. During its 1st phase of implementation, the Support - Animation and Monitoring Unit of “Psychargos” implementation agencies undertook the monitoring of the programme.

The long-term goal of the action programme is for asylums for the mentally ill to cease to exist and for their patients to return to the community. This is achieved through suitable Mental Health services that provide their target groups with prevention, diagnosis, treatment/therapy, care, psycho-social rehabilitation and social re-integration in a holistic manner.

PSYCHARGOS was created in 1997 for the 1997-2006 period. The current Action Plan is its first revision for the 2001-2010 period. The revision aims at updating data and information, so as to more accurately shape its scheduling, at re-focusing priorities by region and sector and at integrating changes that proved necessary through the experience accumulated.

The 1997-2001 period was the 1st Phase of implementation of the Programme (ending on 31/12/2001).

The first phase of the PSYCHARGOS Programme was included in the Operational Programme (OP) “Combating exclusion from the labour market” as a special integrated intervention programme for the socio-economic inclusion of people suffering from mental and intellectual problems.

The OP was financed by the European Social Fund (80%) and by the Greek State (20%). The Public Investment Plan ensured the OP’s continuous and unhindered financing, at least with regard to the Legal Entities under Public Law that implemented actions.

Actions approved for the 1st Phase (2000-2001), budgeted with a total amount of 15.5 billion drachmas, were as follows:

• Improvement of structures (Tutor training): 1.5 billion drachmas .

• Improvement of infrastructure (Upgrading of buildings, equipment of structures): 2.5 billion drachmas.

• Development and improvement of user skills (pre-training, training, employment): 11.5 billion drachmas.

Furthermore, within the framework of the same OP, the creation and operation of the aforementioned “Unit for the Animation and Monitoring of Agencies Implementing the Actions of PSYCHARGOS, 1st phase”, with a duration of 24 months, was approved.

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Psychiatric Hospital

Associated Agencies Scientific Head Housing

Infrastructure Address Telephone

No. Psychiatric Hospital of Thessaloniki

General Prefectural Hospital of Polygyros

Mr. P. Grigoriou, Psychiatrist

Hostel GPH of Halkidiki, Polygyros, Halkidiki, 63100

0371-20350-fax

General Prefectural Hospital of Kavalla

Mr. Goulianos, Psychiatrist

Hostel 28 Dagli & Kassandrou Street, Kavalla, 65403

051-233524-5

Ms. Kotzastrati, Occupational Therapist

Boarding house 8 Nikis Street, Ionia, Thessaloniki, 57008

031-784247, FAX 031-784115

Ms. Zella, Nurse

Hostel 20 Akropoleos Street, Ano Poli, Thessaloniki

031-207883 FAX 031-784115

Mr. Efs. Tsibitzidis

Boarding house 36 Konstantinou-poleos Street, 56429, Thessaloniki

0392-71684, FAX 0392-71620

Psychiatric Hospital of Petra Olympou

General Prefectural Hospital of Volos

Mr. V. Nikas Hostel Filyra, 18 Athanassaki Street, 38222, Volos

0421-38062, FAX 0421- 30960

General Prefectural Hospital of Karditsa

Mr. Ch. Annelou Hostel Kokkini Ekklisia Old People’s Home, 43100, Karditsa

0491-42810-fax

General Prefectural Hospital of Trikala

Mr. Beredimas Hostel Megalo Kefalovrysso, 42100, Trikala

0431-85588-fax

Ms. Arnal 1st Hostel of Katerini

DIONYSSOS Hotel, 14 Georgaki Olymbiou Street, 60100, Katerini

0351-45710, 0351-29655 (PEKEK)

Mr. Lygerinos 2nd Hostel of Katerini

Agiou Georgiou Terminal, 60100, Katerini

0351-45721

General Prefectural Hospital of Larissa

Mr. Xiromeritis Hostel 9 Tsimiski Street, 41223, Larissa

041-55371, fax 041-55406

Leros State Psychiatric Hospital

Mr. Hatziioannou, Psychiatrist Hostel Krithoniou

District, 85400 Leros

0247-23413

Mr. Hatziioannou, Psychiatrist Hostel Agion Saranda

District, 85400, Leros

0247-22511

Mr. Loukas, Psychiatrist Hostel Patelo District,

85400 0247-24125

18


Psychiatric

Hospital Associated Agencies Scientific Head Housing


No. Leros

Mr. Hatziioannou, Psychiatrist Hostel Kamara

District, 85400 Leros

0247-25598

Mr. Tzanetoglou, Mr. Economiskou, Psychiatrist

Hostel Christou District, 85400 Leros

0247-22310

Mr. Hatziioannou, Psychiatrist Hostel Spilia District,

85400 Leros

0247-24172

Psychiatric Hospital of Corfu

General Prefectural Hospital of Preveza

Ms. Efi Bouka, Psychiatrist Hostel 13 Spiliadou

Street, 48100 Preveza

0682-60251, 0682-61181 fax 0682-24837

Ms. Fandi, Psychiatrist Hostel Evropouli,

Corfu 0661-86100 fax 0661-39405, 0661-42354

Mr. Zannis Haviaras, Psychiatrist

Hostel Thinali, Corfu 0661-86100, 42354 fax 0661-39405

Health Centre of Filiata

Mr. Katsaros, Psychiatrist Hostel Filiates,

Thesprotia, 10 Kyprou Street, 49360

0664-23761

General Prefectural Hospital of Arta

Mr. Tsiggas, Psychiatrist Hostel General

Prefectural Hospital of Arta, Lofos Peranthi, Arta

0681-22222, 0681-26665, fax 0681-77311

General Prefectural Hospital of Ioannina

Ms. A. Fotiadou, Psychiatrist

“Charavgi” Hostel Beloyianni & Papandreou Street, 45444, Ioannina

0651-72291, fax 0651-70420

Mental Health Promotion Society of Epirus

Mr. Lyrintzis, Psychologist Hostel 43 Grammou

Street, 45444, Ioannina

0651-30545, 0651-22426

Attica Psychiatric Hospital

Mr. Karoussos, Psychiatrist Hostel 44 Iphigenias &

Grypari Street, Kallithea, 17671

9510456, fax 9574439

Mr. Karoussos, Psychiatrist

Boarding house 55 Iphigenias & Grypari Street, Kallithea, 17671

9510456, fax 9574439

Mr. Megaloikonomou, Psychiatrist

Hostel 59 Dodekanisou Street, 12136 Peristeri

5752750-fax

Mr. Spinoulas, Psychiatrist Hostel 4 Achaias

Street, Peristeri 12135

5752403

Mr. Panettas Boarding house 56 Perikleous Street, Neapolis, Nicaea,

4923497, 4902954, 4924617

19


Psychiatric



No. 184 52

Mr. Kondis, Psychiatrist

1st Hostel 71 Myllerou Street, Metaxourgion, 10436

5227773

Ms. Katsanou Psychiatrist

2nd Hostel 71 Myllerou Street, Metaxourgion, 10436

5227773

General Prefectural Hospital of Halkida

Ms. Afr. Kapsali Hostel Nea Lampsakos, Euboea

0221-79670

General Prefectural Hospital of Agrinio

Mr. Diamandis Mr. Skamnelos

3 Kentrou Street, 30200 Hostel

Agrinio

0641-44301

Dromokaitio Attica Psychiatric Hospital

General Prefectural Hospital of Chios

Mr. Fotopoulos Hostel Oikos Agapis, Neohori, 82100 Chios

0271-32897

Mr. Astrinakis Psychiatrist Hostel 3B

Konstantinou Paleologou Street, Korydallos

4944905

Ms. Moussouri Psychiatrist Hostel 7 Karamitsa &

224 Drossopoulou Street, 11255 Patissia

2116505

Mr. Vourdanou Psychologist Hostel 24 Miaouli

Street, Nicaea 5398200

Psychiatric Hospital of Tripolis

General Prefectural Hospital of Nafplion

Mr. Panagoutsos Psychiatrist Hostel Argos-Nafplion

National Road, Ramadani Area, Former Golemi Private School, Nea Tiryntha, 21100 Nafplion

0752-29421-2, 0752-26777, 0752-29422-fax

General Prefectural Hospital of Kalamata

Ms. Pahi Hostel 99 Athinon Street, Former G.P.H., 24100, Kalamata

0721-94506-7

General Regional University Hospital of Patras

Mr. Manolessos Psychiatrist Hostel 11 Satovrianou

Street, Patras

061-272359, 061-274572, fax 061-272904

General Regional University Hospital of Messolongi

Mr. Broumas Hostel Kyprou & Levidou Street, 30200 Messolongi

0631-23635, fax 0631-23893

General Prefectural Hospital of

Mr. Liakouras Hostel 80th km of Old National Road, 20100,

GPH of Corinth, tel. no. 0741-

20


Psychiatric



No. Corinth Corinth 25711

Mr. Th. Mougias Psychiatrist Hostel 24 Iroon

Politehniou & Karakalou Street, 1st floor, 22100, Tripolis

P.H. of Tripolis, tel. no. 071-391500

Mr. Th. Mougias Psychiatrist Hostel 11 D.

Apostolopoulou Street, 22100, Tripolis

tel. no. 071-391500

General Regional University Hospital of Rio, Patras

Mr. Manolessos Hostel 94 Stratigou Konstantinopoulou Street, Aroi, Patras

061-274572, 061 621694

General Prefectural Hospital of Pyrgos

Mr. Mougias Psychiatrist Hostel Former

Ipparchon Building, Patron-Pyrgos Avenue 27100

Tel. no. 0621-33955, 0621-33922

General Prefectural Hospital of Sparta

Mr. Tyrovolou Hostel 77 Leonidou Street, 23100 Sparta

G.P.H. of Sparta, tel. no. 0731 28671, 89277-9, fax 0731-88157

General Prefectural Hospital of Agrinio

Mr. Diamandis, Mr. Skamnelos Psychiatrist Hostel

Hostel 5 Kafandari Street, 30100 Agrinio

Tel. no. 0641-57333

State Mental Health Hospital of Hania

Ms. Kountadaki Hostel Kalathas Akrotiriou, Nodaraki Residence

Tel. no. 0821-64484

Mr. Chiotakis Psychiatrist Hostel EDEM Hostel,

Corner of 28th October Street, 73100, Kounoupidi and Akrotiriou

Tel. no. 0821-66718

Mr. Chiotakis Psychiatrist Hostel Alkionia

boarding house, Kalamaki, Nea Kydonia, 73100 Galatas

Tel. no. 0821-31656

General Prefectural Hospital of Rethymno

Ms. E. Valergaki Hostel 62 Neas Fokeas Street, 74100, Rethymno (Delibasi Rentals)

G.P.H. of Rethymno, tel. no. 0831-27814, 0831-36033, fax 0831-27928

“Venizelion-Pananion” General Regional Hospital of

Hostel Gouvas, Heraklion, Hotel “Sonia”

G.R.U.H. of Heraklion, tel. no. 081-234600

21


22

Psychiatric Hospital

Associated Agencies Scientific Head Housing


No. Heraklion

General Prefectural Hospital of Heraklion

Mr. Paritsis Hostel 11 Sasa Street, 71201 Heraklion

G.P.H. of Heraklion

General Prefectural Hospital of Agios Nikoalos

Hostel Stylianou Koundourou, 72053, Elounda

0841-25221, 0841-41675 fax 0841-25286


2.1.4.1. Findings from the implementation of the 1st Phase of Psychargos Programme

Until the end of 2001, the largest part of the PSYCHARGOS Programme focused on the de-institutionalisation of patients. The programme began with the operation of 15 hostels and 120 sheltered apartments for the de-institutionalisation of 470 mentally ill persons. To date, 66 hostels, 14 boarding houses and 10 apartments have been created, hosting approximately 1,000 patients from all the psychiatric hospitals of the country, along with 1 boarding house for autistic persons, 1 hostel for mentally ill refugees and 35 training workshops for the mentally ill. Furthermore, 1,200 persons were hired for these structures (young Mental Health professionals) and were trained through special education programmes.

Due to the 1999 earthquake, a large part of the budget intended for the creation of new structures was channelled towards the restoration of 80% of the building infrastructure of the Attica Psychiatric Hospital. Nevertheless, during the same period, a day centre was created for mentally ill refugees, along with a day centre for mentally ill persons of Muslim faith, a day centre for the mentally ill and six new psychiatric wards at new General Hospital buildings.

The present Action Plan focuses on actions/projects that will be implemented during the 2nd phase of the Programme, i.e. during the 2002-2006 period, at the end of which, the second revision of the Programme (for the 2006-2015 period) is scheduled to take place.

PSYCHARGOS consists of two parts:

• Programming of actions for the de-institutionalisation of patients from psychiatric hospitals, shaped on the basis of the diaspora of the patients of each psychiatric hospital to their regions of origin (residence before being committed to the psychiatric hospital).

• Community-based structures to cover all the needs of the Mental Health Sector, in the form of a regional action specified at the level of prefectures and sectors.

These structures consist of sub-programmes adapted to the specific needs of the individual population groups they are called upon to serve. Thus, during their implementation, the following sub-programmes stand out as to the development of community-based structures:

• for patients with mental disorders

• for persons with autism spectrum disorders

• for persons addicted to substances

• for persons suffering from mental disorders and belonging to various cultural and religious backgrounds.

The breaking down of the Programme into specialized Sub-Programmes takes place so as to provide a different, customized approach for the specificities of each group, on the one hand, and to achieve effective administration of each part of the project, in order for the composition of the actions to have a positive result for the entire population, on the other.

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2.1.5 PROJECTS UNDER WAY AND DEGREE OF COMPLETION

The following table presents the bridge-projects between the 1st and 2nd phase of

PSYCHARGOS, as well as their degree of completion.

Table 2.1.5: Bridge-projects

Hellenic Society for the Protection of Autistic Persons

1 hostel for autistic children in Zitsa, Ioannina (in operation)

“To Perivolaki” Hellenic Therapy Centre for Children and Families

1 day centre for autistic children (in operation)

Greek Council for Refugees 1 hostel for refugees suffering from mental disorders

1 day centre for refugees suffering from mental disorders (in operation)

Association of Families for Mental Health (S.O.PS.Y.) (its operation is being prepared)

1 hostel

Pan-Hellenic Association for Psycho-Social Rehabilitation and Vocational Re-Integration (P.E.PS.A.E.E.)

1 day centre – workshop

(in operation)

Hellenic Centre for Inter-Cultural Psychiatry & Care

1 special centre for social re-integration

“ANODOS” Civil non-profit company 1 day centre (in operation)

Psi-Synthesis 1 day centre

“KLIMAKA” Civil non-profit company 1 day centre for Muslims, under the “Psychadelphia” programme (in operation)

1 day centre for Roma, under the “Psychadelphia” programme (in operation)

1 special centre for social re-integration (partially in operation)

24


Special de-institutionalisation actions for the “Dromokaitio” Psychiatric Hospital are

described in the following tables:

STRUCTURES – SCIENTIFIC HEADS – DURATION OF LEASE – PATIENTS

HOSTELS ADDRESS – TEL. NO.

SCIENTIFIC HEAD BUILDING LEASE DURATION

OPERATION – PATIENTS

Ferron – Athens (SEMELI) Tel. 010-8253592-3

Papadopoulos Board Decision 9/7-3-01

15/12/1998 – 15/12/2003

In operation since 27/10/99, hosts 15 men

74 Mezonos Street, Athens, Tel. 010-5221603, 010-5221629

Ch. Garnetas Board Decision 19/31-5-00

20/10/1999 – 20/10/2002

In operation since 8/11/99, hosts 15 women

1 Florinis Street – Aharnon

Kondis Act No. 990/21-9-01

1/2/2001-1/2/2006

Patients are being prepared. Inadequate staffing with hospital personnel. 10 persons are to be hosted (6 men and 4 women)

14 Skylitsi Street, Areos Square

N. Kariki Ext. 209 Board Decision 32/5-9-01

12/2/2001 – 12/2/2006

Reconstruction of sanitation facilities is taking place upon request of the scientific head. 9 to 11 women are to be hosted.

104 Alkamenous Street & Pipinou Street – Athens (Taygeti)

Anna Skalioti Board Decision 25/27-6-01

2/5/2001 – 2/5/2006

In operation since 2/7/2001, hosts 12 women

29 Hayden Street, Athens

K. Vachtsevanos Act. No. 855/13-8-01

3/9/2001 – 2/9/2006

Shortage of nursing and other staff. Approximately 10 persons are to be hosted.

3 Helmou Street – Halandri

K. Vachtsevanos Act. No. 855/13-8-01

14/9/2001 – 13/9/2006

Shortage of nursing and other staff. Approximately 10 persons are to be hosted.

112 Afroditis Street – Argyroupolis

9/8/2001 – 9/8/2006

61-63 Agias Paraskevis Street – Halandri

5/11/2001 – 5/11/2006

36 Athanassiou Diakou Street – Agia Varvara- Egaleo

3/12/2001 – 2/12/2006

25


BOARDING HOUSES

ADDRESS – TEL. NO.



47 Keramikou Street – Athens Tel. 5227529

A. Tsolka Act No. 1324/12-12-00

26/9/2000 – 27/9/2005


6 Ptolemeou Street – Lambrini

S. Tsitouridis Act No.1324/12-12-00

28/7/2000 – 28/7/2005


39 Mezonos Street – Athens

Ch. Garnetas Ext. 500 Board Decision 17/9-5-01

1/3/2001 – 1/3/2006

In the equipment process. 18-20 persons are to be hosted.

23 Arkadiou Street – Korydallos Tel. 010-4940398 010-4960931, 010-4961248

M. Metaxa Board Decision 26/4-7-01

26/3/2001 – 25/3/2006

In operation since 8/6/2001, hosts 11 men and 2 women

34 Eleftheriou Venizelou Street – Pallini

Nikolopoulou Ext 435-450 Act No. 994/28-9-01

6/9/2001-5/9/2006

Shortage of nursing and other staff. Report has been made for equipment. 20 women are to be hosted.

APARTMENTS

ADDRESS – TEL. NO.



32 Thiramenous Street – Aegalaeo

K. Kondis Act No. 1324/12-12-00

28/6/2000 – 27/6/2005

In operation since 1/5/2001, hosting 3 men and 2 women

8 Smolikas Street – Sepolia Ground floor 1st floor 2nd floor

K. Kondis Act No. 1324/12-12-00 Tel. No. . 094-4119914 Ext. 501-2

23/2/2001-24/2/2006 10/11/2000 – 10/11/2005 13/3/2001 – 14/3/2006

Ground floor – 1st floor in operation since July 2001, hosting: 3 men on the Ground floor, 3 women on the 1st floor. The 2nd floor has been in operation since 1/1/2002, hosting 3 men

23 Pergamou Street – Attikis Square

Papadopoulos 9/2/2001 – 9/2/2006

In operation since 5/7/2001, hosting 4 men

99 Kefallinias Street – Kypseli

8/8/2001 – 8/8/2006

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Psycho-social Rehabilitation Units provided by Legal Entities under Private Law within the framework of the “Dromokaitio” Direct Support Programme (P.A.Y.D.)

Societies Units

Society for the psycho-social health of children and adolescents (EPSYPE)

1. Hostel, 15 Trifyllias Street

Halandri, 152 31

Tel. 010-6777521

2. Hostel, 39 Filippou Street

Halandri (Patima), 152 38

Tel. 010-6399189

Society for Social Psychiatry and Mental Health

Hostel, 20 Messinias Street

Kastella

Tel. 010-4113883

Society for Mental Health and Social Rehabilitation of Patients (EPSYKA)

Boarding house, Ai-Yiannis District

Makry Yialos, Pieria

Tel. 03530-41214

Thessalian Society for Mental Health – Care and Rehabilitation

Hostel, 6Α Agiou Orous Street

413 35, Anthoupolis, Larissa

Tel./Fax 041 – 627363

Epirus Society for the Promotion of Mental Health (EPROPSYP)

Hostel: not implemented

Society for Regional Development and Mental Health (EPAPSY)

Hostel, 6 Anastassiou Skoufou Street,

Palea Penteli

Tel. 8047548

“Klimaka” Civil non-profit company Hostel, 3 Negri Street & Koryzi Street

Syngrou Avenue

Tel. 010-9211649

University Institute of Mental Health Research

Hostel, 11 Voutyra Street

Patissia

Tel. 010-8319360

2.2 BROADER ACTIVITY ENVIRONMENT

The Psychiatric Reform is a collective effort undertaken by the State, psychiatrists, Mental Health professionals and society with a view to comprehensively addressing human needs created by mental illness. The institutional framework, implementation agencies and Mental Health infrastructure are presented below.

27


2.2.1 GREEK INSTITUTIONAL FRAMEWORK FOR MENTAL HEALTH

The institutionalization of Psychiatric Reform in the Greek Mental Health sector takes place both through internationally recognized research and practices and through a broad legal framework which is constantly updated and enriched with new innovative provisions and actions. This framework recognizes the need to take measures that will ensure the right of mental patients to lead a decent life as close to the community as possible.

Specifically, the following are taken into account:

• International research underlining that mental illness tends to become the main ailment in the coming decade, due to the modern way of life, a person’s living conditions, unemployment and social and cultural differences.

• At national level, the incidence of mental health problems among special population groups (refugees, immigrants) is constantly rising.

• The request for the provision of specialised services to special population groups (persons with autism, mentally ill criminal offenders).

• The invisible demand among children and young persons with learning difficulties and the psycho-geriatric needs of the mentally ill and the general population.

• The continuous increase of aggravating psycho-pathological factors among drug users and alcoholics.

The strategy and objectives of the Directorate for Mental Health of the Ministry of Health & Welfare, as expressed through the PSYCHARGOS Programme, match the Operational Programme “Health – Welfare 2000-2006” of the 3rd CSF. The Operational Programme is being implemented within the framework of Priority Axis 2 for Mental Health and the measures provided therein.

The framework within which the objectives and measures of PSYCHARGOS take place are consistent with the guidelines of the European Union, Community Policies and the General Objectives of the country’s Development Plan 2000-2006.

Furthermore, the following provisions have been taken into account:

• Decision No. Υ5b/ΟΙΚ.974/29.3.2001 of the Directorate for Mental Health for a “Ten-Year Programme for the Development of Mental Health Units and Actions”.

• Document No. Υ5b/oik.975/29.3.2001 of the Directorate for Mental Health for the “Approval -in terms of advisability- of the inclusion of part of the ten-year PSYCHARGOS Programme in the 3rd CSF under the title PSYCHARGOS Phase II’”.

• Presidential Decree 95/2000 “Organisation of the Ministry of Health & Welfare”.

• Decision No. Α3a/oik.876 of the Ministry of Economy & Finance and the Ministry of Health & Welfare, defining the method of Organisation and Operation of Psycho-social Rehabilitation Units (boarding houses, hostels) and the Sheltered Apartments Programmes of Article 9 of Law No. 2716/99.

• Law No. 2716/99 on the “Development and Modernisation of Mental Health Services and other Provisions”.

• Regulation EEC No. 815/84.

• Law No. 1397/83 on the National Health System.

• Legislative Decree 2592/53.

28


The laws and provisions related to Mental Health concern the development and modernization of Mental Health services in order to achieve the objectives of the Psychiatric Reform, i.e. the de-institutionalisation of the highest possible number of chronic mental inpatients who are currently residing in closed structures, the development of open community-based structures for prevention and therapy/treatment and the implementation of actions for the social and economic re-integration of mental patients.

The positive results from the implementation of the actions of Regulation 815/84, the expansion of these actions during the transition stage (1997-98), the development of the 1st phase of PSYCHARGOS and the innovative actions within the framework of Community Initiatives have led to the accumulation of know-how by mental health agencies and professionals and to the formation of a background for the future development of integrated actions with added qualitative and quantitative features.

2.2.2 INTERNATIONAL TRENDS IN MENTAL HEALTH

The promotion of services in the Mental Health sector has taken on new dimensions internationally. In recent years, the World Health Organisation (WHO) has undertaken actions contributing towards the reinforcement of Mental Health conditions in all its Member States. In one of its latest decisions, it called upon Member States to adopt the proposals included in the World Health Report 2001, New Understanding, New Hope, dedicated to Mental Health.

The report clearly and emphatically states that the protection of Mental Health, which has been neglected to date, is vital for the overall good of people, societies and states and, therefore, should be approached in the light of new developments. Furthermore, the same report underlines the need to promote the protection of human rights of people with mental health problems.

The report focuses on mental disorders, schizophrenia, mental retardation in children and adolescents, addiction to alcohol and drugs, Alzheimer’s disease and epilepsy. All these conditions usually cause serious disability.

The report constitutes a comprehensive research on what is known about current and future difficulties related to mental disorders and the main factors that contribute thereto. It also focuses on the effectiveness of prevention, therapy methods and obstacles, as well as the way in which mental health services are planned and provided. Finally, the report underlines the policies required in order to ensure the end of stigmatization of and discrimination against the mentally ill, on the one hand, and the need to develop and fund structures for effective prevention and therapy/treatment of mental illnesses, on the other.

The WHO is asking regional committees to find ways in which the provisions of the World Health Report 2001 on Mental Health will be implemented at regional level.

Moreover, the Organisation is calling upon its Member States to implement legislation, policies and programmes on mental health that are based on current knowledge and new human rights requirements, always in cooperation with all agencies involved in Mental Health.

Finally, the WHO is encouraging its Member States to invest more funds in the Mental Health sector, both within their own states and within the framework of bilateral and multilateral partnerships. This is considered a basic requirement for the improvement of peoples’ mental health.

29


In Great Britain, the planned health model pertains to the modernization of all health services and social services and will serve as an organizational model for Greece.

With regard to Mental Health, this model adopts a programme for the modernization of the organization of mental health services, which establishes national criteria for the promotion of new treatments, the creation of de-institutionalisation structures, the closing of psychiatric hospitals and the implementation of innovations and methods to evaluate the effectiveness of the model itself in the Mental Health sector throughout the country.

The National Service Framework for Mental Health in Great Britain is subject to frequent revisions, so as to incorporate changes brought about by developments in the broader Mental Health environment.

As for the funding of such an ambitious national plan, it has been deemed necessary to rank investments and re-investments of existing resources and to re-approach mental health services as a single system whose components must operate properly and in balance with each other.

Modernization objectives set by the National Service Framework for Mental Health in Great Britain address the following five areas:

• Mental Health promotion and the discrimination and social exclusion associated to mental illnesses.

• Primary care and access to mental health services.

• Effective services for persons with severe mental illness.

• Support to private citizens who care for people with mental health problems.

• Planning actions necessary for reducing the number of suicides.

Results expected from the programme are the following:

• Inclusion of everyone involved in mental health, patients and mental health professionals, in the planning and provision of services.

• Provision of high quality care and treatment, which will be effective and appropriate.

• Non-discrimination of recipients of treatment and care.

• Easy and continuous access to treatment and care, whenever and wherever it is required.

• Promotion of safety of recipients of treatment and care through mental health services, on the one hand, and the persons providing these services, on the other.

• Offering choices that will ensure independence for recipients of treatment and care through mental health services.

• Proper coordination of mental health services between the staff and the units providing these services, as well as continuous support during the provision of services.

• Accountability of everyone involved in Mental Health.

A similar system, placing emphasis on the creation and operation of de-institutionalisation structures, is also being followed and implemented by Ireland, as well as other European countries that are following the directives of the World Health Organisation.

30


The National Service Framework for Mental Health represents an ambitious programme for changing and modernising the health and social welfare system in Great Britain, placing emphasis on quality and combating the complexity and incompatibilities of existing services.

The programme includes all Mental Health sectors – from the promotion of mental health to continuous care. New processes involving a series of organisations that play a significant role in improving mental health and mental health services have been established.

The programme has clear, fully defined objectives. The way in which these objectives can be achieved is defined through examples of best practices and the framework set for the operation of mental health agencies. Mental health actions are being implemented by regional/local service provision systems that include programmes for the improvement of health, the development of clinical administration and the establishment of agreements with other private agencies for the provision of long-term services.

The efficiency of the programme is measured through a specific number of performance indicators at national/high and regional/local level. Specifically, the definition of local performance indicators is agreed upon by the local branches of the National Health System and the local/regional health and social welfare communities.

Finally, the programme defines the educational and development needs (organizational, professional and personal), as well as the need to develop skills and competences and to disseminate knowledge.

2.2.3 PHILOSOPHY OF TRANSFORMATION FROM A “CLOSED” CARE MODEL TO AN “OPEN” CARE MODEL

The way in which people suffering from mental and behavioural disorders are treated has always reflected prevalent social values related to the social perception of mental illness. Throughout the centuries, people suffering from mental and behavioural disorders have been treated in many different ways. In certain societies, they had a particularly high social position because they were thought to be able to communicate with the gods and the dead. In medieval Europe and elsewhere, they were tortured and burnt. In other eras, they were committed to large institutions.

In 19th century Europe, there were completely different ways of dealing with such patients. One way was to consider and treat them as patients. Another was to isolate them in asylums. These trends were transferred to Africa, America and Asia.

During the second half of the 20th century, a major turn took place in mental health due to three exogenous factors that were independent of each other:

• Significant progress was made in physio-pharmacology, new categories of drugs were discovered (particularly neuroleptics and anti-depressants) and new psychosocial interventions were developed.

• The human rights movement expanded to all the countries of the world, thanks to the United Nations Organisation, and the number of countries with democratic regimes increased.

• The World Health Organisation (WHO) was created and helped to make mental health be viewed as a part of the health sector in general.

31


These technological and socio-political events helped start the implementation of de-institutionalisation of patients and their inclusion in community-based mental health units.

2.2.4 NECESSITY OF PROVISION OF COMMUNITY-BASED MENTAL HEALTH SERVICES

The failure of the operation of asylums was proved by repeatedly unsuccessful treatment of mental patients, the geographical and professional isolation of institutions and of the staff working therein, the poor system of information and accounting, the ineffective administration and management, the poor finances, the lack of personnel training and, finally, the absence of mechanisms to control and implement quality assurance procedures.

It was also repeatedly ascertained that living conditions in psychiatric institutions around the world were particularly poor and that human rights were often violated. If one judges psychiatric institutions in an absolute way, one could say that the conditions in psychiatric hospitals are better in developed countries than in developing countries. However, if one were to examine the difference between psychiatric institutions and general health hospitals in each country, then one would realize that there is always a significant difference in prevailing conditions, which are always worse at psychiatric institutions.

On the contrary, the provision of community-based mental health services tries to support patients suffering from mental and behavioural disorders. In practice, the provision of community-based mental health services means the development of a wide range of services at local level. The implementation of such systems must ensure that some of the protective functions of asylums are given to new structures, without incorporating the negative aspects. In practice, the provision of community-based mental health services means:

• Services located near the home of each patient and General Hospitals are ready to cope with acute cases of mental patients.

• Existence of long-stay structures.

• The treatment and care provided must correspond to the diagnosis of the mental illness and the needs of each patient.

• The provision of a wide range of services commensurate to the needs of target-populations.

• Possibility of provision of Mental Health services by mobile units.

• Legislation that supports the above.

2.2.5 TRANSFORMATION PROCESS

Although de-institutionalisation is a very important action of mental reform, it is not synonymous with the creation of community-based structures, which is a complex process that leads to the creation of an uninterrupted network of mental health services within the community. The closing of asylums without the creation of alternative community-based structures is as dangerous as the creation of these structures without previously closing asylums. The transformation process consists of three basic steps:

32


• Cessation of admission of new patients at psychiatric hospitals through the

provision of mental health services in community-based structures

• Return to society of institutionalized chronic patients that have recovered

• Creation and maintenance of community-based structures for non-institutionalized patients

De-institutionalisation and the creation and implementation of mental health service provision are a difficult process. Reasons leading to a decrease in the number of positive results include the fact that funds which are not used by psychiatric hospitals being closed are not usually given to community-based structures, the fact that professionals are not properly prepared to accept their new roles, and the fact that the stigma associated with mental illness remains strong and helps perpetuate the negative treatment of mental patients.

The process of transformation from hospital structures to community-based structures has been adopted by a large number of countries. For example, Law No. 190, which was applied in Italy in 1978 and decreed the closing of all psychiatric hospitals, shaped and accelerated a pre-existing trend in the care of the mentally ill. The basic principles of the Italian Law state that new patients may not be admitted to large psychiatric hospitals and that there must be no re-admissions. No new psychiatric hospitals are to be constructed, while the psychiatric divisions of General Hospitals should have no more than 15 beds and should come under community-based structures.

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2.3 CONCLUSIONS AND REMARKS

With the completion of the implementation of the 1st phase of PSYCHARGOS, remarkable results have been achieved with regard to the de-institutionalisation of the mentally ill and their integration in the community. A noteworthy number of new structures have been created and the integration of part of the population of mental patients in these structures has begun.

It is equally important that significant experience and know-how have been acquired from effective interventions that have taken place in the Mental Health sector to date and this will help lay the foundations for the new actions in the new programming period.

However, at the same time, there still are some weaknesses, such as the fact that the long-term operation of the closed institutionalised care model has created a reality that makes the progress of psychiatric reform harder. Similarly, due the insufficiency of community-based structures providing primary and secondary mental health care, the needs of the mentally ill are not met, leading to many patients being driven to closed psychiatric structures. Moreover, the infrastructure of certain psychiatric hospitals (such as the Attica Psychiatric Hospital) is now antiquated. Lastly, the Mental Health sector does not yet have an adequate number of specialised personnel who can complete the de-institutionalisation of the mentally ill.

Consequently:

• De-institutionalisation of chronic inpatients of psychiatric hospitals must be pursued through a rehabilitation process that aims at equality-based full labour and social inclusion for the highest possible number of these patients.

• Furthermore, actions for the replacement of antiquated or damaged infrastructures of psychiatric hospitals must be developed and implemented and the effort for comprehensive preparation patients’ discharge and their admission to community-based structures must be encouraged and supported.

• Suitable non-hospital structures must be developed to enhance prevention and to limit admissions to psychiatric hospitals.

• Moreover, the process leading to the closing of a number of existing psychiatric hospitals and their replacement with sectoral mental health services of each hospital’s catchment area must begin.

• Active policies to enhance volunteerism, social solidarity and the integration of target-populations(*) in the social and economic web must be promoted. These actions must take place in synergy with corresponding actions by the

(*) people with mental disorders, people with mental disorders and mental retardation, people with psycho-geriatric problems, people with organic syndromes (regarding their need for psychiatric support), people addicted to drugs and alcohol (mainly in regard to their need for psychiatric support), people with autistic-type behavioral disorders (at the level of early diagnosis, psychological support and connection to school), children and adolescents with learning and behavioral problems, people with Alzheimer’s disease (regarding their psychological support), people who need psychological support due to suffering from other illnesses, people whose mental health is at risk due to socio-economic reasons, people facing psychological problems due to social prejudice linked to their different cultural or religious beliefs, minorities and refugees with particular problems regarding their mental health and any person who needs psychological support for any reason.

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Ministry of Labour and Social Insurance. This will ensure the incorporation of the dimension of equal opportunities for the mentally ill both during the planning of relevant policies and during the provision of services by competent agencies, placing emphasis on personalised treatment and the respect for the rights and choices of beneficiaries.

• Finally, training programmes must be planned and implemented for tutors, executives and other staff of mental health sector services on issues of methods and procedures:

facilitating the transition of people with mental and intellectual problems to community-based sheltered semi-independent and/or independent living and supporting them so as to ensure their socio-economic re-integration.

providing training in new models of health service provision, placing emphasis on the principles of community mental health and modern organisation of mental health services.

creating trans-national partnerships that aim at the transfer of know-how and successful practices.

MINIMUM ACTIONS REQUIRED FOR MENTAL HEALTH

The following Table shows the proposals for Mental Health made by the World

Health Organisation, recorded under three scenarios:

• Low Resources

• Medium Resources

• High Resources

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MINIMUM ACTIONS REQUIRED FOR MENTAL HEALTH CARE, BASED ON THE OVERALL RECOMMENDATIONS OF THE WORLD HEALTH ORGANISATION

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3 OBJE CTI VES AND PRIORIT IES

3.1 STRATEGIC OBJECTIVES

The strategic objective of Actions for Mental Health is the de-institutionalisation of the highest possible number of chronic mental inpatients currently residing in closed structures, the development of open community-based structures for prevention and treatment and the implementation of actions for the social and economic re-integration of the mentally ill.

These goals are grouped into three major categories: de-institutionalisation, infrastructure, training.

3.1.1 STRATEGIC DE-INSTITUTIONALIZATION OBJECTIVES

The special objectives for de-institutionalization are the following:

• The discharge of a high number of chronic patients from psychiatric hospitals through a rehabilitation process that will aim at equality-based full labour and social inclusion for the highest possible number of these patients.

• The development of special actions, particularly at the Athens Psychiatric Hospital of Dafni and, potentially, in other agencies that present similar problems, as well as continuation of the special action at the Leros State Psychiatric Hospital and comprehensive preparation for the exit of patients into the community.

3.1.2 STRATEGIC OBJECTIVES FOR COMMUNITY INFRASTRUCTURES

The objectives for infrastructures are the following:

• The development of suitable non-hospital structures enhancing prevention and limiting admissions to mental hospitals.

• The modernisation of the structures and infrastructure of mental hospitals in order to improve the living conditions of patients and to ensure qualitative characteristics and effectiveness during the stage of the exit of patients into the community, as well as preparation for the closing down of some of these hospitals and their replacement with sectoral mental health services in the hospital’s catchment area.

3.1.3 STRATEGIC OBJECTIVES FOR TRAINING

Supporting the network of structures and services requires a complex set of specialized Mental Health professionals and an anthropocentric perception of the mentally ill on the part of such professionals. This last need calls for major changes in the education and lifelong training of Mental Health professionals, as well as in the methods and procedures for transferring know-how.

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Consequently, strategic objectives for training are as follows:

• Training a team of Mental Health professionals that will operate as a tutor team training the staff of new community-based structures.

• Educating all psychiatric hospital personnel, as well as employees who will staff all new community Mental Health structures.

• Creating alternative teaching methods and materials for the education of people suffering from mental and intellectual problems, as well as mental health professionals.

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3.2 PSYCHARGOS 2001-2010 TEN-YEAR PLAN

3.2.1 INTRODUCTION

The 2001-2010 period of the “Psychargos” Programme provides, with regard to de-institutionalisation, for the creation of 300 housing structures for 3,500 patients residing in psychiatric hospitals or hospitalized in the psychiatric wards of General Hospitals who need supported living within the community for a certain period of time.

The Psychargos Programme includes the following courses of action:

• Sectorization of Mental Health services.

• Improvement of patients’ living conditions during the 2001-2010 period and comprehensive preparation for their exit into the community (mainly for the patients of the Attica Psychiatric Hospital).

• Operational upgrading of Mental Health services.

• Development of community-based primary and secondary Mental Health care structures and programmes, and interconnection of services within integrated networks in the framework of Mental Health sectors.

• Ensuring the continuity of care for target-populations at community level.

• Promotion of prevention.

• Development of actions that promote social solidarity and enhance actions for the re-integration of targeted mental patients into the labour market.

Specifically, each course of action entails the following:

3.2.2 SECTORIZATION OF MENTAL HEALTH SERVICES

Law No. 2716 (1999), voted by Parliament for the “Development and Modernisation of Mental Health Services”, explicitly states that Mental Health services are structured, organised, developed and operate on the basis of the principles of sectorization and community-based psychiatry.

The development of an effective and sectorized network of Mental Health units at the community level (Mental Health Centres, Day Centres, Vocational Re-Integration Units, Mobile Units, Special Units for Autism, Limited Liability Social Partnerships, etc.) contributes towards prevention, direct intervention, provision of care and support to the mentally ill and development of actions and programmes at local level that facilitate the gradual socio-economic re-integration of patients.

The need to develop a network of services at sectoral level was underlined during the 1st Phase of the Psychiatric Reform. An effort is thus being made for mental patients to receive services near their family environment and within the communities where they resided before being committed to psychiatric institutions.

The development of structures for de-institutionalisation and provision of mental health services by Health Region is deemed a prerequisite condition for the success of the entire endeavour of Psychiatric Reform. Health Regions have been divided into Mental Health Sectors (MHS) according to geographical and demographic criteria.

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The borders, territory and seat of each Mental Health Sector have been determined by ministerial decision. Specifically, Mental Health Sectors have been established in every prefecture or broader region, while in Attica and in the Prefecture of Thessaloniki, more than one Sector have been established, along with Mental Health Sectors for Children and Adolescents (MHSCA). Moreover, Mental Health Sectors that do not have sufficient Mental Health Units are subject to adjacent or non-adjacent Mental Health Sectors of the same or different Health Region.

A joint decision of the Minister of the Interior, Public Administration & Decentralisation and the Minister of Health & Welfare set the requirements and the method of scientific, educational, nursing and operational interconnection of services at Mental Health Units of Mental Health Sectors subject to different Health Regions. Finally, Sectoral Committees for Mental Health (SCMH) were established, with competences set out by Law No. 2716/1999, Article 3, paragraph 6.

The model of sectorized organization of mental health services is aligned with the British Mental Health model, as created through the National Service Framework for Mental Health. In this case, Mental Health actions are implemented through regional/local systems of service provision, while mechanisms for the promotion of Mental Health (that were introduced through the Framework and created new possibilities for communication between central and regional/local administration) are activated.

The following list shows:

1. the sectorization of psychiatric services and the inclusion of Mental Health Services in the Sectors,

2. the composition of Sectoral Committees for the Mental Health of Children and Adolescents by Health Region (Law No. 2889/1999, Government Gazette FEK 96/Vol. Α/17-5-1999), as follows.

1st HEALTH REGION: EASTERN MACEDONIA – THRACE

1.1 Prefecture of Evros (Seat: Alexandroupolis) - Establishment of the Psychiatric Sector (Government Gazette FEK 660/Vol. Β/23-5-2000)

- Constitution of the Sectoral Committee for Mental Health (Decision No. Υ5b/oik. 1337/7-5-2001)

1.2 Prefecture of Rhodope (Seat: Komotini) -Establishment of the Psychiatric Sector (Government Gazette FEK 660/Vol. Β/23-5-2000)

-Constitution of the Sectoral Committee for Mental Health (Decision No. Y5b/oik. 1338/7-5-2001)

1.3 Prefecture of Xanthi: (Seat: Xanthi) -Establishment of the Psychiatric Sector (Government Gazette FEK 660/Vol. B/23-5-2000)

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-Constitution of the Sectoral Committee for Mental Health (Y5b/oik. 1344/7-5-2001)

1.4 Prefecture of Drama (Seat: Drama) -Establishment of the Psychiatric Sector (Government Gazette FEK 446/Vol. B/14-2-2000)


1.5 Prefecture of Kavalla: (Seat: Kavalla) -Establishment of the Psychiatric Sector (Government Gazette FEK 446/Vol. B/14-2-2000)


2nd HEALTH REGION: CENTRAL MACEDONIA

2.1 Prefecture of Serres: (Seat: Serres) -Establishment of the Psychiatric Sector (Government Gazette FEK 1408/Vol. B/22-10-2001)

-Constitution of the Sectoral Committee for Mental Health (Decision No. Y5b/G.P. oik. 31903/28-3-2002)

2.2 Prefecture of Thessaloniki: (Seat: Thessaloniki) -Establishment of the Mental Health Sector (Government Gazette FEK 266/Vol. B/6-3-2002>Central Sector) & (Government Gazette FEK 165/Vol. B/14-2-2002>Eastern and Western Sector)

-Constitution of the Sectoral Committee for Mental Health (Central Sector Decision Y5b/G.P. oik. 39517/17-4-2002), (Eastern Sector Decision Y5b/G.P. oik. 41652/23-4-2002) & (Western Sector Decision Y5b/G.P. oik. 39514/17-4-2002)

2.3 Prefecture of Halkidiki: (Seat: Polygyros) -Establishment of the Mental Health Sector (Government Gazette FEK 1408/Vol. B/22-10-2001)

-Constitution of the Sectoral Committee for Mental Health (Decision Y5b/G.P. oik. 39503/17-4-2002)

2.4 Prefecture of Kilkis: (Seat: Kilkis) -Establishment of the Mental Health Sector (Government Gazette FEK 1408/Vol. B/22-10-2001)


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2.5 Prefecture of Pella: (Seat: Edessa) -Establishment of the Mental Health Sector (Government Gazette FEK 1408/Vol. B/22-10-2001)


2.6 Prefecture of Imathia: (Seat: Veroia) -Establishment of the Mental Health Sector (Government Gazette FEK 1408/Vol. B/22-10-2001)


2.7 Prefecture of Pieria: (Seat: Katerini) -Establishment of the Mental Health Sector (Government Gazette FEK 1408/Vol. B/22-10-2001)


3rd HEALTH REGION: WESTERN MACEDONIA 3.1 Prefecture of Florina: (Seat: Florina) -Establishment of the Mental Health Sector (Government Gazette FEK 1408/Vol. B/22-10-2001)


3.2 Prefecture of Kozani – Grevena: (Seat: Kozani) -Establishment of the Mental Health Sector (Government Gazette FEK 1408/Vol. B/22-10-2001)


3.3 Prefecture of Kastoria: (Seat: Kastoria) -Establishment of the Mental Health Sector (Government Gazette FEK 1408/Vol. B/22-10-2001)


4th HEALTH REGION: EPIRUS

4.1 Prefecture of Ioannina – Thesprotia: (Seat: Ioannina)

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-Establishment of the Mental Health Sector (Government Gazette FEK 660/Vol. B/23-5-2000)


4.2 Prefecture of Arta - Preveza: (Seat: Arta) -Establishment of the Mental Health Sector (Government Gazette FEK 138/Vol. B/8-2-2002)


5th HEALTH REGION: THESSALY

5.1 Prefecture of Larissa: (Seat: Larissa) -Establishment of the Mental Health Sector (Government Gazette FEK 292/Vol. B/21-3-2001)


5.2 Prefecture of Magnesia: (Seat: Volos) -Establishment of the Mental Health Sector (Government Gazette FEK 292/Vol. B/21-3-2001)


5.3 Prefecture of Trikala: (Seat: Trikala) -Establishment of the Mental Health Sector (Government Gazette FEK 292/Vol. B/21-3-2001)


5.4 Prefecture of Karditsa: (Seat: Karditsa) -Establishment of the Mental Health Sector (Government Gazette FEK 292/Vol. B/21-3-2001)


6th HEALTH REGION: IONIAN ISLANDS

6.1 Prefecture of Corfu - Lefkada: (Seat: Corfu)

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-Establishment of the Mental Health Sector (Government Gazette FEK 138/Vol. B/8-2-2002)


6.2 Prefecture of Zakynthos – Cephalonia: (Seat: Argostoli) -Establishment of the Mental Health Sector (Government Gazette FEK 138/Vol. B/8-2-2002)


7th HEALTH REGION: WESTERN GREECE

7.1 Prefecture of Aetoloacarnania

7.2 Prefecture of Achaia: (Seat: Patras) -Establishment of the Mental Health Sector (Government Gazette FEK 660/Vol. B/23-5-2000)

-Constitution of the Sectoral Committee for Mental Health (Decision No. Y5b/ oik. 1340/7-5-2001)

7.3 Prefecture of Ilia: (Seat: Pyrgos) -Establishment of the Mental Health Sector (Government Gazette FEK 660/Vol. B/23-5-2000)


8th HEALTH REGION: STEREA ELLADA

8.1 Prefecture of Phthiotis – Evrytania: (Seat: Lamia) -Establishment of the Mental Health Sector (Government Gazette FEK 1603/Vol. B/4-12-2001)

-Constitution of the Sectoral Committee for Mental Health (Decision No. Y5b/G.P. OIK. 29940/28-2-2002)

8.2 Prefecture of Phocis: (Seat: Phocis) -Establishment of the Mental Health Sector (Government Gazette FEK 1603/Vol. B/4-12-2001)


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8.3 Prefecture of Euboea – Boeotia: (Seat: Halkida) -Establishment of the Mental Health Sector (Government Gazette FEK 1603/Vol. B/4-12-2001)


9th HEALTH REGION: ATTICA 10TH HEALTH REGION: PELOPONNESE 10.1 Prefecture of Corinthia: (Seat: Corinth) -Establishment of the Mental Health Sector (Government Gazette FEK 292/Vol. B/21-3-2001)


10.2 Prefecture of Argolis: (Seat: Nafplio) -Establishment of the Mental Health Sector (Government Gazette FEK 380/Vol. B/6-4-2001)


10.3 Prefecture of Arcadia: (Seat: Tripolis) -Establishment of the Mental Health Sector (Government Gazette FEK 380/Vol. B/6-4-2001)


10.4 Prefecture of Messenia: (Seat: Kalamata) -Establishment of the Mental Health Sector (Government Gazette FEK 380/Vol. B/6-4-2001)


10.5 Prefecture of Laconia: (Seat: Sparta) -Establishment of the Mental Health Sector (Government Gazette FEK 380/Vol. B/6-4-2001)


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11th HEALTH REGION: NORTHERN AEGEAN 11.1 Prefecture of Lesbos: (Seat: Mytilini) -Establishment of the Mental Health Sector (Government Gazette FEK 292/Vol. B/21-3-2001)


11.2 Prefecture of Chios: (Seat: Chios) -Establishment of the Mental Health Sector (Government Gazette FEK 292/Vol. B/21-3-2001)


11.3 Prefecture of Samos: (Seat: Samos) -Establishment of the Mental Health Sector (Government Gazette FEK 292/Vol. B/21-3-2001)


12th HEALTH REGION: SOUTHERN AEGEAN 12.1 Prefecture of the Cyclades

12.2 Prefecture of the Dodecanese: (Seat: Leros) -Establishment of the Mental Health Sector (Government Gazette FEK 446/Vol. B/14-2-2000)


13th HEALTH REGION: CRETE 13.1 Prefecture of Hania: (Seat: Hania) -Establishment of the Mental Health Sector (Government Gazette FEK 446/Vol. B/14-2-2000)

-Constitution of the Sectoral Committee for Mental Health (Decision No. Y5b oik. 1342/7-5-2001)

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13.2 Prefecture of Rethymno: (Seat: Rethymno) -Establishment of the Mental Health Sector (Government Gazette FEK 446/Vol. B/14-2-2000)

-Constitution of the Sectoral Committee for Mental Health (Decision No. Y5b oik. 1333/7-5-2001)

13.3 Prefecture of Heraklion: (Seat: Heraklion) -Establishment of the Mental Health Sector (Government Gazette FEK 660/Vol. B/23-5-2000)


13.4 Prefecture of Lassithi: (Seat: Agios Nikolaos) -Establishment of the Mental Health Sector (Government Gazette FEK 660/Vol. B/23-5-2000)


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3.2.3 IMPROVEMENT OF PATIENTS’ LIVING CONDITIONS DURING THE 2001-2010 PERIOD AND COMPREHENSIVE PREPARATION FOR THEIR EXIT INTO THE COMMUNITY.

In addition to sectorization, actions must be programmed for the improvement of living conditions on the basis of distribution of the patients of each psychiatric hospital to their areas of origin (areas of residence before they were committed to the psychiatric hospital)

For the 2001-2010 period, Psychargos Programme provides for the creation of housing structures (mostly boarding houses, as well as hostels and sheltered apartments) for a significant number of patients residing at psychiatric hospitals or hospitalized in the psychiatric wards of General Hospitals who need supported living within the community for a period of time.

The highest percentage of patients currently residing at psychiatric hospitals is over the age of 65. Most of them are psycho-geriatric patients and the majority of this population are double-diagnosis patients (mental illness and mental retardation), while a significant number of patients suffer from other disabilities, physical illnesses or organic syndromes.

Consequently, it is necessary to create a significant number of boarding houses that can meet the need for a long-term sheltered stay of these persons.

Structures to be created (long-term boarding houses) will serve up to fifteen patients each, with an increased number of various professionals. The structures will be constructed at the borders of residential areas, so that patients may settle down and live there without any problems.

3.2.4. OPERATIONAL UPGRADING OF MENTAL HEALTH SERVICES

In recent years, a generalized reformative effort is being made to modernize the system of provision of mental health services. One of the two main directions of this endeavour focuses to the exit of chronic mental patients from psychiatric hospitals, while the other targets their integration in community structures.

The need to create community structures emerged from the fact that patients need to receive services near their family environment, as well as support from that environment, thus preserving their social activity by all means.

This trend is aligned with the guidelines of the World Health Organisation and the courses of action of Mental Health programmes in other European countries, such as Great Britain and Ireland.

Mental Health services developed in these countries concern structures for the de-institutionalisation and short-term hospitalization of the mentally ill and hospitalization in General Hospitals.

Community structures developed in these countries form the backbone of their national mental health systems and have reduced the number of admissions to hospitals and the average number of days of stay per mental patient. Some of these structures are the following:

Out-Patient Mental Health Clinics. These are community structures that citizens visit, usually by appointment, from their homes either to be examined for the first time or to continue the therapeutic treatment they are receiving for the mental illness from which they suffer. These clinics are staffed by a Consultant Psychiatrist, Mental Health Nurses and other Mental Health Professionals. Psychiatrists decide on the treatment of patients either in community structures or in hospitals.

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Day Hospitals. These hospitals only operate during the day for citizens suffering from mental illness who need treatment that must be provided at a hospital without overnight stay. These structures are an alternative for patients who would be forced to be admitted to a hospital if these centres were not available. Day Hospitals mostly address the mentally ill who can receive treatment at home for a period of time but must visit these centres in order to receive some sort of therapeutic treatment. Day Hospitals must also have a consultant psychiatrist, just like outpatient clinics.

Day Centres. These are community structures providing support to patients who need psychological support and visit them on their own volition. The mission of Day Centres is to provide a friendly, supportive environment with activities suitable for the needs of each patient.

Sheltered Workshops. These are community structures where mental patients work in activities suitable for their skills, with support and guidance provided by trained professionals.

Residential Units. Housing is vitally important for mental patients, especially for the chronically ill who depend on the cooperation between hospitals and community-based mental health agencies in order to receive satisfactory services outside hospitals. The mental health services provided by hospitals and non-hospital structures must operate in synergy so as to provide services to mental patients. Some residential units serve as rest areas for patients who need such treatment at some point in their lives.

High Support Group Homes. These are residential structures addressing people who do not need to be in hospitals and can live within the community, but who require hospitalization for 24-hour periods for various reasons. Some people may spend a period of their lives in such structures and then transfer to Medium or Low Support Group Homes.

Medium Support Group Homes. These are structures addressing people who are relatively independent when it comes to most issues of their daily lives, but who need help and support for specific issues (such as finances and cooking). For this reason, these structures are only staffed during the day by nurses or trained personnel.

Low Support Group Homes. These are structures addressing people who are independent for most activities of their daily lives. The overall care and administration of these homes are coordinated by the administration of the controlling hospital. A nurse supervises patients at these homes.

In Greece, which is a Member State of the World Health Organisation and the European Section of the World Federation for Mental Health, these new perceptions brought about changes in the attitudes and approaches of Mental Health professionals, as well as in the structure and types of services provided to patients and citizens in general.

The preparation for de-institutionalisation of mental patients was supported by the implementation of new therapeutic/treatment methods – besides pharmaceutical treatment – that had either been occasionally implemented or had never been implemented before. Among others, these methods included family therapy, systemic, group and occupational therapy, speech therapy, drama therapy, music therapy and other special forms of therapy.

In order to further implement these orientations, it is necessary:

• to create more community-based mental health structures

• to expand the implementation of the aforementioned therapeutic methods and, at the same time,

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• to develop suitable infrastructure and conditions concerning the preparation of

patients for their exit into the community at modern “de-institutionalisation” structures.

The first systematic effort for the implementation of a de-institutionalisation programme took place within the framework of the implementation of the 1st Phase (1997-2001) of “PSYCHARGOS” national programme.

During the implementation of this phase, approximately 1,000 patients were relocated to modern structures providing mental health services and significant experience and know-how has been acquired from this endeavour.

However, the limited – to date – implementation of the de-institutionalisation programme, combined with the existence of social stereotypes and medical practices opting for the model of closed institutionalised care, has created a reality that hinders the progress of psychiatric reform. In other words, society and perhaps most professionals in the sector of Mental Health have not been informed of the positive results that de-institutionalisation of patients and their integration in modern non-hospital structures have for patients themselves.

The problem is also intensified by the fact that existing primary and secondary community mental health care structures are not adequate to meet increasing needs, which results in many patients being committed to closed psychiatric structures.

At the same time, the number of personnel employed in the mental health sector is not sufficient to support the de-institutionalisation effort. Moreover, the existing infrastructure of certain psychiatric hospitals is old (or was damaged by the 2000 earthquakes), with a negative impact on patients’ living conditions.

During the next programming period, the effort for the de-institutionalisation of chronic mental patients and their relocation to community structures must be continued. The care provided must correspond to the needs of the Mental Health sector, must encompass modern perceptions and practices and must be oriented towards the creation of community-based open mental health care structures.

The upgrading is expected to ensue from:

• The relocation of patients to non-hospital structures – hostels, boarding houses , sheltered apartments – and the expansion of the operation of vocational training for the promotion of social and labour re-integration of patients in structures that already exist or will be created, depending on actual needs.

• The implementation of a modern operational model, initially in selected and eventually in all psychiatric hospitals, aiming at abandoning “protectionism” and closed care and at ensuring the provision of modern mental health services.

• The upgrading of existing infrastructure in psychiatric hospitals.

3.2.5 DEVELOPMENT OF PRIMARY AND SECONDARY COMMUNITY–BASED MENTAL HEALTH CARE STRUCTURES AND PROGRAMMES AND INTERCONNECTION OF SERVICES WITHIN INTEGRATED NETWORKS IN THE FRAMEWORK OF MENTAL HEALTH SECTORS

Community structures to be developed are the following:

• Comprehensive psychiatric divisions in General Hospitals.

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• Comprehensive children’s psychiatric wards in General Hospitals (each

comprehensive division/ward includes a hospitalisation ward, a short-stay unit, a Crisis Intervention Centre and an Acute Unit.

• Mental Health Centres for adults,

• Medical-pedagogical Centres for children and adolescents.

• Emergency Crisis Intervention Units for drug addicts at General Hospitals.

• Detoxification and psychological support units for alcoholics.

• Comprehensive units for people with autism spectrum disorders that include a Day Centre, a Hostel, a Crisis Intervention Centre and a Training & Research Centre.

• Mobile Mental Health Units for particularly inaccessible areas (mainly islands and remote mountainous locations).

• Day centres for adults and children or adolescents.

• High or medium support homes and short or medium-stay hostels linked to comprehensive psychiatric wards.

• Vocational re-integration units.

• Special units providing services to families.

• Hostels, Boarding houses and Sheltered Apartments for people suffering from autism spectrum disorders.

• Hostels, Boarding houses and Sheltered Apartments to accommodate 3,500 persons who have resided at Psychiatric Hospitals for long periods of time.

• Centres for Alzheimer’s Disease.

• Units for detention and hospitalisation, in accordance with the provisions of Article 69 of the Penal Code (in cooperation with the Ministry of Justice).

• Detoxification units for substance addicted prison inmates (in cooperation with the Ministry of Justice).

• Limited Liability Social Partnerships in equal number with Mental Health Sectors (MHS).

• For the population of patients deemed capable of living independently within the community, hostels and sheltered apartments will be developed in city districts. In each of these structures, the inter-disciplinary team will adjust its operational models so as to achieve maximum facilitation of their tenants at all times.

3.2.6 CONTINUATION OF CARE FOR TARGET-POPULATIONS AT COMMUNITY LEVEL

Within the framework of ensuring the continuation of care for target-populations at community level, provision has been made for:

• The development of a dynamic process for the rehabilitation and socio-economic (re)integration of chronic inpatients being de-institutionalised and the chronic patients living within the community. The process is expected to support labour and social re-integration of the target-population. This process includes vocational training actions and implementation of policies aiming at the creation of new sources of employment.

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• The creation of Limited Liability Social Partnerships.

• The implementation of actions supporting partnership activities, thus ensuring the creation of equal opportunities for the mentally ill.

3.2.7 PROMOTION OF PREVENTION

The promotion of prevention is particularly enhanced by the development of primary Mental Health services, which can operate as a safety net for the mentally ill and the community, in general. At the same time, these services are expected to contribute towards the avoidance of internment and institutionalisation.

3.2.8 ACTIONS THAT PROMOTE SOCIAL SOLIDARITY AND ENHANCE ACTIONS FOR THE RE-INTEGRATION OF TARGET MENTAL PATIENTS INTO THE LABOUR MARKET

These actions entail raising the awareness of the general population (and particularly those living in intervention areas) on the content and objectives of the de-institutionalisation being promoted, as well as of the psychiatric reform in general.

The purpose of these actions is:

• To limit possible social reactions.

• To combat the stigma resulting from the myths and stereotypes that accompany mental disorders.

• To increase knowledge and raise awareness on issues of mental disorders.

• To improve mechanisms for social acceptance and integration of persons suffering from mental health problems.

Awareness-raising actions will be planned and implemented in close cooperation with professionals (psychologists – psychiatrists – sociologists, etc) working for the promotion of de-institutionalisation and the support mechanism of the Ministry of Health & Welfare.

Interventions will be of an informative – educational character and will take place throughout the duration of the project.

Channels of communication to be used are the mass media, as well as alternative initiatives (mobile units, festivals, shows, exhibitions – presentations, etc.).

There also appears to be a need for interventions targeting special population groups that play a decisive or intermediary role between society in general and the mentally ill (e.g. mayors, educators, employers, opinion makers, etc.).

3.2.9 ACTIONS SUBJECT TO THE INFORMATION TECHNOLOGY SECTOR

Continuation of psychiatric care is expected to be ensured through actions that pertain to the development of structures and infrastructure. These actions must be in synergy with the action of the OP “Information Society”, which concerns the exploitation of new technologies for the improvement of services provided by Mental Health agencies.

It is recommended that actions to be developed should include all necessary interventions aiming at introducing necessary IT systems in Mental Health agencies (Psychiatric Wards, Mental Health Centres, Emergency Intervention Units, etc.) and

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in administrative supervision mechanisms (Regional Health Centres, Ministry of Health & Welfare), with the following basic objectives:

• Improving Mental Health services provided that aim at the psycho-social rehabilitation and social re-integration of the mentally ill.

• Supporting the “Psychargos” National Action Plan for Mental Health.

IT support of Mental Health in Greece, can be developed within the framework of Information Society (IS) and in the three sectors herebelow. Specifically, interventions to be planned must have the following purpose:

• The development-evolution of necessary information database with the direct objective of better executive planning of administrative policy (Regional Health Centres, Ministry of Health & Welfare) and the long-term objective of successfully implementing the reforms being attempted.

• The development of online information portals aiming at informing citizens on all Mental Health issues.

• The development of cutting-edge pilot applications in the following directions: a) electronic mental health record, b) pilot tele-psychiatry system and c) tele-conference system.

Better organization of the Mental Health sector and improvement of services provided to citizens necessitate the creation of a database to support the collection, classification and utilization of information related to:

• Psychiatric Services

• Treatment of drug addiction

• Treatment of alcohol addiction

• Autism

• Alzheimer’s Disease and organic syndromes

Information Database This database will collect information from all mental health agencies and institutions; Regional Health Centres will act as intermediary data collectors, while the Ministry of Health & Welfare will be the final recipient. The information collected concerns primary data and specific indicators.

In order for Regional Health Centres to collect information, “Internal Networking” structures (departments, intra-hospital hostels, workshops, other structures) must be developed and connected to non-hospital structures (Mental Health centres, day centres, hostels, boarding houses) and, finally, to Regional Health Centres.

Specifically:

Attica Psychiatric Hospital • Internal Networking-approximately 200 computer jobs.

Already covered by a relevant 2nd CSF project.

• External structures-approximately 100 computer jobs in Attica.

“Dromokaitio” Psychiatric Hospital of Attica

• Internal Networking-approximately 200 computer jobs. To be covered by a hospital networking project

• External structures-approximately 80 computer jobs in

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Attica

Attica Psychiatric Hospital (Dau-Rafina)

• Internal Networking. To be covered by a hospital networking project.

• External structures-approximately 40 computer jobs in Attica.

• To be closed down as a Psychiatric Hospital in 2005-6. Its non-hospital structures and departments will be organically transferred to other General Hospitals and Children’s Hospitals in Attica. It may continue operating subsequently as a Rehabilitation Centre.

Tripoli Psychiatric Hospital • Internal Networking-approximately 100 computer jobs. To be covered by a hospital networking project.

• External structures-approximately 60 computer jobs in Tripoli.

• To be closed down as a Psychiatric Hospital in 2006 and incorporated into the “Panarcadiko” General Hospital of Tripolis (possible relocation to the building facilities of the University of the Peloponnese).

State Psychiatric Hospital of Hania

• Internal Networking-approximately 100 computer jobs. To be covered by a hospital networking project.

• External structures-approximately 60 computer jobs in Hania.

• To be closed down as a Psychiatric Hospital in 2006 and incorporated into the General Hospital of Hania.

Leros State Psychiatric Hospital


• External structures-approximately 30 computer jobs on the island.


• Internal Networking-To be covered by a hospital networking project:

Α) approximately 120 computer jobs in Petra Olympou.

Β) approximately 60 computer jobs in Katerini.

• External structures-approximately 20 computer jobs in Katerini.

• To be closed down as a Psychiatric Hospital in 2006 and incorporated into the General Hospital of Katerini. Its facilities at Petra are to operate as a detoxification centre and as a cooperative.

Psychiatric Hospital of Thessaloniki


• External structures-approximately 120 computer jobs in the Prefecture of Thessaloniki.

Psychiatric Hospital of Corfu • Internal Networking-approximately 80 computer jobs. To be covered by a hospital networking project.

• External structures-approximately 80 computer jobs on the island.

• To be closed down as a Psychiatric Hospital in 2006

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and incorporated into the General Hospital of Corfu at its old building facilities. Potential operation of Ionian University departments.

General Hospitals (Psychiatric wards – Mental Health centres –Medical-Pedagogical centres)

Apart from the general networking of each hospital, special networking is required for the psychiatric services of each hospital. To be covered by a hospital networking project. In total:

Α) Psychiatric Divisions, Detoxification Units, Autism Units, Alzheimer’s Disease Units = 444 computer jobs throughout the country. Of these jobs, the ones in hospitals will be covered by other actions.

Β) Mental Health Centres and Medical-Pedagogical centres = 216 computer jobs throughout the country.

C) Community Structures = 556 computer jobs throughout the country.

Mental Health Centres Α) Central Athens = 50 computer jobs, Community structures = 20 computer jobs.

Β) Piraeus = 10 computer jobs.

C) Thessaloniki = 10 computer jobs.

Non-Governmental Organisations funded by the Ministry of Health & Welfare

Estimated computer jobs = approximately 200 throughout the country.

Limited Liability Social Partnerships

15 units throughout the country, approximately 200 computer jobs.

Drug addiction and alcoholism treatment agencies

Α) KETHEA-Internal Networking = 30 computer jobs. External networking = 180 computer jobs throughout the country.

Β) OKANA - Internal Networking = 30 computer jobs. External networking = 300 computer jobs throughout the country.

Information Portals It has been made clear that in the health sector and, specifically, the mental health sector, the provision of direct access to information through web portals for citizens is an urgent need and, at the same time, marks a huge improvement of services provided.

This information has two main objectives:

• Provision of information on Mental Health structures in each region and the possibilities open to citizens for contacting them (addresses, telephone numbers, working hours, specializations, etc.).

• Provision of information on Mental Health and ways to address conditions and problems that can initially be dealt with “from a distance”, as well as possibility of communication between patients and specialised doctors via e-mail.

Pilot Applications With regard to #3, development of pilot applications:

Α) Patients’ psychiatric records are a special case of electronic medical records with the following characteristics:

55


• They are vitally necessary for monitoring and treating patients,

• The history of each patient is usually quite long, and

• The history of each patient is hand-written for each case.

These characteristics lead to the following conclusions:

• It is vital for the Mental Health sector to be able to easily and quickly find a patient’s record.

• The history of each patient can always be found in printed format and, therefore, the easiest solution at a first stage is to scan documents and enter these images into a computer system.

The application will initially run within a pilot network and its success will be evaluated before it is expanded at national level.

Β) Tele-psychiatry is a method of psychiatric sessions via the Internet, where doctors and patients are not at the same location. Necessary equipment is required to support tele-psychiatry (cameras, ISDN telephone lines, PCs, etc.).

C) Tele-conference services: Given the development of the Mental Health system in many regional agencies where not all professional specializations exist and the need for long cooperation between professionals of various disciplines, the development of a tele-conference system is advisable.

It has been proposed to carry out a pilot development of such a system serving a specific region. Further development of this pilot system will be determined by initial results.

3.3 ACTIONS FORESEEN FOR THE 2001-2010 DECADE

3.3.2 SPECIAL ACTIONS

Within the framework of the implementation of Psychiatric Reform, it is necessary to achieve the following objectives:

• Effective support of the course of implementation of interventions.

• Organisational and scientific monitoring and evaluation of interventions.

• Promotion of de-institutionalisation and final shutting down of psychiatric hospitals.

• Support to de-institutionalisation agencies in the implementation of all actions for de-institutionalisation and social re-integration of mental patients.

3.3.2.1 SPECIAL DE-INSTITUTIONALISATION ACTIONS

• Creation of a Unit for the Support and Monitoring of Implementation Agencies, its main objective being the planning and implementation of mechanisms supporting the progress of the implementation of interventions, as well as the organizational and scientific monitoring and evaluation thereof.

• Creation of an Intervention Structuring Unit in the de-institutionalisation process.

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57

• Relocation of patients to non-hospital structures – hostels, boarding houses, sheltered apartments – and expansion of the training function for the promotion of their social and labour re-integration.

• Support actions for beneficiary agencies that will implement all patient de-institutionalisation and socio-economic re-integration actions.

3.4 ACTIONS FORESEEN FOR 2002-2004

The following actions have been foreseen for the development of structures and infrastructure required by the Psychargos Programme during the 2002-2003 two-year period:


1ST PART (2002-2004)

ACTIONS FORESEEN FOR 2002-2004

Action: Development, Complementing, Expansion of Community Structures

Sub-Action: Development of structures serving prevention and hospitalisation

Objective Agency Activity

Hospital of Samos Adding necessary medical and other staff positions at the existing Mental Health Centre of the Hospital (Ikaria-Fournoi area)

Hospital of Alexandroupolis Adding necessary medical and other staff positions at the Hospital’s Psychiatric division for Adults

Hospital of Mytilini Adding necessary medical and other staff positions at the Hospital’s Psychiatric division for Adults

Hospital of Polygyros Adding necessary medical and other staff positions at the Hospital’s Psychiatric division for Adults

“Papanikolaou” Hospital of Thessaloniki

Adding necessary medical and other staff positions at the Hospital’s Child Psychiatric division

Hospital of Tripoli Notification of hiring/opening of positions to support the operation of the Hospital’s Mental Health Centre

Hospital of Alexandroupolis Notification of hiring/opening of positions to support the operation of the Hospital’s Mental Health Centre

Modernisation of structures and infrastructure of psychiatric hospitals for the improvement of patients’ living conditions

Hospital of Agrinio Notification of hiring/opening of positions to support the operation of the Hospital’s Mental Health Centre

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Continued

“Sotiria” Hospital for Chest Conditions Notification of hiring/opening of positions to support the operation of the Mental

Health Centre Attica Psychiatric Hospital Notification of hiring for immediate coverage of positions of medical staff at the

Mental Health Centre of Agioi Anargiroi or the broader region due to the error made in the act establishing these positions, which stated that the Centre belongs to “Agia Olga” Hospital

Aeginitio Hospital Hiring of Mental Health Centre staff by the Ministry of Education. However, payroll and other operational expenditure will be covered for 1 year by Axis 2 of OP “Health-Welfare” . There will be interventions on the building, along with purchases – improvement of equipment, which will be covered by Axis 2 Measure 2.

Attica Psychiatric Hospital Establishment of the Perama Mental Health Centre and Notification of hiring to

cover staff positions. Dromokaitio Psychiatric Hospital Construction or purchase of buildings that will house 3 Mental Health centres in

the areas of Athens and Piraeus using the hospital’s reserve funds. Attica Psychiatric Hospital Construction or purchase of buildings that will house 3 Mental Health Centres in

the areas of Athens and Piraeus using hospital reserve funds. G. Gennimatas Hospital Purchase or construction of a new building to resolve housing needs of the

Hospital’s Mental Health Centre, which is already operating in a rented building and is to be evicted.

Psychiatric Hospital of Thessaloniki Construction or purchase of buildings that will house 1 Mental Health Centre in the

broader area of Kalamaria using the hospital’s reserve funds.

Psychiatric Hospital of Corfu Construction or purchase of buildings that will house 1 Mental Health Centre using

the hospital’s reserve funds.

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Continued

“Agia Sophia” Children’s Hospital Creation of 2 Medical-Pedagogical Centres and notification of hiring to cover staff

positions “Aglaia Kyriakou” Children’s Hospital Creation of 2 Medical-Pedagogical Centres and notification of hiring to cover staff

positions

Modernization of structures and infrastructure of Medical-Pedagogical Centres

Children’s Hospital of Pendeli Creation of 2 Medical-Pedagogical Centres and notification of hiring to cover staff

positions “Litharaki” Unit for Autistic Children, Nea Smyrni

Adding staff positions at the Day Centre for persons suffering from autistic type disorders

Modernization of structures and infrastructure of Day Centres

Autistic Children’s Care Unit, Palaeo Psychiko

Adding staff positions at the day centre for persons suffering from autistic type disorders

Modernization of structures and infrastructure of Adolescents’ Units

AHEPA Hospital of Thessaloniki

Operation of an Adolescents’ Unit that will include a day centre and a short-stay hostel. It will be necessary to proceed to an amendment of the Organisation, along with the creation of the unit and staff positions and a notification of hiring to cover these job positions. The teaching positions in support of adolescents, so that they do not diverge or get severed from their learning duties, can be filled in by the Ministry of Education.

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Continued

“Georgios Gennimatas” Hospital

Operation of Short-Stay Hostels for the patients of the psychiatric ward. In order to ensure the operation of each of the above hostels, it will be necessary to increase the number of employee positions, with a corresponding amendment to the organization of each hospital and immediate hiring of staff.

“Georgios Gennimatas” Hospital


“Sotiria” Hospital Operation of Short-Stay Hostels for the patients of the psychiatric ward. In order to ensure the operation of each of the above hostels, it will be necessary to increase the number of employee positions, with a corresponding amendment to the organization of each hospital and immediate hiring of staff.

“Sismanogleio” Hospital Operation of Short-Stay Hostels for the patients of the psychiatric ward. In order to ensure the operation of each of the above hostels, it will be necessary to increase the number of employee positions, with a corresponding amendment to the organization of each hospital and immediate hiring of staff.

Hospital of Nicaea Operation of Short-Stay Hostels for the patients of the psychiatric ward. In order to ensure the operation of each of the above hostels, it will be necessary to increase the number of employee positions, with a corresponding amendment to the organization of each hospital and immediate hiring of staff.

Modernization of structures and infrastructure of Short-Stay Units

Hospital of Nea Ionia Operation of Short-Stay Hostels for the patients of the psychiatric ward. In order to ensure the operation of each of the above hostels, it will be necessary to increase the number of employee positions, with a corresponding amendment to the organization of each hospital and immediate hiring of staff.

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Continued

“Thriassio” Hospital Operation of Short-Stay Hostels for the patients of the psychiatric ward. In order to ensure the operation of each of the above hostels, it will be necessary to increase the number of employee positions, with a corresponding amendment to the organization of each hospital and immediate hiring of staff.

Erithros Stavros (Red Cross) Hospital


Modernization of structures and infrastructure of Day Centres

Aeginitio Hospital Hiring of staff to support the needs of the Day Centre, with expenses covered by Axis 2 of OP “Health-Welfare” for one year. Interventions need to be made to the building and equipment has to be purchased. These expenditures will be covered by Axis 2 of the same Programme.

Modernization of structures and infrastructure of Units for Alzheimer’s Disease

Greek Association of Alzheimer’s Disease

Development of Units dealing with Alzheimer’s Disease that will include a Boarding house, a Day Centre and a Family Support Service.

“Sismanogleio” Hospital Additions to existing Psychiatric division with the following Units: Acute episodes, Short-Stay treatment, Crisis Intervention Centre

“Sotiria” Hospital Additions to existing Psychiatric division with the following Units: Acute episodes, Short-Stay treatment, Crisis Intervention Centre

Modernization of structures and infrastructure of psychiatric divisions of General Hospitals

“Agia Olga” Hospital of Nea Ionia

Additions to existing Psychiatric division with the following Units: Acute episodes, Short-Stay treatment, Crisis Intervention Centre

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Continued

“Thriassio” Hospital Additions to existing Psychiatric division with the following Units: Acute episodes, Short-Stay treatment, Crisis Intervention Centre

Hospital of Nicaea Additions to existing Psychiatric division with the following Units: Acute episodes, Short-Stay treatment, Crisis Intervention Centre

“Evangelismos” Hospital Additions to existing Psychiatric division with the following Units: Acute episodes, Short-Stay treatment, Crisis Intervention Centre

“Asclepieion” Hospital of Voula

Construction of buildings for the development of a Psychiatric division

Erithros Stavros (Red Cross) Hospital

Construction of buildings for the development of a Psychiatric division

Children’s Hospital of Pendeli

Construction of buildings for the development of a Child Psychiatric division

“Sotiria” Hospital Construction of buildings for the development of a 2nd Psychiatric division “Sismanogleio” Hospital Construction of buildings for the development of a 2nd Psychiatric division

Hospital of Corfu Construction of buildings for the development of a Psychiatric division. Funding will be covered by reserve funds of the Psychiatric Hospital of Corfu

Hospital of Katerini Construction of buildings for the development of a Psychiatric division. Funding will be covered by reserve funds of the Psychiatric Hospital of Petra Olympou

“Amalia Fleming” Hospital Relocation to an existing building following maintenance – restructuring – repair of the Psychiatric division with a capacity of 15 beds

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Continued

“Elena Venizelou” Hospital Relocation to an existing building following maintenance – restructuring – repair of the Psychiatric division with a capacity of 15 beds, of which 5 are for the “Mitera” special unit

Hospital of Sparta Relocation to an existing building following maintenance – restructuring – repair of the Psychiatric division

“Aglaia Kyriakou” Children’s Hospital

Relocation to an existing building following maintenance – restructuring – repair of the Child Psychiatric division

“Sotiria” Hospital Construction of a new building to meet the operational needs of the Crisis Stabilization Unit for Drug Addiction and Substance Abuse

“Sismanogleio” Hospital Construction of a new building to meet the operational needs of the Crisis Stabilization Unit for Drug Addiction and Substance Abuse

Hospital of Rio Patron Construction of a new building to meet the operational needs of the Crisis Stabilization Unit for Drug Addiction and Substance Abuse

University Hospital of Heraklion

Construction of a new building to meet the operational needs of the Crisis Stabilization Unit for Drug Addiction and Substance Abuse

“Hatzikosta” University Hospital of Ioannina


Modernization of structures and infrastructure of Crisis Stabilization Units for Drug Addiction and Substance Abuse



“Sotiria” Hospital Construction of a new building to meet the operational needs of the Alcoholism Treatment Unit Modernization of structures

and infrastructure of Alcoholism Treatment Units

“Sismanogleio” Hospital Construction of a new building to meet the operational needs of the Alcoholism Treatment Unit

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Continued

Hospital of Rio, Patras Construction of a new building to meet the operational needs of the Alcoholism Treatment Unit


Construction of a new building to meet the operational needs of the Alcoholism Treatment Unit

“Hatzikosta” University Hospital




Hellenic Society for the Protection of Autistic Persons

Development of a Comprehensive Centre for Autism

“Perivolaki” Centre for the Treatment of Children and Families, Athens

Development of a Comprehensive Centre for Autism

Modernization of structures and infrastructure of Units for Persons with Autism

Hellenic Society for the Protection of Autistic Persons, Athens

Development of a unit hosting autistic persons who display particularly high aggressiveness

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SCHEDULED ACTIONS FOR 2002-2004

Action: Development, Complementing, Expansion of Community-based Structures

Sub-action: De-institutionalisation



Development [by the same agency] of de-institutionalisation units in Attica for 160 patients suffering from mental disorders. Specifically, 10 hostels, 3 boarding houses and 5 apartments will be created.

Hospital of Halkida Development of de-institutionalisation units (two sheltered apartments) so as to enable the transfer of new patients from the Attica Psychiatric Hospital to the newly vacated positions in the hostels.

Hospital of Agrinio Development of de-institutionalisation units (two sheltered apartments) so as to enable the transfer of new patients from the Attica Psychiatric Hospital to the newly vacated positions in Hostels.

Reduction of the number of chronic patients by approximately 450 persons at the Attica Psychiatric Hospital

Agencies of Regulation (EEC) 815/84 and other Legal Entities under Private Law belonging to the Mental Health sector

Relocation of 280 patients suffering from mental disorders with underlying mental retardation and other physical problems from the Attica Psychiatric Hospital to 19 boarding houses to be created in Attica and elsewhere, with a capacity of 15 persons each. The boarding houses will create agencies of Regulation (EEC) 815/84 and other Legal Entities under Private Law belonging to the Mental Health Sector.

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Continued

«Dromokaitio” Psychiatric Hospital of Attica

Development [by the same agency] of de-institutionalisation units in Attica for 95 patients suffering from mental disorders and light to medium mental retardation at 5 hostels with a capacity of 12 patients and 6 apartments with a capacity of 6 patients.

Reduction of the number of chronic patients by 217 at the “Dromokaitio” Psychiatric Hospital of Attica

Hospital of Chios Development of 2 sheltered apartments by the Hospital of Chios, which is cooperating with “Dromokaitio” during the 1st Phase of Psychargos Programme, so as to enable the transfer of new patients from the “Dromokaitio” Psychiatric Hospital of Attica to the newly vacated places in the hostel.


Relocation of 120 patients suffering from mental disorders with underlying mental retardation and other physical problems from «Dromokaitio” Psychiatric Hospital of Attica to 8 boarding houses to be created in Attica and elsewhere, with a capacity of 15 persons each.

Relocation of 45 hospitalised chronic patients

Attica Children’s Psychiatric Hospital Development of 3 boarding houses with a capacity of 15 beds each by

the Mental Health Centre in Attica and elsewhere, the first criterion being territorial distribution. Each boarding house will host 45 hospitalised chronic patients who have already reached adulthood. The Mental Health Centre will need to hire staff for the operation of these boarding houses .

Reduction of the number of chronic patients by 165 at the Children’s Psychiatric Hospital of Thessaloniki

Children’s Psychiatric Hospital of Thessaloniki

Development [by the same agency] of de-institutionalisation units in the Prefecture of Thessaloniki for patients suffering from mental disorders. Specifically, the following will be created: 1 hostel with a capacity of 15 patients, 2 boarding houses for 27 patients, 4 apartments

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Continued

Hospital of Polygyros Development of 2 sheltered apartments in order to vacate places at the 2 hostels, which will be filled by new patients from the Psychiatric Hospital of Thessaloniki

Hospital of Kavalla Development of 2 sheltered apartments in order to vacate positions at the 2 hostels, which will be filled by new patients from the Psychiatric Hospital of Thessaloniki

Hospital of Kavalla Development of boarding houses for 12 patients with mental disorders

Hospital of Serres Development of boarding houses for 15 patients with mental disorders

Hospital of Kilkis Development of boarding houses for 11 patients with mental disorders

Hospital of Halkidiki Development of boarding houses for 16 patients with mental disorders

Agencies of Regulation (EEC) 815/84 and other Legal Entities under Private Law belonging to the Mental Health Sector

Development of de-institutionalisation units by agencies of Regulation (EEC) 815/85 and other Legal Entities under Private Law belonging to the Mental Health Sector, with the objective of relocating 57 patients to 4 boarding houses . These units will be created in Thessaloniki and elsewhere, the first criterion being distribution, for patients of the Psychiatric Hospital of Thessaloniki suffering from mental disorders with underlying mental retardation and other mental and physical problems.

Reduction of the number of chronic patients by 241 at the Psychiatric Hospital of Petra Olympou


Development [by the same agency] of the following units in the Prefecture of Pieria, with coverage by the existing staff: 3 hostels with a capacity of 10 persons with mental disorders, 1 boarding house with a capacity of 14 persons with psycho-geriatric problems, 3 apartments with a capacity of 3 persons each.

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Continued

Hospital of Volos Development of 2 sheltered apartments in order to vacate places at the hostels, which will be filled by other chronic patients from the Psychiatric Hospital of Petra Olympou

Hospital of Larissa Development of 2 sheltered apartments in order to vacate positions at the hostels, which will be filled by other chronic patients from the Psychiatric Hospital of Petra Olympou – Development of 1 hostel for hosting 12 persons with mental disorders, 2 apartments for 3 and 4 persons

Hospital of Trikala Development of 2 sheltered apartments in order to vacate places at the hostels, which will be filled by other chronic patients from the Psychiatric Hospital of Petra Olympou – Development of 1 hostel hosting 11 persons

Hospital of Karditsa Development of 2 sheltered apartments in order to vacate places at the hostels, which will be filled by other chronic patients from the Psychiatric Hospital of Petra Olympou – Development of 1 Hostel for hosting 13 persons

Hospital of Kozani Development of 1 Hostel for hosting 10 persons

Agencies of Regulation (EEC) 815/84 and other Legal Entities under Private Law in the Mental Health sector

Development of boarding houses in the region including the prefectures of Central Macedonia, Western Macedonia and Thessaly for cases of mental disorders with underlying mental retardation and other psycho-geriatric problems. These boarding houses will be constructed by agencies of Regulation (EEC) 815/84 and other Legal Entities under Private Law in the Mental Health Sector for 70 cases of psycho-geriatric problems and 65 cases of mental retardation.

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Continued


Development of 4 boarding houses for persons suffering from mental disorders, psycho-geriatric problems and mental retardation, as well as 3 sheltered apartments by the same agency, with personnel provided by the agency from staff already employed, corresponding to 50% of the staff required for operation

“Hatzikosta” Hospital of Ioannina

Development of 2 sheltered apartments by the hospital

Hospital of Arta Development of 2 sheltered apartments by the hospital

Hospital of Preveza Development of 2 sheltered apartments by the hospital

Hospital of Filiata Development of 2 sheltered apartments by the hospital

Reduction of the number of chronic patients at the Psychiatric Hospital of Corfu by 76 persons


Development of 4 boarding houses in the region of Epirus by agencies of Regulation (EEC) 815/84 and other Legal Entities under Private Law belonging to the Mental Health sector for patients suffering from medium to severe mental and other disabilities.

The objective is to reduce the number of chronic patients at the Psychiatric Hospital of Tripolis by 170 persons


Development of structures by the same agency and with exclusive personnel employed at 1 boarding house with a capacity of 15 persons, 2 hostels with a capacity of 10 persons each, 3 sheltered apartments with a capacity of 2-3 persons each.

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Continued

Hospital of Corinth Development of 2 sheltered apartments at the hospital, which will host patients from the hostels, where the newly vacated positions will be filled by other chronic patients of the Psychiatric Hospital of Tripolis, and 1 hostel for patients suffering from various severe disorders and problems who have had a long-term stay at the Psychiatric Hospital of Tripolis

Hospital of Nafplion Development of 2 sheltered apartments at the hospital, which will host patients from the hostels, where the newly vacated positions will be filled by other chronic patients of the Psychiatric Hospital of Tripolis, and 1 hostel for patients suffering from various severe disorders and problems who have had a long-term stay at the Psychiatric Hospital of Tripolis

Hospital of Sparta Development of 2 sheltered apartments at the hospital, which will host patients from the hostels, where the newly vacated positions will be filled by other chronic patients of the Psychiatric Hospital of Tripolis

Hospital of Kalamata Development of 2 sheltered apartments at the hospital, which will host patients from the hostels, where the newly vacated positions will be filled by other chronic patients of the Psychiatric Hospital of Tripolis

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Continued

Hospital of Pyrgos Development of 2 sheltered apartments at the hospital, which will host patients from the hostels, where the newly vacated positions will be filled by other chronic patients of the Psychiatric Hospital of Tripolis, and 1 hostel for patients suffering from various severe disorders and problems who have had a long-term stay at the Psychiatric Hospital of Tripolis

Hospital of Patras Development of 2 sheltered apartments at the hospital, which will host patients from the hostels, where the newly vacated positions will be filled by other chronic patients of the Psychiatric Hospital of Tripolis

Hospital of Messolongi Development of 2 sheltered apartments at the hospital, which will host patients from the hostels, where the newly vacated positions will be filled by other chronic patients of the Psychiatric Hospital of Tripolis, and 1 hostel for patients suffering from various severe disorders and problems who have had a long-term stay at the Psychiatric Hospital of Tripolis

Hospital of Agrinio Development of 2 sheltered apartments at the hospital, which will host patients from the hostels, where the newly vacated positions will be filled by other chronic patients of the Psychiatric Hospital of Tripolis

University Hospital of Rio, Patras

Development of 1 Hostel for patients suffering from various severe disorders and problems who have had a long-term stay at the Psychiatric Hospital of Tripolis

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Continued

Hospital of Cephalonia

Development of 1 hostel for patients suffering from various severe disorders and problems who have had a long-term stay at the Psychiatric Hospital of Tripolis

Agencies of Regulation (EEC) 815/84 and other Legal Entities under Private Law belonging to the Mental Health Sector

Development of 2 boarding houses by agencies of Regulation (EEC) 815/84 or other Legal Entities under Private Law belonging to the Mental Health Sector in the region that includes the prefectures of the Peloponnese and/or other prefectures of bordering areas, the main criterion being distribution of patients.

State Psychiatric Hospital of Hania

Development of hostels and boarding houses by the State Psychiatric Hospital of Hania, which will be staffed by approximately 50% from the personnel already employed at the Hospital and by 50% from personnel to be hired in the future. Specifically, the hospital will develop 2 hostels with a capacity of up to 10 persons each for patients suffering from mental disorders, 1 boarding house with a capacity of up to 20 persons for patients suffering from mental retardation and mental disorders, 1 psycho-geriatric boarding house with a capacity of up to 15 persons.

Hospital of Rethymno Development of 1 boarding house with a capacity of up to 15 places


Development of 1 hostel with a capacity of up to 12 places

Reduction of the number of chronic patients at the State Psychiatric Hospital of Hania by 100 persons

Hospital of Agios Nikolaos

Development of 1 hostel with a capacity of 10 places for persons suffering from mental disorders

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Continued

Legal Entities under Private Law belonging to the Mental Health sector

Development of 1 boarding house in the Prefecture of Lassithi with a capacity of up to 15 places for patients suffering from mental retardation and/or other conditions who are either from the Prefecture of Lassithi or the Prefecture of Heraklion

Leros State Psychiatric Hospital – Health Centre

To be developed by the same agency, but also in cooperation with other hospitals in the Dodecanese, basically by utilizing existing personnel and, secondarily, by hiring new personnel at associated hospitals, which will be approved immediately after the fulfilment of the requirements set for the completion of the Special Action at Leros under the 2nd CSF ROP of the Southern Aegean.

Reduction of the number of chronic patients at the Leros State Psychiatric Hospital – Health Centre


Development of boarding houses widely distributed throughout the entire country, excluding the Dodecanese, for 200 patients of the Leros State Psychiatric Hospital – Health Centre


2ND PART (2003-2006)



Sub-Action: Development of structures that serve prevention and hospitalisation


Competent Sectoral Committee for Mental Health of Kalamata

Operation of the Mental Health Centre of Kalamata

Competent Sectoral Committee for Mental Health of Rethymno

Operation of the Mental Health Centre of Rethymno

Competent Sectoral Committee for Mental Health of Papagou / Holargos

Operation of the Mental Health Centre of Papagou / Holargos

Hospital of Larissa Operation of a Mental Health Centre after vacant employee positions have been filled

Sectoral Committee for Mental Health of Attica

Operation of 2 Mental Health Centres after staff positions have been covered following a relevant notification of hiring

Creation of structures and infrastructure of Mental Health Centres

Sectoral Committee for Mental Health of Thessaloniki

Operation of 1 Mental Health Centre after staff positions have been covered following a relevant notification of hiring

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Continued

Creation of structures and infrastructure of Medical-Pedagogical Centres

“Sotiria” Hospital Operation of a Medical-Pedagogical Centre in the building originally designed as a hostel and located at the edge of the “Sotiria” Hospital area bordering on the Municipality of Papagou. A notification of hiring will be issued in order to cover personnel positions.

Attica Child Psychiatric Hospital

Operation of the Medical-Pedagogical Centre at Ellinorosson with medical and other personnel positions covered following a notification of hiring issued within 2002 rather than from the Attica Child Psychiatric Hospital staff, as is currently the case.


Operation of the Medical-Pedagogical Centre of Pallini with medical and other personnel positions covered following a notification of hiring issued within 2002 rather than from the Attica Child Psychiatric Hospital staff, as is currently the case


Operation of the Medical-Pedagogical Centre of Neo Heraklion with medical and other personnel positions covered following a notification of hiring issued within 2002 rather than from the Attica Child Psychiatric Hospital staff, as is currently the case.


Operation of a Medical-Pedagogical Centre with medical and other personnel positions covered following a notification of hiring issued within 2002 rather than from the Attica Child Psychiatric Hospital staff, as is currently the case

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Continued

Central Committee of Mental Health of Attica

Operation of 5 Medical-Pedagogical Centres in Attica, following a relevant opinion issued by the Central Health Council and immediate issuance of establishment decisions and the establishment of staff positions, so as to ensure timely notification of hiring and beginning of operation by late 2003. The Medical-Pedagogical Centres cover areas that completely lack any type of mental health unit for children and record increased social problems (Perama, Mandra Elefsinas, etc.)

“Erithros Stavros” (Red Cross) Hospital

Operation of a psychiatric ward, provided the construction of necessary buildings has been completed by 2002

“Asclepieion” Hospital of Voula

Operation of a Psychiatric ward, provided the construction of necessary buildings has been completed by 2002

“Sotiria” Hospital Operation of a Psychiatric ward, provided the construction of necessary buildings has been completed by 2002

“Sismanogleio” Hospital Operation of a Psychiatric ward, provided the construction of necessary buildings has been completed by 2002

Hospital of Sparta Operation of a Psychiatric ward, provided necessary interventions at suitable locations have taken place by 2002

Creation of psychiatric ward structures and infrastructure

“Amalia Fleming” Hospital Operation of a University Psychiatric Clinic, provided necessary interventions on suitable hospital sections have taken place by 2002. Opening of positions and notification of hiring will cover needs in hospital personnel.

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Continued

“Elena Venizelou” Hospital Operation of a University Psychiatric Clinic, provided necessary interventions on suitable hospital sections have taken place by 2002. Opening of positions and notification of hiring will cover needs in hospital personnel.

“Venizelion” Hospital of Crete

Addition of necessary medical and other staff positions at the psychiatric ward for adults

Hospital of Volos Addition of necessary medical and other staff positions at the psychiatric ward for adults

Hospital of Kalamata Addition of necessary medical and other staff positions at the psychiatric ward for adults

“Sismanogleio” Hospital Addition of necessary medical and other staff positions at the Acute Short-Stay Care Unit and Crisis Intervention Centre

“Sotiria” Hospital Addition of necessary medical and other staff positions at the Acute Short-Stay Care Unit and Crisis Intervention Centre

“Agia Olga” Hospital Addition of necessary medical and other staff positions at the Acute Short-Stay Care Unit and Crisis Intervention Centre

“Thriassio” Hospital Addition of necessary medical and other staff positions at the Acute Short-Stay Care Unit and Crisis Intervention Centre

Hospital of Nicaea Addition of necessary medical and other staff positions at the Acute Short-Stay Care Unit and Crisis Intervention Centre

“Evangelismos” Hospital Addition of necessary medical and other staff positions at the Acute Short-Stay Care Unit and Crisis Intervention Centre

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Continued

Hospital of Agios Nikolaos, Crete or the adjacent Hospital for Incurable Diseases

Creation of a psychiatric ward following interventions on the existing facilities of the Hospital of Agios Nikolaos, Crete or, alternatively, at the adjacent Hospital for Incurable Diseases

Children’s Hospital of Penteli Operation of a children’s psychiatric ward, provided the infrastructure development scheduled for 2002 has been completed. Opening of positions and notification of hiring will cover needs in personnel.

“Aglaia Kyriakou” Children’s Hospital

Operation of a children’s psychiatric ward, provided the infrastructure development scheduled for 2002 has been completed. Opening of positions and notification of hiring will cover needs in personnel

Creation of children’s psychiatric ward structures and infrastructure

University Hospital of Rio, Patras

Operation of a children’s psychiatric ward using existing infrastructure. Opening of positions and notification of hiring will cover needs in personnel.

Creation of Mobile Units structures and infrastructure

Sectoral Committee for Mental Health of the Cyclades

The development of 3 Mobile Mental Health units (or 3 teams and 1 unit) has been scheduled in order to cover the needs of the entire island complex of the Cyclades, where there is a complete lack of mental health services and where the geographical uniqueness requires a different approach to detecting and meeting needs. Opening of positions and notification of hiring will cover needs in personnel.

“Sotiria” Hospital Operation of a Substance and Drug Addiction Crisis Unit, provided its construction within the framework of OP “Health-Welfare” for the 2002-2003 two-year period has been completed. Opening of positions and notification of hiring will cover needs in personnel.

Creation of structures and infrastructure of Substance and Drug Addiction Crisis Units

“Sismanogleio” Hospital Operation of a Substance and Drug Addiction Crisis Unit, provided its construction within the framework of OP “Health-Welfare” has been completed.

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Continued

Hospital of Rio, Patras Operation of a Substance and Drug Addiction Crisis Unit, provided its construction within the framework of OP “Health-Welfare” has been completed.


Operation of a Substance and Drug Addiction Crisis Unit, provided its construction within the framework of OP “Health-Welfare” has been completed.





“Sotiria” Hospital Operation of an Alcoholism Treatment Unit, provided its construction within the framework of OP “Health-Welfare” for the 2002-2003 two-year period has been completed. Opening of positions and notification of hiring will cover needs in personnel.

“Sismanogleio” Hospital Operation of an Alcoholism Treatment Unit, provided its construction within the framework of OP “Health-Welfare” has been completed.

Hospital of Rio, Patras Operation of an Alcoholism Treatment Unit, provided its construction within the framework of OP “Health-Welfare” has been completed.

Creation of structures and infrastructure of Alcoholism Treatment Units


Operation of an Alcoholism Treatment Unit, provided its construction within the framework of OP “Health-Welfare” has been completed.

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81



Continued



Hospital of Kozani Operation of a Short-Stay Hostel for the patients of the psychiatric ward

Hospital of Alexandroupolis Operation of a Short-Stay Hostel for the patients of the psychiatric ward

Hospital of Kavalla Operation of a Short-Stay Hostel for the patients of the psychiatric ward

Hospital of Kilkis Operation of a Short-Stay Hostel for the patients of the psychiatric ward

AHEPA Hospital Operation of a Short-Stay Hostel for the patients of the psychiatric ward


Operation of a Short-Stay Hostel for the patients of the psychiatric ward

Hospital of Kalamata Operation of a Short-Stay Hostel for the patients of the psychiatric ward

Hospital of Volos Operation of a Short-Stay Hostel for the patients of the psychiatric ward

Creation of Short-Stay Hostel structures and infrastructure


Operation of 3 Short-Stay Hostels for patients at the 2 University Clinics and 1 Department of the Psychiatric Hospital of Thessaloniki. Staff positions will be increased through hiring.

Creation of structures and infrastructure of Short-Stay Hostels for Children


Operation of 2 Short Stay Hostels for children hospitalized at the Attica Child Psychiatric Hospital. Each hostel will be staffed by 15 persons. Medical personnel to be provided by the Hospital and other job positions will be specified in the Technical Report to be prepared by the Hospital.




Sub-Action: De-institutionalisation



The hospital is completing the actions scheduled for the year 2002 and complements them with new actions for patients suffering from mental disorders either by developing other units or by acting in a complementary manner by covering positions at hostels and boarding houses developed by other psychiatric hospitals and/or associated General Hospitals or, finally, by cooperating with other General Hospitals for the development of units on the criterion of the origin of patients hospitalized there or the accommodation of close relatives, ensuring that the maximum possible distribution of these units is achieved.

Further reduction of the patients at the Attica Psychiatric Hospital by 300 persons.


Contribution to the effort by undertaking the care of more patients, who are either suffering from psycho-geriatric problems or mental retardation or other problems, so as to achieve the objective of further reducing the number of hospitalized persons at the Attica Psychiatric Hospital by 300 persons in total by the year 2003.

Further reduction by 141 of the number of chronic patients hospitalized at «Dromokaitio” Psychiatric Hospital of Attica


Through development of units for the psycho-social rehabilitation of 69 patients in Attica by the same agency. Specifically: 3 boarding houses with a capacity of 15 persons each for a total of 45 patients suffering from mental disorders and 2 hostels with a capacity of 12 persons each for a total of 24 patients suffering from mental disorders.

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Continued


In cooperation with the Hospital of Pyrgos, Ilia, development of a hostel with a capacity of 10 places which will be filled by 4 patients from Ilia, 2 patients from Achaia, 1 patient from Arcadia and 1 patient from Aetoloacarnania. The last two places in the hostel will be filled either by patients from the Psychiatric Hospital of Tripolis who come from this area or by patients living in the community who need support.

Legal Entities under Private Law in the Mental Health sector

As during the last year, on the criterion of unit distribution, development of 4 boarding houses in Attica with a capacity of 16 persons each, for patients suffering from light, medium and severe mental retardation and mental disorders and/or psycho-geriatric patients (64 in total).

Support for new boarding houses

Mental Health Centre of the Attica Child Psychiatric Hospital

Development of 2 boarding houses for chronic patients of the Hospital by the Mental Health Centre. The Mental Health Centre will need to hire staff for the operation of these boarding houses .


Development of 1 psycho-geriatric boarding house with a capacity of up to 25 persons

Hospitals of Veroia Depending on the place of origin of patients, development of units for psycho-social rehabilitation (hostels or boarding houses) of patients suffering from mental disorders, as follows: 1 boarding house with a capacity of 10 persons

Hospital of Kozani Depending on the place of origin of patients, development of units for the psycho-social rehabilitation (hostels or boarding houses) of patients suffering from mental disorders, as follows: 1 boarding house with a capacity of 10 persons

Further reduction by 111 persons of the number of chronic patients hospitalized at the Psychiatric Hospital of Thessaloniki

Hospital of Yiannitsa Depending on the place of origin of patients, development of units for the psycho-social rehabilitation (hostels or boarding houses) of patients suffering from mental disorders, as follows: 1 boarding house with a capacity of 15 persons

83


Continued

Legal Entities under Private Law in the Mental Health sector

Development of 3 boarding houses with a capacity for 55 persons for individuals with mental disorders, psycho-geriatric cases and similar diagnosis, depending on patients’ place of origin


No actions are to begin in 2003. All the actions started by agencies during the previous year will be completed according to the schedule of their proposals, so as to approach the final objective of reforming the Psychiatric Hospital of Petra Olympou.


Development of 1 Hostel and 4 boarding houses for 71 persons in total who are suffering from psycho-geriatric problems, mental retardation and mental disorders

Further reduction by 119 persons of the number of chronic patients hospitalized at the Psychiatric Hospital of Corfu


Development of 2 boarding houses in the region of Epirus for 48 patients suffering from mental retardation and other disabilities


No new units are developed by the Psychiatric Hospital. The actions for the 2 hostels and the boarding house that began in the year 2002 are being completed.

Hospital of Kalamata Development of 1 boarding house in cooperation with the Psychiatric Hospital

Planning of discharge of last chronic patients and final transformation of the Psychiatric Hospital of Tripolis Hospital of Sparta Development of 1 boarding house in cooperation with the Psychiatric Hospital

Continued

84


85


Development of 3 additional boarding houses for psycho-geriatric patients and patients suffering from mental retardation in the Peloponnese and, potentially, other regions as well, according to the criterion of distribution of Programme units.

State Mental Health Hospital of Hania

Development of 4 sheltered apartments with a capacity of 2-3 places each by the Treatment Centre, so as to house patients residing in hostels founded during the 1st Phase of Psychargos Programme or during the 2nd Phase of Psychargos Programme that took place in 2002 or even patients that may be considered ready to reside in a sheltered apartment and are currently hospitalized. The places freed will be filled by other patients. Moreover, an additional psycho-geriatric boarding house with a capacity of 15 persons will be developed.

Hospital of Rethymno Development of 2-3 sheltered apartments with a capacity of 3-4 persons each for patients suffering from mental disorders. The existing hostel created within the framework of the 1st Phase of Psychargos Programme can operate as an intermediate structure.


Development of up to 2 sheltered apartments with a capacity of 3 persons each for patients being prepared to move from the hostel developed during the 1st Phase of Psychargos Programme and the hostel developed during the 2nd Phase of Psychargos Programme, scheduled for 2002.

Further reduction by approximately 70 persons of number of chronic patients hospitalized at the State Mental Health Hospital of Hania

“Venizelio” Hospital of Heraklion

Development of 1 psycho-geriatric boarding house with a 17-place capacity.

Continuation of 2002 Actions

State Hospital – Health Centre of Leros

Actions are being continued, as during the previous year, both by the Hospital itself and by associated hospitals in the Dodecanese and Legal Entities under Private Law in the Mental Health Sector (agencies of Regulation [EEC] 815/84 and others)


4 DETAILE D PLAN N ING PE R REGI ON

4.1 DE-INSTITUTIONALISATION STRUCTURES

Within the framework of the 2nd phase of implementation of the “PSYCHARGOS” National Programme, community-based de-institutionalisation structures will be developed for 3,000 chronic patients committed to asylums.

Specifically, the following will be developed:

No. of Structures

Type of Structures

31 Comprehensive psychiatric divisions at General Hospitals

5 Comprehensive children’s psychiatric wards at General Hospitals (each comprehensive division includes a Hospitalisation Department, a Short-Stay Unit, a Crisis Intervention Centre and an Acute Care Unit)

34 Mental Health Centres for adults

32 Medical-Pedagogical Centres for children and adolescents

11 Emergency Crisis Intervention Units at General Hospitals for persons addicted to narcotic substances

10 Detoxification and psychological support units for alcoholics

8 Comprehensive Units for persons suffering from autism spectrum disorders, which will include a day centre, a hostel, a Crisis Intervention Centre and an Education & Research Centre

21 Mobile Mental Health Units for areas facing unique accessibility problems (mainly islands and remote mountainous locations)

12 Day Centres for adults and children or adolescents

16 High or medium support and short or medium stay hostels linked to the Comprehensive Psychiatric divisions

46 Vocational Re-Integration Units

15 Hostels, boarding houses and sheltered apartments for persons suffering from autism spectrum disorders

211 Hostels, boarding houses and sheltered apartments for the relocation of 3,000 long-term inpatients of psychiatric hospitals

15 Limited Liability Social Partnerships

86


During the same period, 5,500 new Mental Health professionals from all sectors and of all specializations will be hired and trained.

At the end of this period, the psychiatric services of General Hospitals and Psychiatric Hospitals are scheduled to have been replaced and the following Psychiatric Hospitals will have closed down:

a. Attica Children’s Psychiatric Hospital

b. Psychiatric Hospital of Petra Olympou

c. Psychiatric Hospital of Corfu

d. Psychiatric Hospital of Tripolis and

e. State Psychiatric Hospital of Hania .

The personnel of these mental hospitals will be gradually utilized at the new structures, while existing building infrastructure will be used for the training and employment of patients and for the development of various University Departments (Corfu, Tripolis, Hania).

At the same time, the Attica Psychiatric Hospital, the “Dromokaitio” Psychiatric Hospital of Attica and the Psychiatric Hospital of Thessaloniki will reduce the number of their beds by 500, 350 and 250 respectively, and will only cover acute cases with medium-stay hospitalization. The completion of community structures by 2012-2015 will allow the final shutting down of all three aforementioned psychiatric hospitals. Similar provisions have been made for the Leros State Psychiatric Hospital, with the development of the specialized programme titled “Special Action for Leros”.

DE-INSTITUTIONALISATION OF THE MENTALLY ILL

The provision of mental health treatment through closed-type psychiatric institutions was deemed ineffective mainly due to the large number of unsuccessful treatments of mental patients and other problems, such as:

• isolation of patients from their family, social, professional and social environment due to the geographical and professional isolation of such institutions

• isolation of personnel employed at these facilities, for the same reasons

• inadequate financial resources

• lack of personnel training

• lack of mechanisms for the control and implementation of quality assurance procedures

• significant difference in prevailing care and living conditions in psychiatric institutions, which are far worse than those in General Hospitals.

For these reasons, it was decided to create community-based mental health structures where a wide range of services would be developed at local level. These new structures must feature all protective functions of closed psychiatric institutions, but without their negative aspects. These structures are to have, among others, the following features:

• ensuring the possibility of providing mental health services near the home of each patient

• offering the possibility of long stay for patients

87


• ensuring the provision of a wide range of high quality services that meet the

needs of target-populations.

In order to implement aforementioned actions, in addition to the enactment of Legislation that supports them and creates infrastructure at General Hospitals to allow for the treatment of acute cases, it is necessary to adopt a reform that will include the following basic steps:

• Creation of structures for the provision of community-based mental health services

• Creation and maintenance of community-based structures for non-institutionalized patients

• Return of cured institutionalized chronic patients to the community.

The following tables make extensive reference to structures that will be developed in order to achieve:

1. Down-sizing of the following psychiatric hospitals:

“DAFNI” P.H. of Athens

“DROMOKAITIO” P.H. of Athens

P.H. of Thessaloniki

2. Closing down of the following psychiatric hospitals through special procedures

Athens Children’s Psychiatric Hospital

Leros State Psychiatric Hospital – Health Centre

3. Final shutting down of the following psychiatric hospitals

P.H. of Petra Olympou

P.H. of Corfu

P.H. of Tripolis

P.H. of Hania

In order for these actions to be implemented, the competent Regional Health System must continuously monitor their progress and close and successful cooperation must take place between the Regional Health Systems involved in each action, particularly in cases where the structures created by a psychiatric hospital belong geographically to more than one Regional Health Systems.

88


1. PSYCHIATRIC HOSPITALS BEING DOWN-SIZED Α. ‘DAFNI’ ATTICA PSYCHIATRIC HOSPITAL

Goal: to reduce chronic patients by 952 places

DEVELOPMENT OF DE-INSTITUTIONALISATION AND SOCIO-ECONOMIC RE-INTEGRATION STRUCTURES FOR LONG-TERM

INPATIENTS

DEVELOPED BY THE PSYCHIATRIC HOSPITAL ITSELF(to be completed by the end of 2003)

TYPE OF STRUCTURE CITY - AREA NUMBER OF

STRUCTURES

Hostel Attica and broader area 17

Boarding house Attica and broader area 43

Sheltered apartment Attica and broader area 9

DEVELOPED BY GENERAL HOSPITALS

TYPE OF STRUCTURE

GENERAL HOSPITAL CITY-AREA NUMBER OF

STRUCTURES

Sheltered apartment

Prefectural General Hospital of Halkida Halkida 2

Sheltered apartment

Prefectural General Hospital of Agrinio Agrinio 2

Boarding house Regional General Hospital of Tripolis – Panarcadian

Prefecture of Arcadia 1

Hostel Regional General Hospital of Tripolis – Panarcadian

Prefecture of Arcadia 1

Boarding house University Hospital Larissa Prefecture of Larissa 1

Hostel University Hospital Larissa Prefecture of Larissa 1

Boarding house Prefectural General Hospital of Lamia Prefecture of Phthiotis 1

BOARDING HOUSES DEVELOPED BY NON-PROFIT AGENCIES

NUMBER OF STRUCTURES AGENCY CITY-AREA 2002 2003

89


90


Attica – Sterea Ellada 1 1


Sterea Ellada 1 -

“IRIS” Society for the Promotion of Children’s and Adults’ Psycho-social Health

Attica – Sterea Ellada 1 -



‘ANODOS’ Mental Health Unit – Civil non-profit company


Regional Development & Mental Health Company – ‘KLIMAKA’ Civil non-profit company


Pan-Hellenic Association for Psycho-Social Rehabilitation and Vocational Re-integration


“EDRA Social Cooperative Activities for Vulnerable Groups” Vocational Rehabilitation and Social Support Unit


Psycho-geriatric Society Attica – Sterea Ellada 1 -

Psycho-social Motor Rehabilitation and Health Care Society


Mental Health Centre Attica – Sterea Ellada 1 -


Β. ‘DROMOKAITIO’ PSYCHIATRIC HOSPITAL OF ATTICA

Goal: to reduce chronic patients by 217 as follows:


INPATIENTS



STRUCTURES

Hostel Attica 5

Apartment Attica 6


TYPE OF STRUCTURE


STRUCTURES

Sheltered apartment

“Skylitseio” Prefectural General Hospital of Chios

Chios 2


NUMBER OF STRUCTURES AGENCY CITY-

AREA 2002 2003


Attica – Sterea Ellada

1 1



1 1

“KLIMAKA” Civil non-profit company


1 -

Mental Health Centre Attica – Sterea Ellada

1 -

Hellenic Centre for Inter-cultural Psychiatry & Care


1 1

Family and Child Care Centre Attica – Sterea Ellada

1 1

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C. THESSALONIKI PSYCHIATRIC HOSPITAL

Goal: to reduce chronic patients by 165 as follows:

DEVELOPMENT OF DE-INSTITUTIONALISATION AND SOCIO-ECONOMIC RE-INTEGRATION STRUCTURES FOR LONG-TERM INPATIENTSDEVELOPED BY THE PSYCHIATRIC HOSPITAL ITSELF (to be completed by the end of 2003)


STRUCTURES

Hostel for patients with mental disorders Prefecture of Thessaloniki 1

Boarding houses for patients with mental disorders

Prefecture of Thessaloniki 2

Apartments for patients with mental disorders Prefecture of Thessaloniki 4


TYPE OF STRUCTURE


STRUCTURES

Sheltered apartment

Prefectural Regional Hospital of Kavalla Kavalla 2

Boarding house Prefectural Regional Hospital of Kavalla Kavalla 1

Boarding house Prefectural Regional Hospital of Kilkis Kilkis 1

Boarding house “Gregoriou” Prefectural Regional Hospital of Serres

Serres 1

Sheltered apartment

Prefectural Regional Hospital of Halkidiki Polygyros 2

Boarding house Prefectural Regional Hospital of Halkidiki Polygyros 1



AREA 2002 2003

92


93

International Society for Mental Health Services

Drama 1 -

Society for Mental Health & Patients’ Social Rehabilitation

Drama 1 1


Thessaloniki 1 -


Kozani - 1

“SYNTHESI” Non-profit Company for Research in Education and Psycho-social Rehabilitation

Thessaloniki 1 -


Halkidiki 1 -


Thessaloniki - 1


Edessa 1 -


Serres - 1


Evros 1 1


2. PSYCHIATRIC HOSPITALS CLOSING DOWN FOLLOWING SPECIAL PROCEDURES Α. ATTICA CHILDREN’S PSYCHIATRIC HOSPITAL

Goal: to reduce the number of hospitalized patients who have come of age a long time ago


INPATIENTS

DEVELOPED BY MENTAL HEALTH CENTRE


STRUCTURES

Boarding house Attica and elsewhere; top priority criterion is wider distribution

3


TYPE OF STRUCTURE


STRUCTURES

Hostel “Dafni” Psychiatric Hospital of Attica Attica 3

Hostel “Sotiria” General Regional Hospital for Chest Diseases

Attica 1

Boarding houses

“Dafni” Psychiatric Hospital of Attica Attica 5

Boarding houses

“Dromokaitio” Psychiatric Hospital of Attica

Attica 5

Β. LEROS STATE PSYCHIATRIC HOSPITAL – HEALTH CENTRE

Goal: to reduce the number of its chronic patients

a. By the hospital itself as well as in cooperation with other hospitals of the Dodecanese, mainly through the use of currently employed personnel and, secondarily, through hiring new staff at cooperating hospitals, which is to be approved as soon as the prerequisite conditions are fulfilled for the completion of Leros Special Action of ROP South Aegean under the 2nd CSF.

b. On a case-by-case basis by the agencies of Regulation (EEC) 815/84 and other Legal Entities under Private Law operating in the sector of mental health, development of boarding houses for the hospital’s 200 patients throughout the entire country with the exception of the Dodecanese.

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PSYCHIATRIC HOSPITALS TO BE CLOSED DOWN

Α. PSYCHIATRIC HOSPITAL OF PETRA OLYMPOU

Goal: to reduce by 241 persons the number of chronic patients


INPATIENTS

DEVELOPED BY THE PSYCHIATRIC HOSPITAL ITSELF (to be completed by the end of 2003)


STRUCTURES

Hostel Pieria 3

Boarding house Pieria 1

Sheltered apartment Pieria 3


TYPE OF STRUCTURE


STRUCTURES

Sheltered apartment

Prefectural General Hospital of Volos Volos 2

Sheltered apartment

“KOUTLIBANEIO” Regional General Hospital of Larissa

Larissa 2

Sheltered apartment

Prefectural General Hospital of Trikala Trikala 2

Sheltered apartment

Prefectural General Hospital of Karditsa Karditsa 2

Hostel for persons with mental disorders

LARISSA UNIVERSITY HOSPITAL

Larissa 1

Sheltered apartment


Larissa 2

Hostel “MAMATZEIO” Prefectural General Hospital of Kozani

Kozani 1

Hostel Prefectural General Hospital of Trikala Trikala 1

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Hostel Prefectural General Hospital of Karditsa

Karditsa

1



AREA 2002 2003

Thessalian Society for Mental Health, Care & Rehabilitation

Larissa 1 1


Larissa 1 1

Society for Regional Development & Mental Health

Trikala 1 -


Trikala 1 -


Karditsa 1 -

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DEVELOPMENT – COMPLETION – EXPANSION OF COMMUNITY-BASED STRUCTURES BY GENERAL HOSPITALS (to be completed by 2003)

GENERAL HOSPITAL

ACTION

Α. Completion of psychiatric division infrastructure and structure, which includes:

a. Construction of Short-stay Hospitalisation Unit for Adults–700m2

b. Construction of Crisis Intervention Centre for Adults– 350m2

c. Construction of a Hostel for Adults – 500m2

Β. Construction of a multi-functional crisis intervention centre for drug addicts

Prefectural General Hospital of Kozani

C. Development of Mobile Unit

Α. Creation of integrated infrastructure and structure of Psychiatric division, which includes:

a. Creation or construction of hospital unit– 400m2

b. Creation or construction of short-stay hospitalisation unit for adults + adolescents (two sub-units) – 700m2

c. Construction of hostel for adults– 500m2

B. Construction of a multi-functional crisis intervention centre for drug addicts

Prefectural General Hospital of Karditsa


Α. Completion of infrastructure and structure of the psychiatric ward, which includes:

a. Construction of short-stay hospitalisation unit for adults–700m2

b. Construction of a Crisis Intervention Centre for Adults – 350m2

c. Construction of a Hostel for Adults – 500m2

d. Construction of short-hospitalisation unit for children and adolescents (two sub-units) – 700m2

e. Construction of Crisis Intervention Centre for Adolescents – 350m2

f. Creation or construction of a hostel for adolescents – 500m2


Β. Construction of a multi-functional crisis intervention centre for drug addicts – 600m2 including short-term drug treatment centre and counselling station

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GENERAL ACTION HOSPITAL

C. Construction of an Alcoholism Treatment Centre – 700m2

D. Day Care Centre Operation

Α. Completion of psychiatric division infrastructure and structure, which includes:

a. Construction of short-stay hospitalisation unit for adults – 700m2

b. Construction of Crisis Intervention Centre for Adults – 350m2

c. Construction of hostel for adults – 500m2

d. Construction of short-stay hospitalisation unit for children and adolescents (two sub-units) – 700m2

B. Construction of a multi-functional crisis intervention centre for drug addicts – 500m2

C. Development of Mobile Unit – to meet the needs of the Sporades

Prefectural General Hospital of Volos

D. Full development of hospital laboratories

Prefectural General Hospital of Katerini

Α. Development of comprehensive psychiatric division infrastructure and structure, which includes:

a. Construction of hospital unit – 400m2





f. Creation or construction of hostel for adolescents – 500m2

98


99


GENERAL HOSPITAL

ACTION

Α. Development of comprehensive psychiatric division infrastructure and structure of the, which includes:






f. Creation or construction of hostel for adolescents – 500m2

B. Construction of a multi-functional crisis intervention centre for drug addicts – 500m2


Prefectural General Hospital of Trikala

D. Day Centre


Β. PSYCHIATRIC HOSPITAL OF CORFU

Goal: to reduce the number of chronic patients by 76 persons

DEVELOPMENT OF DE-INSTITUTIONALISATION AND SOCIO-ECONOMIC RE-INTEGRATION STRUCTURE FOR LONG-TERM INPATIENTS



STRUCTURES

Boarding houses Island of Corfu 4

Hostels -

Sheltered apartments Island of Corfu 3


TYPE OF STRUCTURE


STRUCTURES

Sheltered apartments

“Hatzikosta” Regional General Hospital of Ioannina

Ioannina 2


Prefectural General Hospital of Arta Arta 2


Regional General Hospital of Preveza Preveza 2


Hospital – Health Centre of Filiata Filiata 2



AREA 2002 2003

“KLIMAKA” Civil non-profit company

Corfu 1 1

“E.PRO.PS.Y.H” Epirus Society for the promotion of Mental Health

Ioannina 1 1

“I ESTIA” Association of Epirus Families for Mental Health

Konitsa 1 -

“I ESTIA” Epirus Association of Families for Mental Health (S.O.PS.Y. EPIROU)

Arta - 1

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GENERAL HOSPITAL

ACTION

Α. Completion of infrastructure and structure of the psychiatric ward for adults and the children’s psychiatric ward which includes:

a. Construction of short-stay hospitalisation psychiatric unit for adults – 700m2

b. Construction of Psychiatric Crisis Intervention Centre for Adults – 350m2


d. Construction of short-stay hospitalisation unit for children and adolescents (two sub-units) 700m2


f. Construction of hostel for adolescents

Β. Development of Mobile Unit (for children-adolescents-adults)

C. Construction of a multi-functional crisis intervention centre for drug addicts

Construction of 600m2 building, including short-term drug treatment centre and counselling station

D. Creation of Integrated Centre for Autism, which includes:

a. Construction of Day Centre - 500m2

b. Construction of hostel for autistic persons– 700m2

c. Crisis Intervention Centre– 400m2

d. Autism Education and Research Centre– 200m2

Regional General University Hospital of Ioannina

E. Day Centre

“Hatzikosta” Regional General Hospital of Ioannina

Α. Alcoholism Treatment Centre – 700m2

Β. Full development of laboratories for patient training

Prefectural General Hospital of Arta

Α. Completion of infrastructure and structure of the psychiatric division for adults, which includes:

a. Construction of short-stay hospitalisation unit– 700m2

b. Construction of Crisis Intervention Centre– 350m2


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102


GENERAL HOSPITAL

ACTION

Β. Development of the children’s psychiatric ward, which includes:

a. Construction of short-stay hospitalisation unit for children and adolescents (two sub-units)– 700m2 in total

b. Construction of hostel for adolescents– 350m2

C. Development of Mobile Unit (for children – adolescents - adults)

Α. Construction of Mental Health Centre and Medical – Educational Centre

Β. Construction of a multi-functional crisis intervention centre for drug addicts, construction of building - 500m2

C. Construction of day centre for autistic persons – 500m2

D. Day centre for mental patients

Prefectural General Hospital of Preveza

Ε. Laboratories for patients’ training

Α. Construction of Mental Health Centre and Medical–Educational Centre – 500m2

Β. Mental Health Day Centre

Prefectural General Hospital of – Health Centre of Filiata

C. Laboratories for patients’ training

Α. Comprehensive psychiatric division infrastructure, which includes:

a. Construction of 30-bed psychiatric ward – 700m2

b. Construction of short-stay hospitalisation unit for adults– 700m2

c. Construction of Crisis Intervention Centre– 500m2 (adults’ - adolescents’ sub-units)

d. Construction of a multi-functional crisis intervention centre for drug addicts – 500m2

B. Creation of Mobile Unit (for children – adolescents – adults)

C. Development of laboratories at the Psychiatric Hospital of Corfu

Prefectural General Hospital of Corfu

D. Day centre for persons with autism


C. PSYCHIATRIC HOSPITAL OF TRIPOLIS

DEVELOPMENT OF RE-INSTITUTIONALISATION AND SOCIO-ECONOMIC RE-INTEGRATION STRUCTURES FOR LONG-TERM INPATIENTS


TYPE OF STRUCTURE CITY-AREA NUMBER OF

STRUCTURES

Boarding house Tripolis 1

Hostel Tripolis 2

Sheltered apartment Tripolis 3


TYPE OF STRUCTURE


STRUCTURES

Sheltered apartment

Prefectural General Hospital of Corinth Corinth 2

Sheltered apartment

Prefectural General Hospital of Nafplion Nafplion 2

Sheltered apartment

“Ioannis & Aekaterini Gregoriou” Prefectural General Hospital of Sparta

Sparta 2

Sheltered apartment

Prefectural General Hospital of Kalamata Kalamata 2

Sheltered apartment

“Manolopouleion” Prefectural General Hospital of Pyrgos

Pyrgos 2

Sheltered apartment

Prefectural General Hospital of Patras Patras 2

Sheltered apartment

Prefectural General Hospital of Messolongi

Messolongi 2

Sheltered apartment

Prefectural General Hospital of Agrinio Agrinio 2

Hostel “Manolopouleion” Prefectural General Hospital of Pyrgos

Pyrgos 1

103


Hostel Regional General University Hospital of Patras

Rio, Patras 1

Hostel Prefectural General Hospital of Nafplion Nafplion 1

Hostel Prefectural General Hospital of Corinth Corinth 1

Hostel Prefectural General Hospital of Messolongi

Messolongi 1

Hostel Prefectural General Hospital of Cephalonia

Argostoli 1



AREA 2002 2003

Hellenic Centre of Inter-cultural Psychiatry & Care

Corinth 1 -

Family & Child Care Centre Peloponnese 1 1


Achaia 1 -


Argolis - 1

Regional Development & Mental Health Company – ‘KLIMAKA’

Peloponnese 1 1

DEVELOPMENT – COMPLETION – EXPANSION OF COMMUNITY-BASED STRUCTURES BY GENERAL HOSPITALS (Completion in 2003)

GENERAL HOSPITAL ACTION

104


105

DEVELOPMENT – COMPLETION – EXPANSION OF COMMUNITY-BASED STRUCTURES BY GENERAL HOSPITALS (Completion in 2003)


Α. Construction of comprehensive psychiatric division, which includes:


b. Construction of short-stay hospitalisation unit in adults psychiatric ward - 700m2

c. Construction of Crisis Intervention Centre in adults psychiatric ward – 700m2

d. Construction of hostel for Adults – 500m2

e. Construction of short-stay hospitalisation unit for children and adolescents (two sub-units) –700m2

f. Construction of Crisis Intervention Centre for Adolescents – 350m2

Β. Construction of Comprehensive Autism Centre, which includes:

a. Construction of hostel for autistic persons– 700m2

b. Crisis Intervention Centre– 400m2

c. Construction of day centre– 500m2

d. Autism Education and Research Centre– 200m2

C. Construction of a multi-functional crisis intervention centre for drug addicts – 500m2

D. Development of Mobile Unit

Regional General Hospital of Tripolis

Ε. Abolition of Psychiatric Hospital of Tripolis


D. INFIRMARY FOR MENTAL DISEASES OF HANIA

Goal: to reduce the number of chronic patients by about 100

DEVELOPMENT OF RE-INSTITUTIONALISATION AND SOCIO-ECONOMIC RE-INTEGRATION STRUCTURE FOR LONG-TERM

INPATIENTS


TYPE OF STRUCTURE CITY-AREA NUMBER OF

STRUCTURES

Hostel for persons with mental disorders Hania 2

Boarding house for individuals with mental retardation

Hania 1

Psycho-geriatric boarding house Hania 1


TYPE OF STRUCTURE


STRUCTURES

Boarding house Rethymno Hospital Rethymno 1

Hostel Regional Hospital of Heraklion Heraklion 1

Hostel Hospital of Agios Nikolaos Agios Nikolaos 1



AREA 2002 2003

“Xenios Zeus” civil non-profit company

Hania - 1

“Xenios Zeus” civil non-profit company

Lassithi 1

DEVELOPMENT – COMPLETION – EXPANSION OF COMMUNITY-BASED STRUCTURES BY GENERAL HOSPITALS (completion in 2003)


Prefectural General Operation of the inoperative psychiatric division of the Rethymno Hospital

106


DEVELOPMENT – COMPLETION – EXPANSION OF COMMUNITY-BASED STRUCTURES BY GENERAL HOSPITALS (completion in 2003)


Operation of the inoperative Mental Health Centre

Hospital of Rethymno

Operation of hostels at leased premises so as to accelerate patients’ flow through psychiatric wards and meet the needs of mental patients who reside in the community

Development and operation of Psychiatric ward at the Agios Nikolaos Hospital


Prefectural General Hospital of Agios Nikolaos

Construction and operation of University Mental Health Centre (systemic school)

“VENIZELEIO/PANANEIO” Prefectural General Hospital of Heraklion

Operation of the inoperative Mental Health Centre


Construction and operation of crisis intervention centre for drug addicts

Operation of Autism Centres at leased premises

Regional General University Hospital of Heraklion

Operation of the inoperative children’s psychiatric ward

107


4.2 GOALS AND EXPECTED RESULTS

• Development of structures and infrastructure based on the principles of sectorization and community-based psychiatry, so as to ensure continuity of psychiatric care. It is underlined that this action is in synergy with the action of OP “Society of Information” concerning the exploitation of new technologies for the improvement of services provided by Mental Health agencies.

• De-institutionalisation, psycho-social rehabilitation and social re-integration of 3,500 long-term inpatients of the country’s psychiatric hospitals.

• Ensuring full sufficiency of primary care, out-of-hospital care and hospital care in the context of General Hospitals.

• Development of Mental Health services aiming at prevention, diagnosis, treatment and care, as well as psycho-social rehabilitation and social re-integration of persons with autism spectrum mental disorders and learning problems.

• Development of actions for prevention and prompt intervention in crises of users of addictive substances.

The specific goals of Regional Health Systems (PE.S.Y.) are specialized as follows:

PE.S.Y. OF EASTERN MACEDONIA & THRACE

Α. Gradual achievement of full sufficiency of all Mental Health sector services , with regard to the population covered by the PE.S.Y.

Β. De-institutionalisation of all chronic patients originating from the area who are hospitalized in the country’s psychiatric hospitals.

C. Reduction of average hospitalization time in psychiatric wards by 20%.

D. Ensuring patients’ rights.

108


Ε. Raising community awareness and mobilization of local communities into volunteer actions.

F. Securing employment for 30% of patients capable of working until 2005 and increasing this figure to 40% by 2010.

G. Relieving the needs of (an estimated) 30% of individuals with autism and their families by 2010.

Η. Meeting the needs for health support of 35% of drug users and 50% of alcoholics (estimated data) by 2010.

1ST PE.S.Y. OF CENTRAL MACEDONIA

Α. Gradual safeguarding of full sufficiency of all Mental Health sector services, with regard to the population covered by the PE.S.Y.



D. Ensuring patients’ rights.



109




2ND PE.S.Y. OF CENTRAL MACEDONIA


Β. Reduction of the capacity of Thessaloniki Psychiatric Hospital to 250 beds (together with the Department of the University of Thessaloniki) by 2006 and its further downsizing by 2010.

C. Abolition of the Psychiatric Hospital of Petra Olympou and its replacement – with regard to the provision of psychiatric services by the General Hospitals of the area.

D. De-institutionalisation of all chronic patients originating from the area who are hospitalized in the country’s psychiatric hospitals.

Ε. Reduction of average hospitalization time in psychiatric wards by 40%.

F. Guaranteeing patients’ rights.

G. Raising community awareness and mobilization of local communities into volunteer actions.

110


Η. Securing employment for 25% of patients capable of working until 2005 and increasing this figure to 45% by 2010.

I. Relieving the needs of (an estimated) 30% of individuals with autism and their families by 2010.

J. Meeting the needs for health support of 40% of drug users and 50% of alcoholics (estimated data) by 2010.

PE.S.Y. OF WESTERN MACEDONIA




D. Guaranteeing patients’ rights.





111


112

PE.S.Y. OF EPIRUS







G. Relieving the needs of (an estimated) 40% of individuals with autism and their families by 2006 and of 55% of them by 2010.

Η. Meeting the needs for health support of 40% of drug users and 45% of alcoholics (estimated data) by 2006 and further increase by 20% of the coverage of such needs by 2010.


PE.S.Y. OF THESSALY



C. Reduction of average hospitalization time in psychiatric wards by 40 %.






113


PE.S.Y. OF IONIAN ISLANDS


Β. Abolition of the Psychiatric Hospital of Corfu and its replacement, with regard to the provision of psychiatric services, by the General Hospitals of the area and Mobile Units.

C. De-institutionalisation of all chronic patients originating from the area who are hospitalized in the country’s psychiatric hospitals.






114


PE.S.Y. OF WESTERN GREECE









115


PE.S.Y. OF STEREA ELLADA









PREFECTURE OF ATTICA (1ST – 2ND – 3RD PE.S.Y. OF ATTICA)

116



Β. Reduction of the capacity of the Attica Psychiatric Hospital (to 500 beds) and of «Dromokaitio” Psychiatric Hospital of Attica (to 350 beds) by 2006 and their further downsizing by 2010.

C. Abolition of the Children’s Psychiatric Hospital of Attica by 2006 and its replacement, with regard to the provision of psychiatric services, by the General Hospitals of Attica.

D. De-institutionalisation of all chronic patients originating from the area who are hospitalized in the country’s psychiatric hospitals.

E. Reduction of average hospitalization time in psychiatric wards by 20 %.


G. Raising community awareness and mobilization of local communities into volunteer actions.

H. Securing employment for 30% of patients capable of working until 2005 and increasing this figure to 55% by 2010.

I. Relieving the needs of (an estimated) 40% of individuals with autism and their families by 2010.

J. Meeting the needs for health support of 40% of drug users and 60% of alcoholics (estimated data) by 2010.

117


PE.S.Y. OF PELOPONNESOS


Β. Abolition of the Children’s Psychiatric Hospital of Tripolis by 2006 and its replacement, with regard to the provision of psychiatric services, by the General Hospitals of the Peloponnese.



E. Raising community awareness and mobilization of local communities into volunteer actions.


G. Relieving the needs of (an estimated) 50% of individuals with autism and their families by 2006 and of 80% by 2010.

H. Meeting the needs for health support of 40% of drug users and 50% of alcoholics (estimated data) by 2006 and further increase by 20% of the coverage of such needs by 2010.

118


PE.S.Y. OF NORTHERN AEGEAN









119


PE.S.Y. OF SOUTHERN AEGEAN

Α. Gradual achievement of full sufficiency of all Mental Health sector services , with regard to the population covered by the PE.S.Y., placing special emphasis on developing Primary Care services, by “twinning” each island with the Psychiatric division of a General Hospital of Athens or Piraeus and the operation of Mobile Units.


C. Guaranteeing patients’ rights.

D. Raising community awareness and mobilization of local communities into volunteer actions.

E. Securing employment for 15% of patients capable of working until 2005 and increasing this figure to 35% by 2010.

F. Relieving the needs of (an estimated) 35% of individuals with autism and their families by 2006 and of 55% by 2010.

G. Meeting the needs for health support of 35% of drug users and 50% of alcoholics (estimated data) by 2010.

120


2ND PE.S.Y. OF SOUTHERN AEGEAN

Α. Continuing the de-institutionalisation of chronic patients outside the island of Leros.

Β. Reduction of the capacity of the Leros State Psychiatric Hospital , the long-term goal being its transformation to a 60-bed Psychiatric division of the Leros Hospital – Health Centre.

C. Development of a second mental health service provision pole on the island of Rhodes.

D. Operation of Mobile Units to cover the entire population of the Dodecanese.

Ε. Development of “Special Action for Leros” interventions aiming at handling the negative impact that the downsizing of the State Psychiatric Hospital is going to have on the island.


G. Coverage of a significant part of support needs and of the health care necessary for autistic individuals, drug users and alcoholics in the Dodecanese.

PE.S.Y. OF CRETE

121



Β. Abolition of the State Mental Hospital of Hania and its replacement, with regard to the provision of psychiatric services, by the General Hospitals of Crete.


D. Reduction of average hospitalization time in psychiatric wards by 40 %.

E. Guaranteeing patients’ rights.

F. Raising community awareness and mobilization of local communities into volunteer actions.



H. Meeting the needs for health support of 40% of drug users and 20% of alcoholics (estimated data) by 2006 and further increase by 20% of the coverage of such needs by 2010.

4.3 TABLE OF ACTIONS OVER THE DECADE FOR EACH PREFECTURE AND AGENCY

Table of Mental Health Structures in the 1st Regional Health System of Central

Macedonia for the period 2001-2010

Mental Health Structures: 1st Regional Health System of Central Macedonia

MENTAL HEALTH STRUCTURES 2001 2010


Comprehensive Psychiatric – Children’s Psychiatric Wards in General Hospitals

7

Hospitalization units for adults 2 4

Short-term hospitalization units for adults 6

Acute case units for adults 1

Crisis Intervention Centres for adults 6

122


Satellite hostels for adults 6

Hospitalization units for adolescents 2 2

Short-term hospitalization units for adolescents 6

Acute case units for adolescents

Crisis Intervention Centres for adolescents 4

Satellite hostels for adolescents 5

Hospitalization units for children 1

Short-term hospitalization units for children 5

Acute case units for children 1

Crisis Intervention Centres for children 1



Mobile Units 2

Day Centres 3 5

Psycho-Social Rehabilitation Units and Programmes 1 8

Hostels 1 5

Residential Centres 3

Sheltered Apartments

Social-Vocational Reintegration Units 2 5

Comprehensive Centres for Persons with Autism spectrum disorders

2

Day Centres 2

Crisis Intervention Centres 2

MENTAL HEALTH STRUCTURES (continued) 2001 2010

Hostels/Residential Centres 2

Education and Research Centres 2

Centres for Alzheimer’s patients

Crisis stabilization centres for substance abusers 2

Crisis stabilization centres for alcoholics

Social Cooperatives – Limited Liability Social Cooperatives (upon initiative of the agencies)

5

Table of Mental Health Structures in the prefectures of the 1st Regional Health System I of Central Macedonia for the period 2001-2010

Prefecture of Kilkis

123





1



Acute case units for adults



Hospitalization units for adolescents



Crisis Intervention Centres for adolescents

Satellite hostels for adolescents

Hospitalization units for children

Short-term hospitalization units for children

Acute case units for children

Crisis Intervention Centres for children

Mental Health Centres

Medical-Pedagogical Centres

Mobile Units 1

Day Centres

MENTAL HEALTH STRUCTURES (…continued) 2001 2010

Psycho-Social Rehabilitation Units and Programmes 1

Hostels 1

Residential Centres


Social-Vocational Reintegration Units 1


Day Centres

Crisis Intervention Centres

Hostels/Residential Centres

Education and Research Centres


Crisis stabilization centres for substance abusers


124


Social Cooperatives – Limited Liability Social Cooperatives (at the initiative of the agencies)

1

Prefecture of Serres




1


















Mobile Units

Day Centres 1


Hostels 1



Social-Vocational Reintegration Centres/Units 1


Day Centres


125








1

Prefecture of Halkidiki




1


















Mobile Units 1

Day Centres


Hostels 1 2


126



Social-Vocational Reintegration Centres/Units 1 1


Day Centres








1

Prefecture of Thessaloniki (section of the Regional Health System I – Central Macedonia)




4






Hospitalization units for adolescents 2 2








127





Mobile Units

Day Centres 3 4


Hostels 1

Residential Centres




2

Day Centres 2





MENTAL HEALTH STRUCTURES (continued) 2001 2010




2

Table of Mental Health Structures in the 2nd Regional Health System of Central Macedonia for the period 2001-2010


Psychiatric Hospitals 2 1


6

Hospitalization units for adults 6







128











Mobile Units 2 2

Day Centres 3 5


Hostels 7 17

Residential Centres 4 11

Sheltered Apartments 24 27




1

Day Centres 1




Centres for Alzheimer’s patients 1


Crisis stabilization centres for alcoholics 1


5

Table of Mental Health Structures in the Prefectures of Regional Health System II – Central Macedonia for the period 2001-2010

Prefecture of Thessaloniki (part of the 2nd Regional Health System of Central Macedonia)



129



3


















Mobile Units 1 1

Day Centres 3 4


Hostels 4 9





1

Day Centres 1








2

130


Prefecture of Pella




1


















Mobile Units

Day Centres 1


Hostels 1





Day Centres




131






1

Prefecture of Imathia




1


















Mobile Units

Day Centres


Hostels



Social-Vocational Reintegration Centres/Units

Comprehensive Centres for Persons with Autism spectrum

132


disorders

Day Centres








1

Prefecture of Pieria


Psychiatric Hospitals 1


1


Short-term hospitalization units for adults















Mobile Units 1 1

Day Centres

133



Hostels 3 7





Day Centres









1

Table of Mental Health Structures in the Regional Health System of W. Macedonia for the period 2001-2010




1













134




Mental Health Centres 3


Mobile Units 3

Day Centres 1


Hostels 2

Residential Centres





1

Day Centres 1








3

Table of Mental Health Structures in the prefectures of the Regional Health System of W. Macedonia for the period 2001-2010

Prefecture of Florina




Hospitalization units for adults



Crisis Intervention Centres for adults

135


Satellite hostels for adults


Short-term hospitalization units for adolescents











Mobile Units

Day Centres

Psycho-Social Rehabilitation Units and Programmes

Hostels

Residential Centres




Day Centres








1

Prefecture of Kastoria



Comprehensive Psychiatric – Children’s Psychiatric Wards

136


in General Hospitals


















Mobile Units 1

Day Centres


Hostels

Residential Centres




Day Centres








1

137


Prefecture of Kozani




1


















Mobile Units 1

Day Centres 1


Hostels 2

Residential Centres




1

Day Centres 1





138





1

Prefecture of Grevena




















Mobile Units 1

Day Centres


Hostels

Residential Centres




139


disorders

Day Centres









1

Table of Mental Health Structures in the Regional Health System of Epirus for the period 2001-2010




3
















Medical-Pedagogical Centres 2

Mobile Units 2

Day Centres 3

140



Hostels 7 8






1

Day Centres 2








2

Table of Mental Health Structures in the prefectures of the Regional Health System of Epirus for the period 2001-2010

Prefecture of Ioannina




2












141








Mobile Units 1

Day Centres 1


Hostels 4 4





1

Day Centres 1








1

Prefecture of Thesprotia










142













Mobile Units

Day Centres 1


Hostels 1 1





Day Centres








Prefecture of Arta




1


143


















Mobile Units 1

Day Centres


Hostels 1 1


Sheltered Apartments 1



Day Centres








1

144


Prefecture of Preveza




















Mobile Units

Day Centres 1


Hostels 1 2

Residential Centres




Day Centres 1





145






1

Table of Mental Health Structures in the Regional Health System of Thessaly for the period 2001-2010




4

















Mobile Units 2

Day Centres 1 2


Hostels 5 11





146



1

Day Centres 1








4

Table of Mental Health Structures in the prefectures of the Regional Health System of Thessaly for the period 2001-2010

Prefecture of Larissa




1

















147



Mobile Units

Day Centres 1 1


Hostels 2 5





1

Day Centres 1








1

Prefecture of Trikala




1












148








Mobile Units 1

Day Centres 1


Hostels 1 2





Day Centres








1

Prefecture of Magnesia




1







149













Mobile Units 1

Day Centres


Hostels 1 2

Residential Centres




Day Centres








1

Prefecture of Karditsa



Comprehensive Psychiatric – Children’s Psychiatric Wards 1

150



















Mobile Units

Day Centres


Hostels 1 2





Day Centres









1

151


Table of Mental Health Structures in the Regional Health System of the Ionian Islands for the period 2001-2010




1






Hospitalization units for adolescents 1











Mobile Units 3

Day Centres


Hostels 2 6






Day Centres 1




152






2

Table of Mental Health Structures in the prefectures of the Regional Health System of the Ionian Islands for the period 2001-2010

Prefecture of Corfu




1
















Mobile Units 1

Day Centres


Hostels 2 4




153



Day Centres 1








1

Prefecture of Lefkada





















Mobile Units 1

Day Centres

154



Hostels

Residential Centres




Day Centres








1

Prefecture of Cephalonia


















155





Mobile Units 1

Day Centres


Hostels 1

Residential Centres




Day Centres








1

Prefecture of Zakynthos









156













Mobile Units

Day Centres


Hostels 1

Residential Centres




Day Centres









1

Table of Mental Health Structures in the Regional Health System of W. Greece for the period 2001-2010




157



















Mobile Units 4

Day Centres 2


Hostels 6 6






1

Day Centres 1








3

158


Table of Mental Health Structures in the prefectures of the Regional Health System of W. Greece for the period 2001-2010

Prefecture of Aetoloacarnania




1


















Mobile Units 2

Day Centres 2


Hostels 3 3





Day Centres


159








1

Prefecture of Achaia




1


















Mobile Units 1

Day Centres


Hostels 2 2



160




1

Day Centres 1








1

Prefecture of Ilia




1


















Mobile Units 1

161


Day Centres


Hostels 1 1





Day Centres








1

Table of Mental Health Structures in the Regional Health System of Sterea Ellada for the period 2001-2010




5








Acute case units for adolescents 5



162








Mobile Units 1 1

Day Centres 1


Hostels 3 5





2

Day Centres 2









3

Table of Mental Health Structures in the prefectures of the Regional Health System of Sterea Ellada for the period 2001-2010

Prefecture of Fthiotida




2



163
















Mobile Units

Day Centres 1


Hostels 2






1

Day Centres 1








1

Prefecture of Fthiotida


164




2


















Mobile Units

Day Centres 1


Hostels 2





1

Day Centres 1







Social Cooperatives – Limited Liability Social Cooperatives 1

165


(at the initiative of the agencies)

Prefecture of Evrytania





















Mobile Units

Day Centres


Hostels

Residential Centres




Day Centres



166







1

Prefecture of Phokida




1


















Mobile Units 1 1

Day Centres


Hostels 1 1

Residential Centres



167



Day Centres








1

Prefecture of Boeotia




1

















168


Mobile Units

Day Centres


Hostels





1

Day Centres 1









1

Prefecture of Euboea




1












169







Mobile Units

Day Centres


Hostels 2 2

Residential Centres





Day Centres








1

Table of Mental Health Structures in the 1st Regional Health System I of Attica for the period 2001-2010




7






170







Hospitalization units for children 1 1







Mobile Units 1

Day Centres 1


Hostels

Residential Centres




1

Day Centres 1







Support units for children of mentally ill parents 2

Centres for education and intervention planning in natural disasters and major accidents

1

Special Psychiatric divisions for Support of Mothers 1

Cancer victim support units 1


3

171


Table of Mental Health Structures in the 2nd Regional Health System II of Attica for the period 2001-2010




12












Hospitalization units for children 1 1




Hostels for abused children 1



Mobile Units

Day Centres 2 4


Hostels 1 2

Residential Centres




2

Day Centres 2



172






Support units for children of mentally ill parents 1

Centres for education and intervention planning in natural disasters and major accidents


3

Table of Mental Health Structures in the 3rd Regional Health System III of Attica for the period 2001-2010




7

















Mobile Units 1

Day Centres 2 5


173


Hostels 23 46





3

Day Centres 3








Cancer victim support units 1


3

Table of Mental Health Structures of Attica-based agencies outside the Regional Health System for the period 2001-2010















174







Mobile Units

Day Centres 2 3


Hostels 2 3






Day Centres








Table of Mental Health Structures in the Regional Health System of the Peloponnese for the period 2001-2010




5






175














Mobile Units 4

Day Centres 1 2


Hostels 6 7





1

Day Centres 3








5

Table of Mental Health Structures in the prefectures of the Regional Health System of the Peloponnese for the period 2001-2010

Prefecture of Corinth


176




1


















Mobile Units 1

Day Centres


Hostels 1 1





Day Centres 1 1







Social Cooperatives – Limited Liability Social Cooperatives 1

177


(at the initiative of the agencies)

Prefecture of Argolida




1

















Mobile Units

Day Centres


Hostels 1 1





178


disorders

Day Centres 1









1

Prefecture of Arcadia




1





Satellite hostels for adults 3 4












Mobile Units 1

Day Centres 1 1


179


Hostels 2 3






1

Day Centres 1








1

Prefecture of Laconia




1















180




Mobile Units 1


Day Centres


Hostels 1 1





Day Centres








1

Prefecture of Messinia




1










181










Mobile Units 1

Day Centres 1


Hostels 1 1





Day Centres








1

Table of Mental Health Structures in the Regional Health System of the N. Aegean for the period 2001-2010




3




182
















Mobile Units

Day Centres


Hostels 1 3

Residential Centres




Day Centres








3

183


Table of Mental Health Structures in the prefectures of the Regional Health System of the N. Aegean for the period 2001-2010

Prefecture of Lesbos




1

















Mobile Units

Day Centres


Hostels 1

Residential Centres




Day Centres



184








1

Prefecture of Chios




1

















Mobile Units

Day Centres


Hostels 1 2

Residential Centres



185




Day Centres








1

Prefecture of Samos




1


















186


Mobile Units

Day Centres


Hostels

Residential Centres




Day Centres








1

Table of Mental Health Structures in 1st Regional Health System I of the S. Aegean for the period 2001-2010















187








Mobile Units 5

Day Centres


Hostels

Residential Centres




Day Centres








1

Table of Mental Health Structures in the 2nd Regional Health System II of the S. Aegean for the period 2001-2010




188



















Mobile Units 1

Day Centres


Hostels 23 26

Residential Centres




1

Day Centres 1









1

189


Table of Mental Health Structures in the Regional Health System of Crete for the period 2001-2010




5

















Mobile Units 1 5

Day Centres 1 2


Hostels 6 17






1

Day Centres 2




190






1

Table of Mental Health Structures in the prefectures of the Regional Health System of Crete for the period 2001-2010

Prefecture of Hania




1


















Mobile Units 1 2

Day Centres 1 1


Hostels 2 9


191





Day Centres 1








1

Prefecture of Rethymno




1

















Mobile Units 1

192


Day Centres


Hostels 1 2

Residential Centres




Day Centres








1

Prefecture of Heraklion




2














193






Mobile Units 1

Day Centres 1


Hostels 2 4





1

Day Centres 1








1

Prefecture of Lassithi




1






194













Mobile Units 1

Day Centres


Hostels 1 2

Residential Centres




Day Centres









1

195


196


5 P RO GR A MM E F U NDIN G

For the period 2001-2010 funding for new actions to develop mental health structures and infrastructures will amount to 31.5 billion drachmas, 20.2 billion (64.2%) coming from the European Union and 11.3 billion (20.2%) from the Ministry of Health and Welfare.

The PSYCHARGOS programme expenditures for 2001-2010 are listed in the table below:

Psychargos programme expenditures for 2001-2010

Cost of investments and start-up of structures 250 billion drachmas

Ongoing operation of structures during reference period 300 billion drachmas

Total spending 550 billion drachmas

The funding of the costs for investments and start-up of structures is broken down in the following table and in Diagram 1.

Funding of costs for investments and start-up of structures

Operational Programme ‘Health-Welfare’

72 billion drachmas 28.8%

National Public Investment Programme 25 billion drachmas 10%

Ordinary Budget 108 billion drachmas 43.2%

Social Insurance 45 billion drachmas 18%

Total 250 billion drachmas 100%

197


Diagramme 1: Funding of costsδύand start-up of structures

O.P. "Health-Welfare”

National P.I.P. Ordinary

Budget

Soc ial Insurance

45

(Amounts in billion GRD)

72

108 25

The cost of funding the ongoing operation of the structures over the period 2001-2010 will be met as follows: 76.7% (or 230 billion drachmas) from the Ordinary Budget and 23.3% (or 70 billion drachmas) from Social Insurance.

198


6 MAN AGEME NT A ND EV AL UATION MEC HA N ISMS

6.1 MANAGEMENT MECHANISMS

The attempted de-institutionalization of mental patients is a complex process which will require interventions at the most varied levels of the current system. It is only natural that the agencies involved may not have the capacity to reform themselves and to manage such a large and important undertaking. Special support will be required, given that the issue has so many components and requires a high level of special skill at all levels.

More specifically, the targets of the psychiatric reform programme will require not only specialist expertise but also know-how for the management of the project as a whole.

Implementation of the interventions will require:

• organizational and scientific support for the implementing bodies (hospitals, psychiatric hospitals, agencies under Regulation 815, etc.) as well as agencies engaged in the social economy sector

• scientific support from specialists in de-institutionalization procedures, who will provide scientific evaluation of the procedures being implemented, and finally

• organizational and management support – in the form of a project team - for the central departments of the Ministry and specifically the Directorate for Mental Health. To this end three distinct Support Mechanisms will be set up, to be selected by open procedures.

The Implementation Agencies Support and Monitoring Unit will be a legal entity or association of physical persons staffed by mental health specialists and experienced staff in the management of non-tangible measures, which will undertake, after the necessary open procedures, the work of supporting and monitoring the implementation agencies.

The Unit will be involved at all levels of intervention by the agencies, supporting and monitoring their actions and, in association with the competent Directorate of the Ministry, promoting and animating the overall de-institutionalization process.

The Unit will have a special section to motivate and support the staff and patients of the Attica Psychiatric Hospital (APH) and to promote special actions and measures related to the hospital.

The need for special treatment for the APH is derived from the special conditions of the hospital and its particular importance within the Psychargos programme.

Finally, the Unit will be responsible for supporting agencies engaged in the social sector of the economy (social enterprises - Limited Liability Social Cooperatives), assisting their establishment, organization, development and coordination.

The Unit responsible for planning interventions in the de-institutionalization process will be an association of physical persons set up through open procedures addressed to personalities and experts in the mental health field. It will engage in the

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scientific monitoring and evaluation of de-institutionalization interventions, in order to promote best practices and correct any mistaken approaches, on the basis of international practice and know-how.

Finally, the Implementation Authority Support Team will be a project team selected through open procedures and entrusted with supporting the Directorate for Mental Health in the work of implementing, monitoring and coordinating the overall programme.

6.2 EVALUATION MECHANISMS

Ex-ante evaluation Ex-ante evaluation is the responsibility of the authorities entrusted with the drafting of plans, interventions and programming complements. It is carried out at the level of plans and programmes, including programming complements, and involves:

Analysis of the findings of previous evaluations

Analysis of the strengths, weaknesses and potential of the regions and/or sectors

Assessment of the raison d’etre and cohesion of the proposed strategy

Quantification of priorities and objectives

Analysis of anticipated impacts and validation of the policy

Quality of implementation mechanisms

Mid-term evaluation

The mid-term evaluation is conducted at the level of the CSF and the Operational Programme being implemented within that context. Its objective is essentially to feed the CSF and the programme in question, half-way through their implementation period, with any necessary adjustments, and to offer information for assessment of the performance of the various interventions.

The evaluation is carried out at the responsibility of the O.P. Managing Authority, in cooperation with the CSF Managing Authority and the European Commission, within the framework of the partnership.

Taking the initial results of the programme, it examines the correctness and prospects for implementation of the objectives. It also evaluates the use of credits and the progress of monitoring and implementation. The mid-term evaluation involves a critical analysis based on the data collated from monitoring and other sources. It also decides on the correctness and validation of possible adjustments to the initial quantified objectives.

The evaluation is carried out by an independent evaluator and submitted to the Monitoring Committee of the CSF/O.P. before being forwarded to the European Commission. The independent evaluators must respect the confidentiality of the monitoring data to which they have access. The results of the mid-term evaluation may not be published without the prior consent of the Monitoring Committee.

Pursuant to article 42 para. 3 of Reg. (ΕC) 1260/99, the Commission verifies the accuracy and quality of the evaluation using criteria agreed beforehand with the member state, on a partnership basis, in view of the revision of the interventions and allocation of the performance reserve.

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The mid-term evaluation is to be updated in the form of a first report no later than 31st December 2005. It is up to the member state to decide whether, for its own reasons and to meet its own needs, it will conduct additional evaluations beyond the two mandated by the Regulation and mentioned above (mid-term and first report) .

Ex-post evaluation

The ex-post evaluation pertains to the interventions and is the responsibility of the Commission in cooperation with the member state and Managing Authority. It is intended to analyse the use of resources, the efficacy and performance of the interventions, their impacts and their usefulness and duration.

The evaluation is conducted on the basis of methodological recommendations by the Commission, in agreement with the member states, in a uniform and coordinated manner, in order to draw lessons relating to the interventions and to the economic and social cohesion policy as a whole. Again, the evaluation is carried out by independent evaluators and must be completed no later than three years from the end of the programming period.

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7 ANT IC IP ATED R E SULTS

7.1 INTRODUCTION

It is anticipated that the reform of psychiatric care will entail a regional reorganization of the National Health System at all levels of care and its radical organizational and operational restructuring.

Moreover, the intention is to de-institutionalize the largest possible number of chronic mental patients currently living in closed structures, to develop open community structures for prevention and care, and finally to implement actions for the social and economic reintegration of the mentally ill.

The development, in particular, of primary mental health services will provide a safety net for mental patients and for the community in general. It will help prevent the phenomenon of internment and institutionalization and help lift the causes of social exclusion.

7.2 RESULTS FOR EACH CATEGORY OF ACTION

The results of the mental health reform can be classified at two levels. The first pertains to actions to expand or construct structures, while the second involves training actions.

In respect of the first level, the anticipated results are as follows:

• Operation of de-institutionalization structures and mental health care structures

• Expansion of vocational training workshops for mentally patients

• Operation of Mental Health Centres and Medical-Pedagogical Centres, as well as other specialist units, in addition to the operation of Social Enterprises and Cooperatives.

The results at the second level are as follows:

• Creation of a significant number of jobs for specialist staff and for unskilled workers

• Employment of mental health professionals with various specializations

• Improving the knowledge and skills of staff in de-institutionalization and community-based care structures

• Ensuring equal opportunities for all and especially for persons with mental health problems finding it difficult to achieve integration into socio-economic life.

The above results will allow the attainment of the following objectives:

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• Operation of primary and secondary prevention structures

• Planning of relevant policies and provision of services by the competent agencies, with emphasis on tailored approaches and respect for the rights of the individual

• Prevention, where possible, through counselling and/or timely diagnosis, of occurrence of mental illness

• Prevention of relapses

• Reduction of time spent in closed treatment

• Raising community awareness to foster greater acceptance of the mentally ill

7.3 RESULTS OF OPERATION OF SUPPORT MECHANISMS

The results of the operation of the support mechanisms in the areas of health, mental health and welfare are expected to be seen on three levels, namely:

• The efficiency and effectiveness of measures and procedures,

• The exploitation and/or transfer of know-how

• The systematic monitoring of projects and measures – always in the context of the public sector.

Τhe results are given below in detail, for each level:

a . Efficiency and effectiveness of measures and procedures

• Reduction of time needed for the execution of administrative procedures related to project contracts.

• Development of more effective cooperation between public and private sector. Ensuring projects are completed on time and within the approved budget.

• Improving controls at regulatory and financial level.

• Substantial upgrading of the level of provision of information to the Greek public, specialists and professionals in the health and welfare sectors, as well as improved documentation of plans and policies in health and welfare issues in Greece.

• Improved coordination of actions for health and welfare in Greece and saving of resources by avoiding funding of overlapping or repetitive projects and actions.

• Development of more effective cooperation between the public and private sector in areas relating to health and welfare, and securing more efficient operation of relevant bodies, whether already in existence or still at the planning stage.

• Securing reliable, timely and documented monitoring of the efficiency of the projects and measures being implemented, especially those co-funded by the European Union.

• Improved monitoring of developments at regulatory and statutory level. Developing the use of the Ministry website (www.ypyp.gr) as a permanent channel of communication and information for implementation agencies, final beneficiaries, contractors, etc, as well as members of the public, in relation to the inclusion of projects and the invitation to tender for actions under the O.P. and also in respect of the overall progress towards implementation of the O.P. and of the reform programme as a whole.

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b . Exploitation and/or transfer of know-how

• Exploitation of the know-how of staff in the public and private sector derived from related projects and projects by other agencies. Transfer of know-how to health and welfare units and change of prevalent culture in the relations between the two sectors.

• Enhancement of the flexibility and adaptability of the public sector in respect of possible changes in methods of implementing projects and measures – changes often required by rapid advances in technology. Provision of specialist support for authorities, organizations and other public and private agencies in areas pertaining to developments in the health and welfare sector.

• Transfer of international cutting-edge know-how, dissemination of best methods and practices, assistance in the exchange of experiences, know-how and information among agencies in Greece and abroad in specific themes and policies. Creation of permanent, reliable and stable “reference point” to assist policy-making and decision-taking in areas related to health and welfare.

• Valorisation of know-how of public and private sector staff in relation to issues and applications in the health and welfare sectors.

• Transfer of cutting-edge know-how in relation to issues touching on developments and the progress of projects and measures in health and welfare, as well as the dissemination of best methods and practices.

• Valorisation of drafting procedure for strategic plans for health and welfare in each region, in order to activate the involvement of the local population and public and private sector agencies in order to jointly draft policy at local level.

c . Systematic monitoring of projects and measures. Systematization of research on developments in health and welfare in Greece and worldwide, through

• Regular inventory, analysis and presentation of relevant statistical data and indicators.

• Systematization of investigation of needs, in relation to the programming of projects and measures, in the areas of health and welfare –in relation to both the public and private sector.

Documents

Action Plan for the Reform of the Mental Health Sector · epidemiological reality in the Mental Health sector over the last twenty years have made it necessary to expand and enrich