Το: Mr Vladimir Spidla, Commissioner of DG Employment, Social Affairs and Equal Opportunities, European Commission
Mr Georges KINTZELE, Head of Unit EMPL/C/2, European Commission
Dear Commissioner Mr Vladimir Spidla
“ARGOS” is a network of 36 NGOs, non-profit making Legal Persons of Private Law (LPPLs), which, since 1990, constantly participate in (always with the authorisation of the Greek government) and contribute to: 1) the de-institutionalisation of chronic mental patients and people with mental retardation, 2) their psychosocial reintegration, 3) the reform of the mental healthcare system as this is required and imposed for moral, scientific and common EU policy reasons.
In 1990, the Greek Ministry of Health and Social Solidarity (MHSS) commissioned us to design and then implement the intervention to the Leros Public Psychiatric Hospital and PIKPA; this resulted to the reactivation of the EU Regulation No 815/84 that had been suspended by the European Community due to the “Leros scandal”.
However, twenty years since the beginning of the psychiatric reform in Greece, after the world outcry about the sordid conditions in public psychiatric hospitals, there is a threat for people with mental health problems to return in public psychiatric hospitals due to severe weaknesses in the operation of the rehabilitation units. There are problems concerning the long-term organizational planning and monitoring of these units as part of the public mental health services system, the low priority for mental health policy on the agenda of the ministry and as a result cutbacks in financing.
The first discharge of people with mental health problems from the Asylum of Leros and the transfer of care in residential homes and hostels in the community, which began in 1990, after a five year period of preparation, signalled a new policy for public mental health, which was welcomed in scientific as well in political level. People with mental health problems were transferred in rehabilitation units in the community, near their place of birth in most cases. The results of this movement are visible as 1.289 chronic psychotic have been discharged from psychiatric hospitals, now living in 148 rehabilitation units in the community (more than 1.600 employees work at these units), the public psychiatric hospitals of Petra Olympou, Chania and Corfu, have been closed and 2 more public psychiatric hospitals are about to close soon (Tripoli and Attica’s Childern’s Psychiatric Hospital (Daou)).
The majority of these rehabilitation units operate under the responsibility of Non Governmental Organisations, according to the guidelines of the World Health Organisation, which place the NGOs as a part of Public Mental Health, something which has been proved to result in greater effectiveness both in therapeutic and in social level (GREEN PAPER for State of Mental Health of EU). These 36 Non Governmental-non profit Organisations are managed by Professors of Psychiatry and Mental Health professionals, having a scientific and social profile at the same time. The overall work, that took place since 1990 (within the framework of European and national programs - regulation 815/84, Psychargos A and B phase) constitutes an important achievement and indeed has reversed the negative opinions and attitudes by the European Union, World and European Mental Health institutions and by the citizens of Europe about the quality of the social state in Greece. It has received praises from the national governments, the responsible bodies of the Commission and the World Scientific Psychiatric Community.
These units face currently severe financial problems (for third time during the last three years), emitting a signal of danger, as the Ministry of Health and Social Solidarity is unable to correspond to its obligations, due to not finding the necessary budget-lines by the Ministry of Finance (for 2007were given 52 millions of Euros against 62 that were required, for 2006 were given 50 millions of Euros against 56 that were required and for 2005 were given 41,42 millions of Euros against 42,4 that were required) and the total deficiency is estimated at 17,2 millions of Euros. We should also mention that significant payment delays are recorded due to the Ministry’s full responsibility, even though we have repeatedly stressed out the critical situation the units are facing.
The results of all these are:
· limitation of rehabilitation and therapeutic work of the units, decreased level of quality of care, since the necessary resources do not exist for the supply of essential materials and services
· a large number of employees in these units remain unpaid for many months, with negative consequences for themselves and the patients and more than 300 trained employees have resigned due to the bad financial situation
· entire geographic regions of the country such as Cyclades, Thrace, Fthiotida, are threatened with remaining without care cover in the mental health sector, since several units of Primary Health Care (Mobile units, Day Centres) are unable to cover the operation expenses.
· the units inevitably are facing operational problems and owe large debts and fines to the ORGANISATION OF SOCIAL INSURANCE and the Inland Revenue, which threaten even with the imprisonment of the mental health head-professionals who manage these units. Also, they are threatened with closure after the accumulation of debts to the NATIONAL ELECTRICAL COMPANY, the GREEK TELECOME, the WATER COMPANY, to the householders of buildings, to the suppliers
· Reverse of engagements that the Greek state has taken towards the EU in the framework of conventions on the B and C CSF, placing at risk the continuation of financing of Operational Program. “Health and Welfare 2000-2006” and the continuation of reform in the area of Public Mental Health.
In this framework, the NGOs managing these rehabilitation units have already proceeded with several letters and meetings and despite the assurances of the political leadership by the Ministry of Health and Social Solidarity, the problem remains and the payment of the reduced sums for the New Year is almost certain.
At this point it must be mentioned that the Ministry of Health and Social Solidarity gives the opportunity to the NGOs to proceed to the formulation of contracts with the Social Insurance Organizations in order to receive the cost of nursing of each patient. Furthermore the Ministry included the 2% of the fee for social and humanitarian perception to be received from the NGO’s in order to balance the lack of funding from the Ministry of Economics. Despite the fact that both measures are positive it is worth mentioned that their implementation is not efficient enough due to the severe bureaucratic obstacles.
In our opinion, in order not to invalidate the work done, the following must be applied:
v The government ought to complete the de-institutionalisation process and to continue the psychiatric reform.
v Immediate financing of our bodies for the years 2005, 2006 and 2007, at the estimated level according to the management system of the ‘Health-Welfare, 2000-2006’ programme and the feasibility authorizations issued by the MHSS. The constant and adequate financing of the bodies should be also ensured in order to continue the psychiatric reform and to complete the community psychiatric services network.
v Efficient financing for the year 2008, according to the budget estimations of our organizations, according to the management system of the ‘Health-Welfare, 2000-2006’ programme and the feasibility authorizations issued by the MHSS.
v Conclusion of a contract of obligations and rights between the MHSS and the LPPL agents, in accordance with the process followed in other EU countries and depending on the feasibility authorisations of the projects carried out by each body, on the basis of what was agreed with the European Commission and provided for in Council Regulation (EC) No 1260/1999 of 21 June 1999 laying down general provisions on the Structural Funds.
v Establishment, in cooperation with scientific bodies, of criteria for the assessment and monitoring of the scientific work.
Subsequently, we would like to ask your intervention in order to stop the violation of the rights of the patients and their families, to prevent the collapse of the public psychiatric care system and the further decrease of the level of quality of care and to avoid the re-opening of the psychiatric hospitals closed down in accordance with the international guidelines and the regulations of the B and C Community Support Frameworks as well as the regulations of the Operational Program “Health and Welfare”.
We thank you in advance for your interest and yours interventions and we remain at your disposal for any further information.
President of the coordination committee of AGROS Network
 Budgets were submitted during the year 2005, as required by the MHSS.