« Ongoing evaluation of the implementation of the National Action Plan ‘Psychargos’

Psychargos- a journey from the Asylum to the society

The historical evolution of Psychargos Contributing factors 1.The deficiency of the existing services. 2.The radical changes of psychiatric care the 1970s 3.Leros psychiatric hospital case National Legislative basis 1.regulation Mental Health Act (Law 2716/1999) = ‘Psychargos’ Programme (A and B phases) 3.‘Psychargos’ Phace C ( )

The Evaluation Team  Greek and UK experts in the field of mental health  Academic and health sector experts  Ex post evaluation for the period  On going evaluation for the period

Dimensions of the Evaluation 3 Dimensions 1.Policy evaluation 2.Implementation evaluation 3.Evaluation of managerial processes for reform Criteria : 1.Consistency, logic, timeliness 2.Outcomes, results and impact 3.Administrative structure and management/monitoring Indicators

Implementation evaluation Management & Organization Development of a services network Human resources Users

Main categories of Mental Health Services

Main providers of Mental Health Services

Network of MH services

6 th Health Region Authorities –Mental Health Services– 1990 Psychiatric Department of General Hospitals

6 th Health Region Authorities –Mental Health Services– 2008 Residencies Adults’ satellite guest house Day hospitals Protected Apartments Mental Health Centers Psychiatric Department of General Hospitals Mobile Unit

6 th Health Region Authorities –Mental Health Services– 2012 Residencies Adults’ satellite guest house Day hospitals Protected Apartments Mental Health Centers Psychiatric Department of General Hospitals Mobile Unit

Mental Health Services

Development of services’ key points  Progress in reducing Mental Health Hospitals  Partially successfulness in the development of community mental health services  Lack of specialised services for children, seniors, autism etc  Geographical inequalities  Need for a specific action plan with priorities, targets  Private sector?

Management and organisation of Mental Health services

Management and Interoperability levels in the Mental Health System Fragmented and uncoordinated system - Centralized management

Management important issues  Management levels with specific roles  Interoperability between service providers  Inclusion of different kind of providers incl. private sector  Monitoring of the system  Connection with Health Services and especially primary health care  Connection with Social Security organisations  Intersectoral cooperation (education, justice etc)

Human Resources

MH Professionals:  Understaffing issues in the Mental Health Services.  Inability to recruit MH professionals (MoU because of the economic crisis).  Signs of tiring, frustrated and burnout staff.  Delays in salaries payments. Training :  Fragmented training activities  Lack of a recording system with updating data needs  Practical guidelines and protocols

The user’s perspective Accessibility in MH services Geographical inequalities Lack of specialized services Quality Lack of treatment protocols and clinical guidelines User satisfaction ? Weaknesses in continuity of care within the catchment area User Rights – representation Increase in the users participation Associations of families and friends Not equivalent participation in decision making Exceeded number of involuntary admissions- treatment Indications of stigma reductions Employment and rehabilitation Social enterprises – limited number Need for legal framework adaptation and alternative employment models Service user

Business planning Prioritization Measurable targets Budgeting the intervention Management & Organization Development of a services network Human resources Users