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From Leros Asylum To Community-Based Facilities: Levels of Functioning and Quality of Life Among Hostel Residents in Greece

SAGE Publications Inc
International Journal of Social Psychiatry
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Abstract

The pattern of mental health care in Greece is undergoing a major transformation. The Leros Projects I and II supported the development of 13 community hostels located throughout the Greek mainland. These hostels provide residential care to more than 100 former psychiatric inpatients, mainly from Leros asylum. The present study evaluates the impact of the resettlement process on the residents' perceived quality of life (QoL) together with an examination of the residents' psychiatric and behavioural functioning four years after the move from hospital. The target sample (n = 99) comprised of individuals who may be considered 'chronic' psychiatric patients with a long history of institutionalisation and many are socially deprived with few family ties. The residents' functioning profile indicates a range of different levels of abilities. The QoL findings show that the majority of residents (70%) perceived the movement from the traditional hospital regime to the community hostels as being a positive change and expressed their satisfaction (74%) with the new living situation. This study demonstrates that even the most dependent, chronic psychiatric patients in Greece can be maintained in community settings and are able to articulate generally reliable and valid responses concerning the impact of service changes.
... As part of the response to a request from the Greek government for financial support, EEC Regulation 815/84, Programme B, was adopted in 1984 and provided a grant of 120 million ECU. The strategic objectives of the 5year plan in fact extended beyond 1989, up to 1995, and emphasised decentralisation of mental health services and the develop ment of communitybased services, deinstitutionalisation of longstay patients and improvement of conditions in the public mental hospitals, with special attention to the Leros Mental Hospital (Bouras et al, 1992;Christodoulou et al, 1994Christodoulou et al, , 1999Zissi & Barry, 1997). In 1989, the Hellenic Psychiatric Association, following an evaluation by a task force, prepared a comprehensive report on the Leros asylum (Hellenic Psychiatric Association, 1989) and made a number of recommendations to the Greek Ministry of Health. ...
...  transformation of the public mental hospitals, with the parallel deinstitutionalisation of longstay patients (Madianos et al, 1999b)  decentralisation of the mental health services by provision of communitybased structures, especially alternatives for community placement of discharged longstay patients (Zissi & Barry, 1997;Madianos, 2002). In fact, the implementation of EEC Regulation 815/84, Programme B, within the period 1984-95, and the new Psychoargos programme have contributed to the gradual discharge of thousands of psychiatric patients. ...
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Greece joined the European Community in 1981 and, 3 years later, the Commission of the European Communities provided financial and technical assistance under EEC Regulation 815/84 for the modernisation of the Greek mental healthcare system, with an emphasis on decentralisation and the development of community-based services, as well as the deinstitutionalisation of long-stay patients and improvement of conditions in public mental hospitals.
... It recommended a collaboration of Greek psychiatrists with experts from other European countries (Ramsay, 1990), fostering a cooperative effort to implement the envisioned reforms. This is how the Leros asylum case triggered the process of reform of Greek mental health institutions (Zissi & Barry, 1997). ...
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Throughout the history of mental illness and its treatment in Europe, remarkable progress has been achieved, especially over the past 100 years with the evolution of medical services, diagnostics, social policies, and social attitudes. The process of deinstitutionalisation of mental health care progressed together with the acknowledgment of social and relational aspects of the mental illnesses. Consideration of the environment as an important factor of one’s mental wellbeing came to replace the earlier view of mental issues residing solely in the individual and their biological features. Over the last 60 years, the social status, economic and other factors, have all been increasingly acknowledged as having an important role in therapy. When such conditions are unfavourable, they tend to aggravate the existing condition, as has been evident world-widely in the majority of mental health institutions before the necessary reforms took place. Greece is no exception, as will be shown in this article; from alienation, isolation and stigmatisation of the mentally ill, a number of initiatives and psychiatric reforms facilitated the process of deinstitutionalisation and rehabilitation, and have helped society move away from stigmatisation towards integration of the persons with mental issues and learning difficulties into the society and family life. The process is however, far from complete, and much remains to be done. The article begins with a brief history of the development of psychiatric practices in Europe from 17th to 20th century. It then examines modern Greece as the case study, where the major psychiatric reform came rather late in comparison to other European states, particularly between 1970s-1990s. Three psychiatric reforms will be examined (Leros I and II, and Psychargos reform) as well as the subsequent collaborative efforts between Greece and EU services. The progress, as evidenced, has been slow and inhibited by numerous obstacles; nonetheless the outcomes are significant and continuously evolving.
... A crucial factor in the broadening of discourses on mental distress has been the development of community mental health care. In Greece the shift from asylum psychiatry to a community based mental health care system started in the 1980s (Zissi & Barry, 1997), and has been slow and disjointed, resulting in an uneven and partially developed system of community based services, which is now shrinking due the recent economic crisis (Christodoulou et al., 2012;Triliva, Fragkiadaki, & Balamoutsou, 2013). The existence of a community mental health service network provides individuals in distress who enter the system the opportunity, beyond medication and hospitalisation, to make use of available resources in order to manage their experiences. ...
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During the last decades, there is increasing acknowledgment of the contribution of socioeconomic factors in the development and course of psychosis. This paper presents findings from a biographical study examining the role of social parameters and processes in the biographical trajectories of people with psychotic experiences. 27 biographical narrative interviews were conducted with individuals who experience severe distress, have received diagnoses of psychotic disorders and have been in contact with mental health professionals and services. The biographical narratives elicited were subjected to several layers of analysis, resulting in hermeneutic reconstruction of each narrative as well as the formation of groups and types of biographical trajectories of distress. In this paper we present one of the two groups of biographical narratives, the narratives in which participants recognize, own and attempt to manage their distressing experiences, and seem to be in a process of recovery. The main features of this group of narratives are the free-flowing reflexive narrative style, depicting the emergence of psychosis as a point of biographical disruption, references to various adverse experiences in childhood and adolescence, early acknowledgment and community management of distressing experiences, and finally continuing participation in interpersonal relationships and social networks. Participants in this group can be subdivided into two types, those who position themselves as struggling with severe distress and those who struggle against the biomedical model and the mental health service system, referred to in the literature as ‘users’ and ‘survivors’ respectively. We discuss the factors that enable biographical trajectories of recovery, demonstrating a dialectical relation between on the one hand professional institutions, knowledges and practices and on the other social networks and popular discourses on mental health as determining factors of a person’s biographical trajectory with regard to severe distress.
... Eventually, it was the Leros case that triggered the process of reform of Greek mental health institutions. 5 Under the two reform projects, Leros I and Leros II (1990-1994), numerous interventions took place. In 1990, 19 community hostels were established on Leros. ...
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Leros became infamous worldwide in the 1980s because of a scandal in its mental institution, the Leros asylum. The scandal provoked universal outrage and the international pressure triggered the Greek mental health reform. Under the reform projects Leros I and Leros II (1990–1994), numerous interventions took place in the Leros asylum as part of deinstitutionalisation. Following that, the Psychargos programme advanced developments for community-based services. Deinstitutionalisation and development of community mental health services have advanced significantly since the 1980s. However, this reform is still incomplete, given that sectorisation, adequate primary care policies, inter-sectoral coordination and specialised services are under-developed. This problematic situation is further complicated by the severe impact of the current financial crisis.
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Η παρούσα διπλωματική εργασία στοχεύει στη μελέτη των κοινωνικών συνεταιρισμών ως εναλλακτικό παράδειγμα επιχειρηματικής οργάνωσης. Εστιάζει, στο ρόλο τους ως προς την ένταξη στην εργασία ατόμων από περιθωριοποιημένες ομάδες πληθυσμού και συγκεκριμένα στους λήπτες ψυχιατρικών υπηρεσιών (ΛΨΥ). Προκειμένου να εντοπιστούν τα χαρακτηριστικά της συνεταιριστικής οργάνωσης που εν δυνάμει διευκολύνουν την ένταξη στην εργασία των ΛΨΥ, αναζητήθηκαν, μέσω βιβλιογραφικής ανασκόπησης, οι παράγοντες της υποστηριζόμενης εργασίας που ενισχύουν την ένταξη στην εργασία των ΛΨΥ. Σύμφωνα με μαρτυρίες των ίδιων των ΛΨΥ, εντοπίστηκαν δεκαέξι παράγοντες και είναι οι: δημιουργική απασχόληση, υποστηρικτικό περιβάλλον, κουλτούρα συμπεριληπτικότητας, παροχή εκπαίδευσης για ανάπτυξη δεξιοτήτων, αρμονικές διαπροσωπικές σχέσεις, αποτελεσματική διοίκηση ανθρωπίνων πόρων, ελαστικό ωράριο, δημοκρατική δομή, δυνατότητα κοινωνικών δραστηριοτήτων εκτός εργασιακού περιβάλλοντος, ικανοποιητικό εισόδημα, ασφαλείς θέσεις εργασίας, εναλλαγή εργασιακών καθηκόντων, εγγύτητα χώρου εργασίας με τόπο διαμονής, ήσυχο εργασιακό περιβάλλον, δυνατότητα εξ’ αποστάσεως εργασίας και ύπαρξη ομάδων αυτοβοήθειας. Στη συνέχεια αναζητήθηκε η συμβατότητα των χαρακτηριστικών της συνεταιριστικής οργάνωσης, όπως αυτή ορίζεται από τη Διεθνή Συνεταιριστική Συμμαχία, με τους παράγοντες που διευκολύνουν στην εργασιακή ένταξη των ΛΨΥ. Εντοπίστηκε ότι: η φροντίδα των συνεταιρισμών να παρέχουν ποιοτικές θέσεις εργασίας, η οριζόντια και δημοκρατική διακυβέρνηση, η εκπαίδευση, η καλλιέργεια κοινωνικού κεφαλαίου μέσω της δικτύωσης και η σύνδεση με την κοινωνία των πολιτών αποτελούν εν δυνάμει ενισχυτικούς ως προς την ένταξη παράγοντες. Τέλος, προτάθηκε η πρακτική εφαρμογή των προαναφερθέντων εργαλείων/αρχών της συνεταιριστικής οργανωσιακής φιλοσοφίας σε εντοπισμένα από προηγούμενες έρευνες ζητήματα που αντιμετωπίζουν στην Ελλάδα οι κοινωνικοί συνεταιρισμοί περιορισμένης ευθύνης (Κοι.Σ.Π.Ε.).
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Psychiatric care in Greece has a long history of traditional in-patient treatment in large public institutions (the public asylum period), which lasted until 1983. European Economic Community (EEC) intervention in 1984 marked a transitional period (1984–1989) characterised by the beginning of the transformation of the mental healthcare system. The current reform era started in 1999 and has included new mental health law, the closure of six public mental hospitals and the establishment of several sectorised mental health services.
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Uganda, in common with many countries in sub-Saharan Africa, has many population risk factors predictive of high levels of mental disorder but poor coverage of mental healthcare (Kigozi, 2005). Recent population studies conducted in Uganda have shown rates of disorder in excess of 20% (Kasoro et al , 2002; Bolton et al , 2004; Ovuga et al , 2005) and the survey by Kasoro et al (2002) showed a high prevalence of patients with severe mental illness and poor access to services. There are 19 psychiatrists for 24.8 million people in Uganda, all but one of whom is based in the capital city, Kampala (Kigozi, 2005). The provision of mental health services relies on the use of psychiatric clinical officers (a cadre of trained mental health workers, similar to community psychiatric nurses, who currently cover 18 of the 56 districts in Uganda), primary care personnel, non-governmental organisations and members of the community. Liaison with traditional healers is encouraged (Ovuga et al , 1999).
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Objective The aim of the study is to evaluate the impact of transfer of care from the psychiatric hospital to community residential homes on the patients' level of social functioning, one year after discharge. Method A repeated measures design was employed in order to compare 73 patient's level of functioning one week before the transfer to the psychiatric hospital and one year later in community residential homes. A Personal data and psychiatric history form was used as well as the Scale of Rehabilitation Evaluation of Baker and Hall (1984). Descriptive statistics and One-Way ANOVA were used to analyze the data.Results A statistically significant improvement was noted in the rehabilitation and social functioning status of the patients (p<0.01). Conclusions Specific interventions developed in the community residential homes seems to have positive impact in many domains of social function of chronic psychiatric patients.
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The recent exposure of the plight of inmates living in poor conditions at the state asylum on the Greek island of Leros has caused public and professional outrage. If Greece is to avoid mistakes made by other countries, the plans for rehabilitating the patients and closing the hospital should from the outset include identification of the precise needs of patients for support and care. The survey of the patients' characteristics and needs for care found that most patients had no outside friends or relatives, and most were unable to perform basic daily skills. They shared many basic characteristics, however, with a large sample of the long-stay population in the UK, and 25% were thought to be able to live independently.