Greek child psychiatry fights back to survive the crisis

Dimitris Anagnostopoulos: “Our youth mental health services are in great danger to collapse”

Over the ages, the people of Greece have proved many times that they are very good at overcoming a crisis. Good for them, because they are facing a huge one now. And it hits child mental health services at least as hard as any other hard-won achievement. Dr Dimitris Anagnostopoulos, professor of child and adolescent psychiatry at the National and Kapodistrian University of Athens, underlines the seriousness of the crisis for all Greek families and gently lowers his voice when he speaks respectfully about the creative efforts of so many of his compatriots – often volunteers – that put all their energy and creativeness in surviving. The historic context is that since the early 1980’s child psychiatry in Greece has been presenting a continuous development of establishing a modern community based mental health service system which now is under threat because of the austerity measures.

Dr Anagnostopoulos: “We work voluntarily. We offer our patients more hours of work, for less money paid – our salaries have already been
portrait of Dimitris Anagnostopoulus cut tremendously. We try to compensate the resignation of so many experienced colleagues by creating a network of volunteer workers in every aspect of child and adolescent psychiatry. At the University of Athens, we doubled our evening shifts. Very regularly we work form half past eight in the morning untill half past eight in the evening.”

“We know we are all under threat and we are prepared to face all these dangers. A further decrease of jobs in the mental health services has been announced and we know that our youth mental health services are in great danger to collapse. But we have to separate our political claims and discussions from the real needs of patients. Demonstrating for our salaries becomes trivial and we can always do that in Syntagma square... This is something completely separated from that: this is about the health and wellbeing of our patients. This is my profession and responsibility. And I have to protect myself and my profession against being destroyed by this crisis.”

Experienced
survivors
“We have the culture and the experience and that helps a lot. Since ancient years Greece has been confronted with many enormous crises. Through the ages we always succeeded to survive them. That's in our nature. After four hundred years of Ottoman slavery, we developed a very vivid modern, democratic society in many aspects. We overcame the German and Italian occupation, we survived a civil war. And of course, we kicked out a dictator... So I feel we must be able to handle this crisis as well”
“Psychiatrically spoken, there is something very optimistic about the Greek. We used to have the lowest suicide rate of Europe and one of the lowest in the world. Since the crisis we have seen that the actual number of suicide attempts has not risen significantly, but we do detect a change in the reasons for suicide attempts. 'Unemployment' is the word we hear in a rapidly growing number of cases. This also goes for other disorders. Of course it is very normal to see psychological reactions to bad economic circumstances.”

Traditional personality traits 
help the Greek
“But if there is a pathological reaction, it depends on many other factors – one of them is the mentality. The mentality, or the personality, I believe is a crucial factor. And here we are helped with our Greek personality. We are an extraverted people, and this helps. The sun and the sea help us! This does not devaluate the mental cost of crisis: still there is misery, still there is unhappiness... There is a grey feeling in many Greek families. That is the atmosphere we feel throughout the country. But we rely on our natural talents to overcome this crisis.”
 “The lowering number of experienced and well educated staff is a tough problem. After so many layoffs we simply can no longer do without external help. That's why we try hard to co-work and try to organize synergies with other workers and social entities that share our goals. For example: the church. Here the homogeneity of the Greek population helps us: 95 percent belong to the Orthodox church, there is one language and one culture... We collaborate with the network of the Greek Orthodox church, which is the largest volunteer welfare organization in Greece. Not only in Athens and Thessaloniki – every little village has its own priest. The church contributes food, shelter, and helping hands...”

Eyes and ears of
mental health workers
“We have given them a curriculum to teach them the basic issues on child mental health. This shows to be tremendous value. We make them sensitive to notice mental health problems. This whole network now watches out in and around their religious community – perhaps as distant as a friend of a son of the neighbour of one of the parishioner – is not just unhappy, but maybe there is something more severe going on. They are our eyes and ears. They may warn the parents, the priest and urge them to see a doctor, a welfare worker, a psychologist – and in some cases a child psychiatrist.”
“If the priests are aware of what is going on, the people have a possibility to be referred or to ask for help. These are excellent efforts, but this is not enough. Because there is another big issue that has not been faced yet.”

Dangerous spirit
of individualism
“The biggest danger for the future of my country are the indirecteffects. The political and economical climate has caused an atmosphere that threats mental health. Politicians, business people, state officials and mass media are promoting a dangerous spirit of individualism. They kill all solidarity by preaching that the solution will come from the individuals themselves, not by the collective. Fortunately, allover the Greek population, a movement of solidarity in various and prototype forms has been present since the beginning of the crisis. Another disturbing issue is the continuing, unfair guilt-mongering aimed against Greeks for their current state. While focusing on real weaknesses, this fails to reveal the different degrees of responsibility for different individuals. In addition, this attitude of scape-goating makes us exclusively responsible – different from the rest of the Europeans. This overlooks the fact that the Greek crisis is part of the European one, as well as a consequence of the international crisis that hit in 2008. For example: the IMF and the Troika tell us that all Greeks are corrupted. A huge, generalized argument. But untrue of course. The Greek are not more corrupted than any other people in the world.”
“Only small elite groups of politicians, business people and academicians practice corruption. It is not the average Greek worker who has taken money from Siemens. Nevertheless they create an atmosphere as if all Greek people have a responsibility to pay the bill.”
“In the mean time 27 percent of the Greek population have no jobs. And youth unemployment grew to the unbelievable level of 67 percent. Government has announced that many thousands of layoffs will still be necessary. In my opinion that is the wrong choice: if there is no other alternative, it would be much better to cut salaries in stead of laying everybody off. ”

Sense of
hopelessness
“Mental health problems prove to be strongly related with the fear of unemployment and the sense of hopelessness that comes with not being able to get a job in the future. I notice a rise of similar risk factors. Another example: if unemployment produces more depressive parents, this will have an impact on the mental health of children.”
“Another result is emigration: masses of young, well educated people are forced to emigrate to other countries – and this is an official policy. This is unjust: we spend our money to educate our youths and by the time that they are ready to give back what we have invested, they leave. To practice medicine in Germany, for example – while no German has paid a penny to their education.”

Reasons to fight back
“We should look at the real circumstances, not only the hype of politics, business and media. Imagine what it means that two million out of eleven million people are unemployed? Can you imagine? This means that in every Greek family there is a possible victim of depression or other serious mental issues. 67 percent of Greeks under 35 are out of jobs... That means that two thirds of all young people are out there in the streets. Can you imagine how risky that is for the creation of social pathology? And take a look at the figures of racist behaviour, and this awful fascist movement that is threatening our democracy and the health of our children.. We have all the reasons to fight back: for a better world, a new European identity and a safer environment for the children.”

Respond to this subject.
Dimitris Anagnostopoulos is coordinator of ESCAP for mental health of child and adolescent refugees and he will be a keynote speaker on this subject at the ESCAP 2017 Congress in Geneva. Learn more about this project.

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Dimitris Anagnostopoulos and Eugenia Soumaki have published a well documented article about the state of child and adolescent psychiatry in Greece. ECAP Journal, issue 2, February 2013.
Read more about child and adolescent psychiatry in Greece.
Read about child and adolescent psychiatry in Albania and Kosovo.

 

  • More patient visits

    Patient visits to Greek emergency units, outpatient departments, and mental health clinics in the National Health Care general hospitals have increased by 120 percent in the last three years. Source: Greek Ministry of Health.

    Increase of severe
    disorders in adolescents

    Greek adolescent inpatient units showed an admission increase of up to 84 percent, with borderline diagnoses, severe behavioural disorders, acute psychotic crises, self-harm behaviours, and other similar conditions constituting 78 percent of the total cases in 2011, compared to only 48 percent in 2007.

  • Less employees, more cases

    The existing national healthcare system in Greece, CAMHS, which forms the core of the service provision system, now operates with ten to fourty percent fewer employees, who are not paid regularly and whose salaries have been cut by fourty percent. A large portion of the more experienced personnel has been forced into retirement. At the same time, the number of new cases has increased, and the demand for supportive work within the community (due to the collapse of social services) and schools (due to insufficient psychological services) has also increased.

  • Longer waiting lists, longer waiting time

    A survey in a representative sample of both public and private child psychiatric institutions in Athens, Piraeus, and Thessaloniki between 2007 and 2011 (two years before and two years after the implementation of austerity measure) show a 39.8 percent increase in new cases in public outpatient services for children and 25.5 percent for adolescents, while percentages have dropped by a total of 35.4 percent in the private sector between the years 2007 and 2011. As a result, both the waiting list and waiting time are now longer. In most cases the waiting has tripled and is now longer than a month, while in special cases, it can be up to one year.