1. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 1 Health Sector Managing Authority Ministry of Health June 2013 Mental Health Reform in Greece and Structural Funds Mental Health Reform in Greece and Structural Funds

2. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 2 De- institutionalisation Social rehabilitation of the patients Structural Funds Key words:

3. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 3 The model in Greece up to 1984 exclusively provided by Psychiatric Asylums un-appropriate environment for both patients and mental health professionals unequal distribution of services 9 major psychiatric hospitals over-crowded low quality of service separation of patients from their social context Low capacity of personnel Low skilled Lack of therapeutic targets

4. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 4 case of the Leros Mental Hospital 1984 case of the Leros Mental Hospital 1984 2000 patients in a single unit 1000 employees Only 2 doctors The model in Greece up to 1984

5. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 5 First attempts to reform 1984 -1996 creation of an integrated mental health services system core aims Deinstitutionalization Reduced frequency and the duration of new entries Trained Professionals Development of community structures EU contribution to the effort ESF, ERDFEC regulation 815/1984 120 million ECUs for a five years reform programme - 1984-1989

6. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 6 First attempts to reform 1984 -1996 Lack of a coherent reform plan at that time Very poor first Results - 1988 Lack of a experience in management of a reform at that time Need for thorough revision of policy Regulation eligibility constraints lack of regulatory framework Low political commitment The case of Leros 1989

7. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 7 First attempts to reform 1984 -1996 EC Regulation 4130/88 amending the 815/84 Broader eligibility rules especially for basic infrastructure 161 projects, out of which 65% on basic infrastructure and 35% on pilot projects and training of professionals Results of the policy at the end of 1996: reduction of asylum beds to 0.96/1.000 Enhancement of psychiatric clinics in general hospitals - 16 beds in 1980 to 361 beds in 1996 increase of the primary mental health care centers from 6 to 28 professionals raised to rate 55/100.000 average time spent in public psychiatric hospitals from 207 days in 1983 to 117 in 1994

8. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 8 Integrated approaches 1997 – today PSYCHARGOS era In 1997 major issues still open PSYCHARGOS Phase 1. 1999 -2000 (EU 2nd Programming period – CSF 1994-1999) Phase 2. 2001 - 2010 (EU 3rd Programming Period –CSF 2000-2006) Phase 3. 2011 - 2015 (EU 4th programming Period – NSRF 2007-2013) In the Phase 1 – CSF 1994-1999 (implementation up to 2001) Operational Programme “Combating Social Exclusion” 1994-1999 ESF and ERDF funds equivalent to 45.5 m € 92 hostels, 14 dormitories and 94 protective apartments of supported living 6 new psychiatric department in General Hospital Results of the policy at the end of 2001:

9. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 9 Integrated approaches 1997 – today PSYCHARGOS era …In 2001 major issues still open Phase 2 – CSF 2000-2006 (implementation up to 2009) Phase 2 = PSYCHARGOS 2000-2010 The most integrated policy period 733 million Euros EU FUNDS 211 million Euros National Investment FUNDS 73 million Euros Social Security 132 million Euros Regular National Budget lines 316 million Euros

10. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 10 Integrated approaches 1997 – today PSYCHARGOS era …In 2001 major issues still open Phase 2 – CSF 2000-2006 (implementation up to 2009) Operational Programme Health and Welfare 2000-2006 Priority axis 2: Mental Health Reform 216.21 m€ 116 new dormitories -1545 beds Results of the policy at the end of 2009 17 Hostels - 229 beds 85 protective Apartments, a total capacity of 276 people More than 600 project 100% of professional on mental health trained (5.566 prof) 12 Social cooperatives Final closure of 5 out of 9 major asylums in Greece and to the creation of community based infrastructure

11. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 11 Integrated approaches 1997 – today PSYCHARGOS era independently functioning

12. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 12 Some good practices Ensuring the quality of life of the residents

13. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 13 Improving social skills Developing professional skills Some good practices

14. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 14 Major effect More than 3000 people de -institutionalised and returned back to the community, back to their homes and families and. out of the asylums More than 3000 people de -institutionalised and returned back to the community, back to their homes and families and. out of the asylums The major effect of the policy at the end of 2009

15. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 15 Integrated approaches 1997 – today PSYCHARGOS era In 2010 major issues still open: 1.Psychosocial Rehabilitation 2.Prevention of new patients to becoming chronic 3.Rehabilitation of persons with mental health problems living in the community 4.Ensure the continuity of care 5.Further Transformation of remaining Psychiatric Hospitals 6.Achieve full coverage of care needs in community structures Phase 3 – NSRF 2007-2013 (implementation up to 2015) ESF - Operational Programme Human Resources development 2007-2013 Priority Axis 5 – Health (Mental Health – Primary Health Care – Public Health Available ESF budget for Mental Health Reform - 228 m.€

16. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 16 Integrated approaches 1997 – today PSYCHARGOS era In 2010 major issues still open but there is an economic crisis also …. 60 m € A significant reduction of 60 m € occurred since the interim revision of the OP in October 2012. 60 m € 60 m € to other OP’s priorities regarding unemployment affected primary mental health interventions: Mental Health Centres Mobile mental health units Psychiatric Department at General Hospital Hostels for short stay Social cooperatives There is strong devotion by both EU and Greek Authorities to conclude the Multi-annual reform Memorandum of understanding commissioner Andor – health minister Likourentzos

17. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 17 The Future of EU Funding for Mental Health Reform in Greece In 2013 issues in Mental Health Reform are still open Next programming period 2014 -2020 remaining reform priorities Some New facts: Financial restrictions on public expenses The crisis affects mental health of the population And some old “nightmares” Regulatory framework needs further update and revision Sustainability of the community based services Skills become obsolete

18. Health Sector Managing Authority Ministry of Health sdivanis@mou.gr Page 18 The Future of EU Funding for Mental Health Reform in Greece When the patient is tide up, the psychiatrist is free. When the patient is free, the psychiatrist is at his job When the patient is tide up, the psychiatrist is free. When the patient is free, the psychiatrist is at his job