A ground-breaking study has unveiled shocking insights into the state of mental health care in Greece, exposing the prevalence of incarceration and alarming rates of forced hospitalisations. The deeply concerning study identifies risk factors associated with involuntary hospitalisation and urges urgent reevaluation of laws and comprehensive human rights training, demanding a transformation of mental health care in Greece.
Conducted between 2017 and 2020, the in-depth Study of Involuntary Hospitalisations in Greece (MANE) provides valuable information on the rates, processes, determinants, and outcomes of involuntary hospitalisations. Led by Professor Stelios Stylianidis, a renowned expert in Social Psychiatry at Panteion University, the study is published in the respected journal "Psychiatry," endorsed by the Hellenic Psychiatric Association (EPSE). The comprehensive MANE study spans multiple centres and years, aiming to understand the rates, processes, and risk factors of involuntary hospitalisation, as well as the long-term outcomes for individuals.
Forced Involuntary Hospitalisations
Key findings of the study highlight significant differences in recorded involuntary hospitalisations between Alexandroupolis, Athens, and Thessaloniki. The rates are around 25% in Alexandroupolis, compared to over 50% in the metropolitan areas of Athens and Thessaloniki. This discrepancy may be attributed to variations in the organisation of mental health services and the absence of a densely populated urban environment in Alexandroupolis.
The study also reveals that a higher percentage of involuntary admissions result in forced hospitalisations in Athens and Thessaloniki compared to Alexandroupolis. Conversely, in Attica, nearly all voluntary admissions to emergency departments (ED) lead to hospitalisation, while substantial proportions are turned away in Thessaloniki and Alexandroupolis. Notably, Alexandroupolis exhibits a higher rate of formal referrals during discharge, suggesting better continuity of care and lower rates of involuntary hospitalisation in the region.
A concerning trend highlighted by the study is the high rates of readmission, particularly among individuals voluntarily seeking hospitalisation, emphasising the need for better long-term support and care.
Indefinite and Unlimited Involuntary Incarceration Without Judicial Review
The study also underscores the urgent necessity to modernise legislation governing involuntary hospitalisation. Previously, regulations allowed indefinite and unlimited involuntary incarceration without judicial review, leaving patients entirely dependent on psychiatrists. The researchers stress the importance of aligning the legislation with international standards and promoting community-based care, moving away from outdated practices.
Current laws stipulate that involuntary confinement is only justified when an individual has a mental disorder, lacks decision-making capacity in their best interest, faces a serious deterioration of mental health without hospitalisation, or poses a risk of violence towards themselves or others.
Risk Factors Associated with Involuntary Hospitalisation
The research highlights various risk factors associated with involuntary hospitalisation in Greece. These include being male, single, unemployed, lacking social support and financial resources, and receiving diagnoses related to psychotic disorders and bipolar disorder. Severe symptoms and aggression are also linked to higher rates of involuntary hospitalisation, while previous experiences of involuntary hospitalisations and contact with hospital structures contribute to the process.
The study's documented rates of involuntary hospitalisations offer crucial insights with Ioannina recording a rate of 28%, Patras 45%, Attica 57%, Thessaloniki 53%, and Alexandroupoli 24%.
Researchers Urge Urgent Reevaluation of Laws, Human Rights Training
The researchers urge a reevaluation of the application of relevant laws, emphasising the need for improved communication between prosecutors, judges, and psychiatrists. They advocate for comprehensive training on human rights for all involved parties and challenge the prevailing perception of mentally ill individuals as dangerous, aiming to combat the persistent social stigma. Additionally, they stress the necessity of establishing an organised system of community care and primary mental health services.
A Powerful Call to Action
The MANE study serves as a powerful call to action, demanding a transformation of mental health care in Greece. It provides an opportunity for policymakers, healthcare professionals, and the public to engage in constructive dialogue, with the goal of promoting community-based care, enhancing patient support, and upholding human rights. By embracing the insights gained from this pioneering research, Greece can move towards a more compassionate and effective approach to mental health, prioritising the well-being of individuals in need.