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Mental Health Promotion in Greece - Mediterranea

Mental Health Promotion in Greece
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by Dr Maria Fotiadou

According to the World Health Organisation (2001), mental health is defined as the state of the physical, emotional and social well-being of individuals and their ability to realise the strength of their abilities to effectively work and cope with the everyday stresses that life imposes and also offer to their community. Mental health also refers to the prevention and promotion of mental well-being and also aims to the treatment and rehabilitation of people affected by mental health disorders. However, there are variations in the way that mental health is defined and also promoted across cultures. Anxiety and depression are typically the most common diagnosed mental health disorders among people.
According to World Health Organisation (WHO) mental health problems will be increased in the next decade and it is estimated that depression will be the second leading disease after heart problems worldwide. However, there is no much of comprehensive and sufficient information around mental health services in Europe including Greece. The few studies that have been published conclude that the mental health services in Greece are limited for people that have been diagnosed with a mental health disorder. According to epidemiological studies in Greece around 15% of the general population has been diagnosed with a mental health disorder and this will be increased in the next decade. Recent studies on mental health showed that Greek people experience lower levels of happiness in their lives (43%) and less positive emotions when compared with their affiliate European citizens (61% in happiness levels). This was related to lower energy levels in their daily life and higher levels of stress and anxious feelings. The general use of anti-depressants were related more with stressful and anxious feelings and less with depression feelings compared to the rest of the European citizens.

Greek studies have shown increased risk of anxiety and depression levels related mainly to chronic health problems, such as cancer (Fafouti, et al., 2010). Patients with chronic health problems experience higher levels of anxiety and depression due to the changes in their quality of life, physical pain, functionality and/or uncertainty of the progress of the illness when compared to the general population. Later reports indicate a relationship between mental health disorders with the economical crisis in Greece and it is now considered as one of the main reasons of the increase in the levels of depression and suicides. Despite the lower levels of suicides in Greece when compared with the rest of the European countries, there was a significant increase of suicides the last 4 years. The report also shows that the 90% of people committed suicide experience a physical or mental health problem, mainly depression. These rates are higher in the ages of 35-50 years old men. According to WHO, socio-economical pressures, stressful work environments and rapid social changes can be among the most important factors to contribute to poor mental health for individuals and communities.

In Greece, Mental Health Services are offered by both the private and public sector. During the last two decades there was a development in the number of the psychiatric care departments situated mainly in the big cities across the country, offering secondary care for mental health patients. In addition to that, the financial and technical support provided by the European Union, contributed to a development of further mental health community-based care services. The last ten to fifteen years many private hospitals and university clinics offer a range of services to people with mental health disorders including inpatient care. Primary care and outpatient services are often available in a few community-based centers, outpatient clinics of psychiatric departments in hospitals and by private sectors.

Even though there was an improvement in the mental health care in Greece, still services are considered to be limited and there is a need for further development in the near future especially when considering the increase of psychiatric disorders. In addition, inequalities in the mental health system, such as limited mental health care services in certain geographical areas, insufficient provision of beds for the patients and ineffective support for the education of children diagnosed with mental health disorders, are still imminent (Madianos, Zacharakis, Tsitsa & Stefanis, 1999). The economical crisis and the limited resources are considered to be the main obstacle for further improvements and expansion of mental health care services as the expenditures for medical and care cannot cover the needs of increased number of mental health patients.
Mental health promotion can act as the key factor in building and supporting healthy mental health communities and therefore contribute to the prevention of mental illness. According to WHO, there are some certain health strategies that a government should adopt including mental health activities and educational programmes in schools, social support for elderly, families and patients with chronic health problems, mental health programmes at work, and relevant interventions and self-management programmes for vulnerable groups and communities.

Psychological support and therapies (e.g. self-management programmes) should be the first option available to the patients, however, it is uncertain if this is offered to the patients due to the small number of trained health professionals. According to UK studies, around 80% of mental health disorder cases related to chronic health conditions can be self-managed (Department of Health, 2004; Barlow, et al. 2005). Self-management programmes delivered to mental health patients have shown an improvement in anxiety and depression levels and improving positive affect (Barlow et al. 2006). For example, the Help to Overcome Problems Effectively (HOPE) developed by Coventry University, UK have shown an improvement in anxiety and depression levels in people diagnosed with mental health problems (Turner, et al., 2008; Fotiadou, et al., 2008). HOPE is a short health and lifestyle intervention using cognitive psychological techniques and principles with the aim to help people manage effectively everyday stresses, mental or physical health problems and improve their quality of life. Some of the techniques delivered include effective problem solving, setting goals and achievement motivation, communication with health professionals, building positive thinking, healthy lifestyle, fatigue management and relaxation techniques. HOPE was also delivered to Greek women with chronic health conditions (Fotiadou, in preparation). Results showed that participants indicated reduced psychological distress and improvement in their positive psychological state. Participants reported that being in a supportive, reassuring and empathic environment was one of the most helpful ingredients of the programme. Hence, self-management programmes can help people living with mental health illness feel less isolated and increase the sense of being accepted and appreciated in their community (Barlow et al. 2005; Turner & Barlow, 2007). According to WHO, self-management interventions and programmes are necessary even when economical resources are limited. Adaptation of relevant programmes can promote mental health awareness and help people living with mental health problems improve their quality of life.

Private and public organizations promoting mental health can play an important role in the development of such interventions. The last few years there was a promotion of online services and phone call centers trying to inform and help people living with a mental health problem, such as anxiety and depression. Also mental health organisations promote mental health through counseling and seminars and give hope for those living with mental health problems and their families.

References

Barlow, J., Swaby, L. & Turner, A. (2005). Perspectives of parents and tutors on a self-management program for parents/guardians of children with long-term and life-limiting conditions: “a life raft we can sail along with”. Journal of Community Psychology, 36 (7), 871-884.

Department of Health. (2004). Departmental Report. Department of Health Publications. UK.

Fafouti, M., Paparrigopoulos, T., Zervas, Y., Rabavilas, A., Malamos, N., Liappas, I. & Tzavara, C. (2010). Depression, Anxiety and General Psychopathology in Breast Cancer Patients: A Cross-sectional Control Study. In Vivo, 24, 803-810

Fotiadou, M., Turner, A., & Barlow, J. (2008). Acceptability and usefulness of the HOPE Programme: An Interpretative Phenomenological Analysis. European Health Psychology Conference & BPS Annual Health Psychology Conference, Bath, UK

Fotiadou, M. & Turner, A. (in preparation). Helping to Overcome Problems Effectively (HOPE): A pilot study for women living with chronic illness in Greece. Coventry University, UK.

Knapp, M., McDaid, D., Mossialos, E. & Thornicroft, G. (2007). European Observatory of Health Systems and Policy Series. Mental Health Policy and Practice across Europe. Berkshire: Open University Press.

Madianos, M.G., Zacharakis, C., Tsitsa, C. & Stefanis, C. (1999). The Mental Health Care Delivery System in Greece: Regional Variation & Socioeconomic Correlates. J. Mental Health Policy Econ. 2, 169–176

Madianos, M.G., Tsiantis, J. & Zacharakis, C. (2000).Changing patterns of mental health care in Greece (1984–1996). European Psychiatry, 14 (8), 462-467.

Michael G. Madianos1* , Costas Zacharakis2, Chryssa Tsitsa2 and Costas Stefanis. (1999). The Mental Health Care Delivery System
in Greece: Regional Variation & Socioeconomic Correlates. The Journal of Mental Health Policy and Economics. 2, 169–176

Mystakidou, K., Tsilika, E., Parpa, E., Katsouda, E., Galanos, A. & Vlahos, L. (2005). Assessment of Anxiety & Depression in advanced cancer patients & their relationship with quality of life. Quality of Life Research, 14, 1825-1833.

The ESEMeD/MHEDEA 2000 investigators, Alonso, J., Angermeyer, M.C., Bernert, S. Bruffaerts, R., Brugha, T.S., Bryson, H., de Girolamo, G. et al. (2004). Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica, 47-57, 109.

Turner, A. & Barlow, J. (2007). The Expert Patients Programme (EPP): A Resource for GPs Treating Chronic Disease and Co-existing Common Mental Health Problems? Mental Health Review, 12 (2), 4-6.

Turner, A., Fotiadou, M. & Barlow, J. (2008). Experiences of Attending the Hope Programme: A Qualitative Study. 4th European Conference of Positive Psychology. Opatija, Croatia

World Health Organisation (2010). Mental health: strengthening our response. Fact sheet N°220. http://www.who.int/mediacentre/factsheets/fs220/en/#

World Health Organiastion (WHO) (2001). World Health Report 2001 – Mental Health: New Understanding, New Hope. Geneva: WHO Library Cataloguing in Publication Data.

Onlne resources:

http://www.mednet.gr/

http://www.e-pediatrics.org/

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