Module Thirteen PSYCHIATRIC SERVICES Lesson 1: Psychiatric reformation (2 training hours) Lesson 2: the role of psychiatric services (3 training hours) TOTAL TIME: 5 TRAINING HOURS OF 45 MINUTES

Lesson 1 PSYCHIATRIC REFORMATION TIME : 90 minutes (2 training hours of 45 minutes)

Step 1: Introduction (10΄) Transferring the care for people with psychiatric problems from a big psychiatric institution to the community requires the development of supporting structures that can offer prevention, diagnosis, therapy and psychiatric rehabilitation. International experience has proved that the organization of these services for the first time is a difficult issue and can be achieved only when: There is politic determination, The society supports the effort, There is secure funding, the appropriate organisms can be found.

Step 2: Discussion (15΄) Where are psychiatric services offered in Greece? When did the function of community services begin? What do you know about the Psychiatric reformation and its context ?

Step 3: Theory presentation (20΄) The dominant situation before the Reformation: In Greece, until the middle 80’s, the only public offer of psychiatric care was done in asylums (Psychiatric clinics). Asylums usually hosted people with severe psychoses or antisocial behaviour and the hospitalization aimed firstly to discharge the community from a person with undesirable behaviour and secondly offer treatment to the person.

Step 3 (continued) The conditions in the asylums were miserable: Tenths of patients were rushed in large wards which had no other furniture apart from beds. The hygiene rooms were unacceptable. The personnel (included the doctors) was small in number and not trained. People of all ages lives together. People with Mental Retardation and other Organic Mental Disorders lived with psychotic patients. Any sense of personality, decency, personal choice was reduced to a state Of rigid hierarchy, uniformity and flattening.

Step 3 (continued) The duration of stay in the asylum was always long with undefined end. There were no service of psychiatric care for people with milder disorders or problems.

Step 3 (continued) The period of Reformation On 1981, Greece became the 10 th member of the European Economic Community (EEC). It was acknowledged that the sector of Mental Health among others needed upgrade. After the submission of a concrete proposal an important financial support was approved for the reformation of psychiatric health based on the principles of Community’s Psychiatric Health (standards) This proposal after its approval constituted the regulation 815/84 of EEC and the same year was legislated in Hellenic Republic (law N.1397/84) in the context of application and National Health System.

Step 3 (continued) The context of the Reformation There were four basic targets: Ι. The development of complete networks of psychiatric services throughout the country. This required the separation of the country in Psychiatric Sectors. Each Sector was responsible to offer all psychiatric services required in a determined geographic department. This should have necessarily service of first aid mental care (Mental Health Center), hospitalization service (psychiatric department of central Hospital) and services of psychiatric rehabilitation (work and residence). Appropriate services for children and adolescents should had to be developed.

Step 3 (continued) ΙΙ. Minimize the number of Asylums. This would be achieved by: Minimizing of hospitalization, as the services would be offered to the community and to the specific area. The reintegration of people and groups of patients from asylums to new rehabilitation units in the area of their origin.

Step 3 (continued) ΙΙΙ. Ameliorate the conditions in asylums. With the creation of modern hotel structure. With better personnel. The separation of persons with Mental Retardation and Organic Mental Disorders. The separation of elders.

Step 3 (continued) IV. Give the opportunities of training and further specialized studying, for suitable staff for all psychiatric services to exist

Step 4: Discussion (15΄) In what degree do you think that the targets of Psychiatric Reformation are achieved? What were the reasons in your opinions for the delayed application ? What do you think are the difficulties for its completion?

Step 5: Theory presentation (20΄) The progress of the Reformation The initial schedule for the completion of the reformation was set to five years. During its application there were serious delays and serious problems occurred. (f ex Lero’s issue). Several extensions were given and the validity of the regulation 815/ 84 over passed the decade. Unfortunately during this period it the application of Psychiatric Sections was not achieved.

Step 5 (continued) Random psychiatric community services were developed in several regions where the conditions permitted and there were well trained and experienced personnel, but mainly will and determination. A new law for Mental Health came into force, the law N 2071 / 92, which simply determined the legal frame for the function of these services naming them Units of Mental Health. The asylums even if they improved their structure, the conditions of hospitalization and their general function, they were not substantially decongested and continued to receive the majority of patients.

Step 5 (continued) The few existent psychiatric departments of general hospitals functioned but not as effectively as to keep the persons for hospitalization in their place of origin. The next law for Mental Health, law N. 2716/99 gave again priority to the organization and function of Psychiatric Sections. Its application is promising, as well as the application of the program PSYCHARGOS, through which the psychosocial rehabilitation of many persons that live in psychiatric clinics is intended again.

Step 6: Questions and comments (5΄)

Step 7: Lesson’s evaluation (5΄)

Lesson 2 THE ROLE OF PSYCHIATRIC SERVICES TIME : 135 minutes (3 training hours of 45 minutes)

Step 1: Introduction (5΄) Every minute about 1 out of 6 suffer from a mental disorder. Not all of them are severe. Despite their rate of incidence and the important consequences in people’s life, only recently was emphasized the development of services for their efficient treatment.

Step 2: Slide projection and discussion (20΄) Slide : The role of Mental Health Services Te services of Mental Health must: Offer high quality treatment and care to the society. Satisfy the needs of people who use them and not to discriminate them. Be easily accessed and offer services wherever there are needed. Offer opportunities that promote independence

Step 2 (continued) Offer continuous care and treatment. Offer support to he families of the persons who use them. Collaborate and keep good coordination with other services. Offer training and experience and contribute to the training of skillful staff. Support their personnel and secure its rights. Be held responsible to society.

Step 3: Exercise (20΄) Leaflet : Functions of various Mental Health Services Complete the table of the leaflet with + or - in each square according to the offer or not of the function from a service.

Step 4: Slide projection (35΄) Slide : Communal Psychiatric Services: Centre of Mental Health Prevention in schools, work places, neighborhoods etc. in their families, new parents, couples and people that are liable to mental disorders in sensitive population groups, (f ex immigrants, patients of physical diseases) Evaluation and diagnosis Therapeutical treatment Medication Psychotherapy Social interventions After hospitalization observation Cooperation with other Mental Services. Training of all the sectors of professional in mental health.

Step 4 (continued) Slide : Community Psychiatric Services: Psychiatric department of General Hospital Intervention in social stigma Offer of short hospitalization Treatment of emergency psychiatric problems Diagnostic and therapeutical service Cooperation with other Psychiatric Services Training of all the sectors of professionals in mental health

Step 4 (continued) Slide : Community Psychiatric Services: rehabilitation services Evaluation of social needs, problems, inabilities and abilities of the patients Planning, organization and observation of residence Units Planning, organization and observation of Working Units Creation of new communication means with other social and working organizations Collaboration with other Psychiatric Services Training of all professionals in mental health

Step 4 (continued) Slide : Community Psychiatric Services: units of Partial Hospitalization Day Hospital Offer of all services of any psychiatric department for people that require hospitalization but their state does not demand 24 hour stay in the hospital and have supportive family environment Diagnostic and therapeutical services Development of group activities Promotion of the stay in the community for the person and involvement of the family in the problem. Help to eliminate the stigma

Step 4 (continued) Day Care CentreΚέντρο Ημέρας Support service additional to the rehabilitation services Offer of training in social skills Organization of programs of pre-professional and professional training Offer of creative occupation and entertainment to the persons that are not able to work Development of group activities Cooperation with other Psychiatric Services Training of all professionals in mental health

Step 5: Discussion (10΄) Make a brief discussion regarding your work on Step 3 and the information from Step 4.

Step 6: Brainstorming (10΄) The functions of various Services of Mental Health can possibly overlap and the choice of the most appropriate one is not always obvious. Think of examples.

Step 7: Exercise (25΄) Leaflet : Exercise Complete for every case the most adequate Psychiatric Service.

Step 8:Questions and comments (5΄)

Step 9: Lesson’s evaluation (5΄)