FIGHTING STIGMA IN CYCLADES ISLANDS IN GREECE: pilot interventions by Mental Health Mobile Unit and

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FIGHTING STIGMA IN CYCLADES ISLANDS IN GREECE
pilot interventions by Mental Health Mobile Unit
and the Municipality of Paros

• Stelios Stylianidis
• Ass. Professor of Social Psychiatry- Panteion
  University
• President of EPAPSY
• Board Member of WAPR

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Mental Health Mobile Units of Northeastern and
Western Cyclades Islands
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2 Mental Health Mobile Units of EPAPSY (NGO)

• Aims
• Provision of assessment and treatment for
  children, adolescents and adults suffering from
  psychiatric problems through the integration with
  Primary Health Care System
• Needs assessment of the population of the sector
• Mental Health Promotion (fighting stigma,
  sensitization and training etc)
• Function
• 4 years of function (since 2003)
• Financed by the Ministry of Health (management by
  EPAPSY)
• Multidisciplinary teams of psychologists,
  psychiatrists, child-psychiatrists and social
  workers working part-time in the eleven islands
• The function and management of the Mental Health
  Mobile Units is ruled by a specific Internal
  Regulation (implemented through a consensus
  conference of all the mental health team members)

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The experience of the Mobile Units till now

• More than 4.000 patients have been treated till
  now (almost 700 patients in Paros and Antiparos
  islands, ongoing increase of needs)
• Interventions for promoting mental health and
  fighting stigma have been developed
• Integration with primary health care and social
  services have been achieved
• Local authorities support the function of the
  Units

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Patients treated by the MHMUs
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Therapeutic sessions by MHMUs
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Numbers of intakes in Paros and Antiparos
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Most frequently diagnosed disorders by MHMUs
Counseling for relational problems
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Stigma
I dont want to see a psychologist. All people
in my village will say I am crazy! Only God
will help me to overcome my problems. My family
doesnt want me to see a psychiatrist. Other
people will see me visiting him at the Health
Centre

• Barriers to seeking help by mental health
  professionals
• -shame
• -guilt
• -attitude and cultural patterns of the
  population
• -prejudice of health professionals making the
  referrals, professionals working in education,
  professionals in social services, local priests
• -introverted isolated communities (especially
  during winter)
• -stigmatization results in problems becoming
  chronic within the community
• -no other mental health services
• Severe psychiatric patients have been restricted
  at home for many years without receiving any
  treatment (family secret)
• Monasteries and Local church offer refuge for
  psychiatric patients in some cases

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Interventions in Paros and Antiparos islands

• Paros
• 17.000 residents
• Almost 3000 migrants (Albanese, Polish,
  Egyptians)
• Antiparos
• 1000 residents
• Health and social services
• -Health Centre
• -Day Centre supported by volunteers for people
  with special needs
• -State program aiming at preventing substance
  abuse
• -Social service of Cyclades Prefecture
• -Program of the Municipality providing help at
  home for people of low socioeconomic status
  suffering from health problems
• -Hostel for elderly people developed and
  managed by the local church
• - Day centers for elderly people supported by
  the Municipality of Paros

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Interventions against stigma

• In close collaboration with local authorities,
  health professionals and social services
• Focus groups discussing mental health and
  discrimination issues
• -local authorities
• -local institutions (policemen, Public
  Prosecutors)
• - public education professionals
• -health professionals
• -priests
• -volunteers
• 2. Open events with interventions by mental
  health professionals (referring to general
  population)

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Interventions against stigma

• 3. Interventions through the media (local and
  national newspapers, TV, radio programmes)
• 4. Continuous training of Health Professionals
  working in Primary Care local and national
  seminars and open events in collaboration of
  National Association of GPs
• 5. Action strategic plan submitted to Regional
  Health Authorities (Ministry of Health) for
  promoting mental health and fighting stigma
• Sensitization of local authorities Municipallity
  of Paros, Prefecture of Cyclades)
• 7. Application to the E.U. (P.G. 12) of a
  research-action project (socio-anthropological,
  permanent training of P.H.C. operators) in
  collaboration with the University of Crete
  (Greece),Italy and Turkey

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Outcomes of interventions so far

• Increase of number of mentally ill people seeking
  help by mental health professionals
• Increase of referrals by Primary Health Care,
  Education, local church, social services etc
• People talk more freely about their problems and
  psychiatric care
• Mobilization of local resources Significant
  contribution of local authorities and local
  church - financial support of the Mental Health
  Mobile Units and the interventions against stigma
• Increase of psychiatric demands by ethnic
  minorities

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Recommendations

• Planning and implementation of an epidemiological
  and anthropological study aiming at assessing
  peoples representations regarding mental
  disorders (in collaboration with Panteion
  University of Athens)
• Planning, implementation and assessment of
  outcome of campaign against stigma based on the
  results of the study.
• Involvement of users, families, volunteer
  organizations in specific action plans
• Implementing local health system

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Recommendations

• THINKING GLOBALY, ACTING LOCALY
• Integration of different psychotherapeutic models
  in a community setting
• Increase mobilization of local resources in order
  to meet the unmet needs
• Integration of mental health services in the
  Municipal Enterprise of Health and Solidarity
• Cultural sensitive approach implement a specific
  ethnopsychiatric consultation

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Local Health System

• Whole system approach
• How determining factors of health are
  incorporated in the health system
• - self-help groups, volunteers
• - traditional medical practices
• - socio-economic situation
• - promotion of local networks, new resources

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Local Health System

• Contradictions - Resistances
• -bureaucratic culture of services
• -lack of coordination of services and information
  dissementation
• -fragmentation, conflicting sub-groups
• -discouragement of users participation by health
  authorities
• -dominant culture of medical-biological model
• -limits of the WHO model - relation between
  Primary Health Care and community psychiatric
  care
• - Non-symmetrical relation between providers of
  care and users

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Local Health System

• Basic characteristics aims new strategies
• 1. perception and interpretation health/ mental
  health problems through different ways (Primary,
  Secondary, Tertiary Health Care, mental health,
  environment, local patterns, anthropological
  analysis of the patterns)
• 2. General and specific local decisions on
  health
• 3. Acceptance of responsibility and follow- up
  of decisions by local services (action plans)
• 4. Participation in decision-making
• (bottom-up VS up-bottom approach)
• -discussion between different parties
  (public, private, NGOs etc)
• -aims of agreement what should be done,
  responsibilities, resources, methodology of
  interventions, manifest latent resources
• -sensitization of the general population,
  ongoing communication, development of a simple
  practical program of local development
• 5.constant evaluation, future planning