Since the mid-1980s, a profound reform in the organisation of mental health provision has been taking place in Greece (Madianos & Christodoulou, 2007; Christodoulou, 2009). The aim has been to modernise the outdated system of care (Christodoulou, 1970), which was based on in-patient asylum-like treatment, the beginning of which can be roughly dated to the second half of the 19th century (Christodoulou et al, 2010).
Two major programmes of financial and technical assistance from the European Union, Regulation 815/1984 (1984–94) and Psychargos I and II (1999–2007), greatly contributed to the implementation of the reform. Their main targets were the following:
1 the provision of community psychiatric services in sectors (‘sectorisation’)
2 a progressive reduction in the number of traditional hospitals, in parallel with the creation of a network of housing units
3 the creation of psychiatric units in general hospitals
4 the creation of mobile units in rural areas and the islands
5 the establishment of a network of units for psychosocial rehabilitation
6 the establishment of pilot units for psychogeriatric patients and people with autism.
Mental health policy and legislation
Law 1397 of 1983 on the National Health System provided the legal framework for the psychiatric reform.
Law 2071 of 1992 aimed to modernise the conditions of care in Greece, especially regarding involuntary hospitalisation, and introduced the principle of ‘sectorisation’ (the establishment of sectors of 250 000–280 000 inhabitants) in the provision of services.
Law 2444 of 1996, especially articles 1666–88, offers broad legal guarantees to persons under court protection orders.
Law 2716 of 1999 defined the principles of mental health practice in Greece (article 1) and identified the ‘units of mental health’ (articles 4–12). Sectorisation was again a key principle. This law also introduced the concept of ‘social cooperative units’ (Κοι.Σ.Π.Ε.), which give people with mental health problems and other disabilities the opportunity to engage in work.
Mental health service delivery
Mental health services are provided by the public sector, by non-profit units and by the private sector.
Sectorisation has yet not been systematically organised. There are also deficiencies in primary care and in follow-up, creating increased demand for beds (because the filters that would prevent admission to hospital do not work well).