Fitsiou easteuropean psych.congress 2015

1. ADVOCACY, NETWORKING AND MOTIVATION OF CIVIL SOCIETY: AN INTERVENTION PLAN
FOR MENTAL HEALTH AND HUMAN RIGHTS PROMOTION
4th East European Psychiatric Congress & 3rd Preventive Psychiatry
International Congress
FITSIOU P., M. MOUSMOUTI, DARMOGIANNI N., MALAKOZI A.,
R. AGATSA
SOCIETY OF SOCIAL PSYCHIATRY AND MENTAL HEALTH
This project is funded by Iceland, Liechtenstein and Norway under the EEA Grants Greek
NGO Programme “We are all Citizens”. The Bodossaki Foundation is the Fund Operator of
this Programme. The Programme aims to strengthen civil society and enhance the
contribution of NGOs to social justice, democracy and sustainable development.

2. Introduction
• The burden of mental illness: Neuropsychiatric disorders are the third leading
cause of disability-adjusted life years (DALYs) in Europe and account for
15.2%.
• Effects are disproportionate for vulnerable groups: not equal access to health
services, lack of community services, stigma, and corresponding barriers to
education, work, home, leisure activities, social relationships, active
citizenship and community involvement
• People with mental health problems express unfamiliarity with the term
human rights and advocacy, reflecting the lack of awareness and
information.
• The transition from the medical model of disability to the rights based or
social model, that views people with disabilities as subjects of rights rather
than beneficiaries of charity, relies on two central concepts that aim to
reverse the disabling environments: respect for autonomy and individualised
support as a path to empowerment, and targeted interventions to remove
barriers in information, access to services and representation.

3. The reality for people with mental health problems in
Greece: FACTS and FIGURES
• According to the European Disability Forum (2015) persons with disabilities, in
particular persons with intellectual and psychosocial disabilities are at high risk of
human rights abuse, including violations of the right to life.
• 60,2 % involuntary admissions in the biggest mental health hospital in Athens.
97% of patients were transferred by the police and not by the First Aid Centre
Emergency Ambulance Service. It is not certain that patients were properly
informed of their rights and more specifically of their right to file an appeal, as is
required by law. (Stylianidis, Peppou, Drakonakis, 2012).
• More than 84% of all the admitted were not referred to Community Services
(Stylianidis, Peppou, Drakonakis, 2012)
• Restraint may be used as punishment or counterbalance staff shortages in
overcrowded facilities. More precisely, deaths recorded annual as a consequence
of restrictive practices (Stylianidis 2014)
• 75% of the population with at least one common mental disorder does not receive
any treatment at all for its condition. (Skapinakis et al, 2013)

4. The landscape regarding services
According to Maudsley International and CMT Prooptiki, 2015:
• Many areas in Greece still lack basic mental health units especially primary care
services. The existing system is centralized. Sectorization is not implemented (despite
the fact that it was provided for in law 2716/99 on mental health reform) and the
continuity of care is not achieved.
• The participation of users of mental health services and family associations in sector
committees has not been implemented yet in the active committees
• And while general issues regarding the protection of the patients' rights, their social
rehabilitation and the reduction of stigma connected with mental illness, have been
addressed through legislation, through the establishment of special committees
(Special Committee for the Monitoring of the Protection of Rights of People with
Mental Health Problems) and through specialized reports and interventions of
independent authorities (eg NCHR, Ombudsman), the obsolete institutional
framework in place requires immediate change on sensitive issues such as involuntary
hospitalization, legal capacity, detention and treatment of mentally ill prisoners.

5. The challenge
• Based on the data presented above 2 of the most
acute challenges for the rights of people with mental
health problems concern their limited access to
adequate community services due to fragmentation
and lack of coordination and networking of existing
services and the limited ability to react to abuses of
rights due to lack of information and limited access to
legal services and representation. The case studies
that follow aimed to address these barriers.

6. Case studies: Targeted interventions to address
barriers in mental health
• The 2 case studies we will present refer to 2 new projects implemented by the
Society of Social Psychiatry and Mental Health. These projects are funded by
Iceland, Liechtenstein and Norway under the EEA Grants Greek NGO Programme
“We are all Citizens”. The Bodossaki Foundation is the Fund Operator of this
Programme. The Programme aims to strengthen civil society and enhance the
contribution of NGOs to social justice, democracy and sustainable development.
• We have to say that the Society of Social Psychiatry and Mental Health, in the
framework of the work done in the Mobile Mental Health Units and in the
Rehabilitation Services since 1981, has been fighting for the rights in mental
health and self advocacy promotion, through the systematic networking,
community awareness raising and empowerment of people with mental health
problems.

7. Case study 1: Facilitating access to community services through networking
and a single entry point to the mental health system
• The project titled "BONDS: Strengthening and Networking of Mental
Health Organizations to Improve Services to the Community" aimed to
strengthen networking between mental health services in order to
facilitate equal access to services for people with mental health problems
through the development of Citizens' Information Points for Mental
Health and Rehabilitation Services
• This project built on the experience gained through the local Health Care
Network "Akeso" in the rural area of Fokida Prefecture that was
established by the Society of Social Psychiatry and Mental Health since
2007 to respond to gaps and discontinuity in the treatment of health
services users and irregularities in the referral processes.

8. Aims of Network “Akeso”
• The network aimed to: To inform and facilitate access to health
services for citizens that live in remote areas; Foster collaboration
between health care entities/services; Empower and support each
health care entity; Record health care needs and gaps in the region;
Reinforce solidarity, trust, human rights and inclusion perspective in
local community.
• The network intervened to address the problems identified through
awareness and information, the recording and evaluation of health
care requests, needs and gaps, the empowerment of health entities
and the development of collaboration initiatives.

9. Methods
• Citizens’ information involved an extended awareness campaign to citizens through the use
of posters, brochures, local mass media, social media, personal meetings with officials and
influential people in the community, visits at schools in the region even the most remote
ones.
• Development of collaboration involved communication and meetings with local entities,
development of communication and referral protocols, assignment of contact persons in the
network, regular managerial meetings, feedback meetings, co-organization of public
speeches, cultural and thematic events in the community, monthly letters on news and
scientific topics, use of blog.
• Recording and evaluation of health care requests, needs and gaps involved a telephone line
that accepts, records, refers and keeps truck of health requests, maps of all health services
available in the region, develops a pool with all possible health needs – encoding in 8
categories of 65 needs, construction of rating tool to evaluate requests’ processing every six
months.
• Empowerment of health entities through statistical recording of health needs and gaps,
raising of the issues in the community, update the Prefecture of Fokida and Ministry of
Health, mobilisation of volunteers)

10. Results
• The “Akeso” network dealt with over 450 requests for health or
social needs. 47% of the requests came directly from citizens, 42%
of which had been informed from some public non psychiatric
health entity. Most of the times (82%) some “other” society
member called in the name of the patient, in 61% of the cases it
was a female. The project resulted in increased referrals to the
network, reduced response time, a notable reduction of unmet
needs/demands, a strengthening of people's trust/confidence in
the existing services and a feeling of security and coordinated
actions to address the existing gaps.

11. Case study 2: Advocacy for people with mental health problems
• The project titled "Action Platform for the Rights in Mental
Health" aimed to intervene in a dynamic manner to address the
systemic lack of awareness and information of people with mental
health problems on their rights which are often associated to
stigma and the barriers in accessing legal services and
representation. .
• The project combined the establishment of the first Advocacy
Office in the country with community awareness activities and
targeted capacity building for professionals involved with the rights
of people with mental health problems (lawyers, judges, mental
health professionals, police). The ultimate aim of the Advocacy
office is to support the shift from advocacy to self advocacy, from
"clinical recovery" to social recovery and self- determination.

12. The Advocacy Office
• The Advocacy Office offers individualized support
jointly by lawyers and clinicians. The main services
include information, consultation, guidance and
referral to other services and institutional bodies to
users of mental health services. It works closely with
representative users' and families' associations, trying
to empower people to claim their rights.
• After 5 months the Advocacy office has offered
services to approximately 110 people and there is an
increasing number of requests.

13. Common cases
• The most common cases recorded concern
issues of legal capacity, the right to manage
one's own assets, access to social security
benefits and entitlements, involuntary
admissions, discrimination, bullying or
violence against people with severe mental
health problems.
• In practice, all issues derive from a chronic
neglect and abuse of the interests and the
needs of people with mental health problems

14. Challenges
• The biggest challenges that the Advocacy office
has identified concern the lack of an adequate
network of health and support services, the lack
of continuity in care, the lack of cooperation
between services and institutional bodies
involved with the rights of people with mental
health problems, the lack of data and evidence
based interventions and the complete lack of a
rights based approach in mental health services.

15. Interventions
• To overcome the fragmentation of the system effort is made to
invest in a systematic collaboration with existing services and
institutional bodies. However, the fact that the role of this advocacy
office is not officially statutory/institutionalized limits the potential
of interventions.
• Through this pilot project our vision is to record and elaborate the
data and information received and conclude to a comprehensive
and evidence based proposal for the establishment of advocacy
offices as an institution, in order to mainstream the human rights
perspective in mental health

16. Conclusion
• The ‘paradigm shift’ from the medical model of disability to the
social or rights-based model entails that the burden shifts from
individual limitation and impairments to societal and bahavioral
constraints that inhibit full participation and inclusion of persons
with disabilities in society. Since the adoption of the UN
Convention on the Rights of People with Disabilities, this is not
only an ethical or ideological stance, but a legal obligation. The UN
CRPD is the first international human rights treaty to embrace the
social model of disability and acknowledge disability as a
condition arising from the interaction between individual
limitations and other barriers that hinder full and effective
participation in society on an equal basis with others

17. Conclusion 2
• As shown from the data presented above these barriers include legal,
structural, organizational, financial and behavioral barriers which often
result in a qualitatively different level of enjoyment of rights by people
with disabilities. In Greece, the ‘disabling environment’ in which people
with mental health problems live, includes fragmented and poorly
coordinated services, a chronic lack of information and neglect for their
specific needs, persisting stigma and discrimination in society but also in
professionals who often interact with them.
• The case studies presented are innovative and successful examples of
targeted interventions to address these barriers through improved
referral and networking, the provision of information and legal support,
the provision of targeted capacity building and community awareness
and information.
• These experiments prove that eliminating barriers, facilitating equal
access to services set the foundation for meaningful participation and
engagement for people with mental health problems in society.

18. Thank You
This project is funded by Iceland, Liechtenstein and Norway under the EEA Grants
Greek NGO Programme “We are all Citizens”. The Bodossaki Foundation is the
Fund Operator of this Programme. The Programme aims to strengthen civil society
and enhance the contribution of NGOs to social justice, democracy and
sustainable development.