Economic crisis, mental health and psychiatric care: what happened to the "psychiatric reform" in Greece?

Since 1984, when the EEC Program 815/84 was introduced, the term “psychiatric reform” was made synonymous to the imperative change of the asylic psychiatry towards a decentralized and community based psychiatric care. This program presented various stages of non absorption of funds, stagnation and finally a developmental phase until the completion of the program in 1995. A total of 250 new services and programs have been developed. In 1999, the most progressive Mental Health Law 2716 was passed. In 2000, the “Psychargos” program continued the psychiatric “reform” project, with 700 million euros funding for a ten years period. Its goal was the completion of the reform, the deinstitutionalisation of the remaining long stay patients, in the eight mental hospitals and their closure, the development of psychosocial rehabilitation and housing services as well as the further development of community based mental health services. Four mental hospitals have been closed down until now. Forty three Community Mental Health Centers are in operation (instead of the needed 94). However, there are no evaluative data on their effectiveness and efficiency. Regarding the rest of the types of services, 57 Day Care Centers with 855–900 places (1500 places are needed), 25 Mobile Units, 37 Outpatient Psychiatric Clinics, 28 Psychiatric Departments in General Hospitals, with 650 beds, have been developed in the country. The latter number is insufficient. There is a need of 2900 short stay beds to cover 40,000 admissions per year in order the remaining public mental hospitals to be closed down. Additionally, 343 hostels, sheltered apartments have been developed with 3100 beds as well as 2000 places in various rehabilitation services for the support of the deinstitutionalised patients. To overcome the bureaucratic and rigid public accounting system the intervention of the NGO’s was introduced. In 2012, 65 NGO’s were involved with 220 units (30% of the total mental health units) covering 50% of the deinstitutionalisation beds and a total budget of 45 million euros in 2010. The Ministry of Health had no provision for their evaluation or their requirement to provide fiscal annual reports publicly. It should be noted that the first NGO’s were established by dedicated mental health experts in the eighties, for the fulfilment of the 815/84 program. In the coming years decades of NGO’s were developed under rather unclear criteria by several non mental health professionals for the completion of the Psychargos projects. With respect to the private sector in 2007 there were 4207 inpatient beds.