Deinstitutionalization without planning

He knows the beleaguered field of mental health in Greece like few others. With 40 years at the Attica Psychiatric Hospital in Dafni under his belt («Dafni is where I started and where I stopped»), first as a psychiatrist and later as the head of medical services, he has experienced everything from the era of Leros-type asylums to the first attempts at psychiatric reform and the deinstitutionalization program. Following the tragic death of 22-year-old Stelios Mastoropoulou in a rehabilitation unit recently, Kathimerini talked to Harilaos Varouhakis about the psychiatric care system in Greece. How do you see the care of the mentally ill in Greece? Unfortunately, Mastoropoulou is not the only case. There are many instances of malaise in the psychiatric care system. Matters are going from bad to worse. Society and the state continue to vie with each other as to who is more unwilling or inadequate at providing care. Society is quick to shed tears but is slow to help shoulder the material and moral costs involved in offering genuine solidarity to another person who is suffering. The same goes for the state. The attempts that began 20 years ago to find a place in the sun for those people are continually thwarted. What do you mean? The psychiatric reform program exists purely on paper. It ignores reality. The basic aim is to abolish psychiatric hospitals, which entails organizing services to replace them. Those services have not even been planned. Closing the hospitals is not an aim in itself. The point is for the patients to have a better life. Yet the only thing that has happened is that two or three psychiatric hospitals have been forcibly shut down, and chronically ill people have been transferred from huge asylums to smaller units. So one part of the deinstitutionalization project has been implemented but not the more difficult part. The difficult part, that is, to say that other people will not be deinstitutionalized, has not even been subject to study. Are you saying that new, smaller asylums have been created? But not even the building specifications that such units must comply with have been determined. Even a hotel has certain specifications. It is unacceptable for a halfway house not to have a yard. It is not a house; it must be specified what spaces it must have, how they are to be used, how many people will be in each room. Moreover, there are no provisions for the mandatory appointment of a doctor, let alone a psychiatrist. The chronically ill have serious physical health issues. Don’t patients nowadays have much better lives than they did 20 years ago? Certainly, the material conditions have improved. The body of the patient is accorded greater respect. But the personality, that which distinguishes human beings from all other living things, is ignored in an even worse fashion. Life in a halfway house is determined by the needs of the residents. At present, their basic needs are being met: They live decently, they get their daily requirement of 1,500 calories, and they have a roof over their head. The greatest challenge for a therapist is to try to increase patients’ needs. They need to contribute, to have obligations, to cry, to feel sad, to feel happy. Material well-being can cover up the real situation, so that society, which already doesn’t want to see the problem, can sidestep it more easily. How do you explain that? The state has never understood the need to make use of the experiences of people who have worked in the field. Committees upon committees of nameless experts, of fawning yes-men and party officials have made forays into the decision-making centers and raided the funds that have been made available for the mentally ill. I cannot accuse anyone of getting involved in the mental health field in order to get subsidies because I have no evidence, but I can condemn the lack of transparency with which they are chosen and spring up out of nowhere, they are not people from this field. What do you propose? Suspending implementation of the program and formulating a new action plan, after documenting the present situation properly, and not prettifying it up to suit special interests. I have submitted this proposal to all the recent health ministers but none of them has ever called on me.