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Community Psychiatry in Rural Greece: The Role of the Mobile...
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Community Psychiatry in Rural Greece: The Role of the Mobile Mental Health Units

A special issue of Psych (ISSN 2624-8611). This special issue belongs to the section "Neuropsychology, Mental Health and Brain Disorders".

Deadline for manuscript submissions: closed (20 February 2023) | Viewed by 28375

Special Issue Editors

Dr. Maria Samakouri

E-Mail Website
Guest Editor
Department of Psychiatry, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
Interests: clinical psychiatry; social and community psychiatry; schizophrenia spectrum disorders; education and training
Dr. Ioanna V. Papathanasiou

E-Mail
Guest Editor
Community Nursing Lab, Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece
Interests: community nursing; mental health; community psychiatric nursing; nursing education; nursing research; critical thinking; evidence-based nursing practice; chronic diseases; individualized nursing care
Dr. Orestis Giotakos

E-Mail Website
Guest Editor
Obrela—Neuroscience & Mental Health, Athens, Greece
Interests: emotion dysregulation; emotional trauma; emotional brain; suicidality; sexual offenders; personality disorders; brain modeling; fake news; lithium; interoception; intentionality; mirror therapy; autoi
Dr. Vaios Peritogiannis

E-Mail Website
Guest Editor
Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, 45444 Ioannina, Greece
Interests: social psychiatry; community psychiatry; schizophrenia and psychotic disorders

Special Issue Information

Dear Colleagues,

Despite major progress in community psychiatry and service delivery over the last decades, it is widely recognized that rural and remote areas do not receive adequate mental healthcare due to various reasons. In rural Greece, the model of the Mobile Mental Health Units (MMHUs) was introduced in the early 80s, and expanded in many rural areas of the mainland and in several of the numerous Greek islands over the decades. The MMHUs are interdisciplinary teams that deliver generic mental health services in remote and deprived areas. They are low-cost services that are fully integrated within local primary healthcare settings. However, their work, albeit noteworthy, has been rarely published. The present Special Issue is a great opportunity for the MMHUs to present their work. Indeed, this model of mental health care delivery is unique, thus this Issue would be of interest for an international readership. Also, this model of care is relevant, as funding for mental health may be inadequate in several countries, and low-cost, yet effective services would be prioritizing by mental health policy in rural areas which lack highly-resourced specialized services.

The aim of our Special Topic is to focus on recent advances in mental healthcare delivery by the MMHUs in rural areas of Greece; and to stress the challenges in delivering services in those areas.

Original research, review articles, and perspectives related to this Special Topic are welcome, from clinical research to multidisciplinary clinical management.

Potential themes relevant to this Research Topic may include, but are not limited to, the following:

Care for patients with severe mental disorders

Promotion of mental health in rural areas

Care for special populations, such as refugees and immigrants

Mental health care for children and adolescents

Dr. Maria Samakouri
Dr. Ioanna V. Papathanasiou
Dr. Orestis Giotakos
Dr. Vaios Peritogiannis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Psych is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

 

Keywords

  • community psychiatry;
  • mental health services;
  • mobile mental health units;
  • rural areas;
  • psychotic disorders;
  • schizophrenia

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Published Papers (10 papers)

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Editorial

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5 pages, 197 KiB  
Editorial
Mobile Mental Health Units in Greece: Bridging Clinical Practice and Research in the Rural Context
by Vaios Peritogiannis and Maria Samakouri
Psych 2023, 5(3), 787-791; https://doi.org/10.3390/psych5030051 - 24 Jul 2023
Viewed by 1299
Abstract
The present Special Issue of Psych, which has been now fully released, aimed to highlight the importance of the Mobile Mental Health Units (MMHUs) in delivering services in rural and remote areas in Greece, and to stress their role as an easily accessible [...] Read more.
The present Special Issue of Psych, which has been now fully released, aimed to highlight the importance of the Mobile Mental Health Units (MMHUs) in delivering services in rural and remote areas in Greece, and to stress their role as an easily accessible setting that provides a wide range of community-based psychosocial interventions, well beyond usual psychiatric care [...] Full article
(This article belongs to the Special Issue Community Psychiatry in Rural Greece: The Role of the Mobile Mental Health Units)
4 pages, 207 KiB  
Editorial
Community Psychiatry in Rural Greece: The Role of the Mobile Mental Health Units
by Vaios Peritogiannis, Ioanna V. Papathanasiou and Orestis Giotakos
Psych 2022, 4(2), 277-280; https://doi.org/10.3390/psych4020024 - 16 May 2022
Cited by 4 | Viewed by 2309
Abstract
Almost a decade ago, an article published in the official journal of the Hellenic Psychiatric Association, concerning the state of Greek mental health reform, referred to the significant shortages of mental health staff and services in rural areas of the country [...] Full article
(This article belongs to the Special Issue Community Psychiatry in Rural Greece: The Role of the Mobile Mental Health Units)
5 pages, 492 KiB  
Editorial
Τhe Contribution of Mobile Mental Health Units to Community Psychiatric Care in Greece
by Maria Samakouri, Olympia Evagorou and Athena Frangouli-Sakellaropoulou
Psych 2022, 4(1), 100-104; https://doi.org/10.3390/psych4010009 - 12 Feb 2022
Cited by 6 | Viewed by 2997
Abstract
The implementation of Mobile Mental Health Units (MMHUs) was a decisive step in the psychiatric reform and the development of community psychiatric care in Greece [...] Full article
(This article belongs to the Special Issue Community Psychiatry in Rural Greece: The Role of the Mobile Mental Health Units)
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Research

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12 pages, 753 KiB  
Article
Mobile Mental Health Units in Heraklion Crete 2013–2022: Progress, Difficulties and Future Challenges
by Anna Paschalidou, Maria Anastasaki, Avgi Zografaki, Christina Kalliopi Krasanaki, Maria Daskalaki, Vasilis Chatziorfanos, Anna Giakovidou, Maria Basta and Alexandros N. Vgontzas
Psych 2023, 5(1), 26-37; https://doi.org/10.3390/psych5010003 - 30 Dec 2022
Cited by 2 | Viewed by 2022
Abstract
Mobile mental health units (MMHUs) have been proposed as an effective model to serve the mental health needs of remote underserved areas. In 2013, the Department of Psychiatry, University of Crete, started a pilot MMHU to cover the needs of remote rural areas [...] Read more.
Mobile mental health units (MMHUs) have been proposed as an effective model to serve the mental health needs of remote underserved areas. In 2013, the Department of Psychiatry, University of Crete, started a pilot MMHU to cover the needs of remote rural areas of the Heraklion Prefecture. The main objectives were early detection, prevention and therapy of patients with severe psychiatric disorders, without access to regular psychiatric care. In addition to regular visits to primary care health centers, a community support network was established. During this 10-year period, the MMHU has evaluated 3343 patients and performed 19,935 visits. The most frequent diagnoses are depression and anxiety (52.7%) whereas psychosis and bipolar disorders are the third (12.7%) and fifth most frequent diagnoses (4.7%). Half of the patients with depression/anxiety were older than 65 years and one third were living alone. Furthermore, the first visit with the MMHU of severely mentally ill was about 15 years later from the self-reported onset of psychotic symptoms. We discuss how to improve our ability to detect and intervene earlier in patients with severe mental illness, and how to address effectively, both pharmacologically and psychosocially, the depression and loneliness of older individuals living in small remote communities. Full article
(This article belongs to the Special Issue Community Psychiatry in Rural Greece: The Role of the Mobile Mental Health Units)
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11 pages, 469 KiB  
Article
The Interventions of a Mobile Mental Health Unit on the Refugee Crisis on a Greek Island
by Iliana Fylla, Eleonora Fousfouka, Maria Kostoula and Pinelopi Spentzouri
Psych 2022, 4(1), 49-59; https://doi.org/10.3390/psych4010004 - 3 Jan 2022
Cited by 5 | Viewed by 4210
Abstract
This present study concerns refugees and asylum seekers who have been referred to a Mobile Mental Health Unit (MMHU-Ch) in rural Greece on a Northeast Aegean Island during the refugee crisis in 2015. Our objective is the examination and recording of psychopathology characteristics’, [...] Read more.
This present study concerns refugees and asylum seekers who have been referred to a Mobile Mental Health Unit (MMHU-Ch) in rural Greece on a Northeast Aegean Island during the refugee crisis in 2015. Our objective is the examination and recording of psychopathology characteristics’, the presentation of the therapeutic interventions provided, and the difficulties. The sample is composed of 418 requests made by refugees, asylum seekers, adults, and children. The clinical and demographic data have been gathered from the MMHU-Ch’s charts. The study is retrospective, descriptive with quantitative and categorical variables. The data has been analyzed with the utilization of SPSS. The dominant diagnosis in children involves anxiety disorders, developmental disorders, and PTSD. One noteworthy finding is the high percentage of suicide behavior regardless of psychiatric diagnosis, which should be further examined. As far as interventions are concerned, the conclusions which have arisen are the gradually stronger commitment of the referents, but also the high percentage of requests that dropped out. Further examination of the interventions and their efficiency is recommended as well as probing the features of psychopathology in the long term with a view to clarifying the patronizing and aggravating factors. Full article
(This article belongs to the Special Issue Community Psychiatry in Rural Greece: The Role of the Mobile Mental Health Units)
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9 pages, 255 KiB  
Article
Dietary Habits and Obesity in Patients with Psychotic Disorders in Rural Areas in Northwestern Greece
by Maria Bakola, Thiresia Manthopoulou, Konstantinos Bonotis and Vaios Peritogiannis
Psych 2022, 4(1), 1-9; https://doi.org/10.3390/psych4010001 - 29 Dec 2021
Cited by 3 | Viewed by 2814
Abstract
People suffering from psychotic disorders display high rates of physical morbidity and mortality in comparison to the general population. The present study explores the relation between the dietary habits, the prevalence of obesity and the occurrence of physical morbidity in patients who suffer [...] Read more.
People suffering from psychotic disorders display high rates of physical morbidity and mortality in comparison to the general population. The present study explores the relation between the dietary habits, the prevalence of obesity and the occurrence of physical morbidity in patients who suffer from psychotic disorders in rural regions of northwest Greece. Two scales were applied to evaluate the quality of life (Quality of Life Questionnaire II, Moorehead–Ardelt) and the dietary habits (Dietary Instrument for Nutrition Education (DINE) Questionnaire) of these patients. The study sample used in this study consisted of 55 patients who suffered from a psychotic disorder. Most (75%) were male, with a mean age of 51.5 years and an average duration of disease of 25.1 years. Of these, 38.2% (21 patients) were obese with a BMI < 30 Kg/m2, 32.7% (16 patients) were overweight and 29.1% had a normal body weight. The majority of the sample, 80%, was treated with second-generation medications. With regards to their dietary habits, 94.5% (52/55) of the sample showed a low intake of fiber content, 67.3% (37/55) showed a high intake of saturated fats and 100% (55/55) a low intake of unsaturated fats. The rates of physical morbidity in the present sample were 21.8% with at least one disease and 14.5% with two diseases, whereas 5.5% met the criteria for metabolic syndrome (MS). The average BMI of the women was statistically significantly higher compared to the men. The majority of the sample (69.1%) exhibited acceptable levels of quality of life. No co-relations of quality of life with BMI were found. In addition, no co-relations of BMI with dietary habits were revealed. Full article
(This article belongs to the Special Issue Community Psychiatry in Rural Greece: The Role of the Mobile Mental Health Units)
15 pages, 261 KiB  
Article
Albanian Migrants in Cyclades: Contact with Mental Health Services and Implications for Practice
by Stella Pantelidou, Sofia Manolesou, Antigoni Apostolopoulou, Katerina Giannakopoulou and Stelios Stylianidis
Psych 2021, 3(4), 916-930; https://doi.org/10.3390/psych3040057 - 17 Dec 2021
Cited by 3 | Viewed by 3322
Abstract
The purpose of this study was to examine the potential differences between Albanian migrants and Greeks in the islands of Paros and Antiparos with regard to seeking help from the local public mental health service, namely the Mobile Mental Health Unit of NE [...] Read more.
The purpose of this study was to examine the potential differences between Albanian migrants and Greeks in the islands of Paros and Antiparos with regard to seeking help from the local public mental health service, namely the Mobile Mental Health Unit of NE Cyclades Islands (EPAPSY-NGO). The study’s instruments include the Global Assessment of Functioning (GAF) and a questionnaire for recording psychosocial profile data and information concerning contact with the services. The results showed that significantly less Albanian migrants contacted the mental health services in the past in comparison to Greeks. When using the service, the Albanians were more likely to see a psychiatrist in the Unit, rather than a psychologist-psychotherapist, and they more often received prescriptions for medication. There was a significantly higher dropout rate among Albanian migrants. This study highlights the different aspects of access and use of mental health services among Albanian migrants compared with native residents. Further research should focus on the factors related to early dropouts and difficulties accessing mental health services in rural areas, in order to develop more focused and effective interventions and improve the quality of care provided. Full article
(This article belongs to the Special Issue Community Psychiatry in Rural Greece: The Role of the Mobile Mental Health Units)
12 pages, 237 KiB  
Article
Decrease of Hospitalizations and Length of Hospital Stay in Patients with Schizophrenia Spectrum Disorders or Bipolar Disorder Treated in a Mobile Mental Health Service in Insular Greece
by Aikaterini Garbi, Ioannis Tiniakos, Zacharenia Mikelatou and Ioannis Drakatos
Psych 2021, 3(4), 780-791; https://doi.org/10.3390/psych3040049 - 4 Dec 2021
Cited by 9 | Viewed by 3592
Abstract
In recent years serious mental health issues, such as schizophrenia spectrum disorders and bipolar disorder, have been treated in the community by community-based mental health services. In the present study our goal was to estimate the modification in the number of hospitalizations and [...] Read more.
In recent years serious mental health issues, such as schizophrenia spectrum disorders and bipolar disorder, have been treated in the community by community-based mental health services. In the present study our goal was to estimate the modification in the number of hospitalizations and duration of admissions in either psychotic patients or patients with bipolar disorder, treated by a Mobile Mental Health Unit in the islands of Kefalonia, Zakynthos and Ithaca (MMHU-KZI). Data were collected from a total of 108 patients with schizophrenia spectrum disorders and bipolar disorder. For each patient comparison was made for the same time interval prior and after engagement to treatment with the MMHU-KZI and not for the total hospitalizations that patients had in their history. There was a statistically significant reduction (45.9%) in hospitalizations after treatment engagement with the MMHU-KZI, as the Wilcoxon signed ranks test indicated. Furthermore, a major decrease (54.5%) of hospitalization days was noted after treatment engagement with the unit. This pattern of mental health provision may be beneficial for the reduction of the number and duration of psychiatric hospitalizations. Despite the beneficial contribution of community-based mental health units, hospital based treatment should always be available, since severe relapses are better treated in inpatient setting. Full article
(This article belongs to the Special Issue Community Psychiatry in Rural Greece: The Role of the Mobile Mental Health Units)

Other

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11 pages, 578 KiB  
Perspective
The Contribution of Society of Social Psychiatry P. Sakellaropoulos to the Psychiatric Reform in Rural Greece
by Harilaos Papachristou, Iliana Lazogiorgou-Kousta, Vasilis Chronopoulos and Athena Fragouli-Sakellaropoulou
Psych 2023, 5(2), 497-507; https://doi.org/10.3390/psych5020033 - 6 Jun 2023
Cited by 1 | Viewed by 1150
Abstract
The present paper aims to describe the structure, function, and goals of two of the oldest Mobile Mental Health Units in Greece, namely, the Mobile Mental Health Unit in Fokida (MMHU-F) and the Mobile Mental Health Unit in Thrace (Alexandroupolis, MMHU-T). Information about [...] Read more.
The present paper aims to describe the structure, function, and goals of two of the oldest Mobile Mental Health Units in Greece, namely, the Mobile Mental Health Unit in Fokida (MMHU-F) and the Mobile Mental Health Unit in Thrace (Alexandroupolis, MMHU-T). Information about their historical background, catchment areas, and current staffing, as well as the services provided by each MMHU is discussed. The focus of the paper is slightly biased towards the MMHU-F because it is the only available mental health service in the whole Fokida prefecture. The major goals of the MMHUs are the diagnosis, treatment, and prevention of relapse of severe mental illness within the community. Other important goals of the MMHUs are psychoeducation, psychological support for the family/caregivers, as well as vocational training and support for patients with severe mental illness. Statistical data depicting the demographic characteristics and diagnostic profiles of patients in each MMHU is also provided, and the differences between the two MMHUs are briefly discussed. Full article
(This article belongs to the Special Issue Community Psychiatry in Rural Greece: The Role of the Mobile Mental Health Units)
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8 pages, 227 KiB  
Perspective
The Greek Hybrid Version of the Assertive Community Treatment Model: A Perspective View between Challenges and Limitations
by Vaios Peritogiannis and Fotini Tsoli
Psych 2021, 3(4), 792-799; https://doi.org/10.3390/psych3040050 - 5 Dec 2021
Cited by 5 | Viewed by 2739
Abstract
The Assertive Community Treatment (ACT) model of care has been long considered to be effective in the management of patients with severe mental illness (SMI) in most Western countries. The implementation of the original ACT model may be particularly challenging in rural and [...] Read more.
The Assertive Community Treatment (ACT) model of care has been long considered to be effective in the management of patients with severe mental illness (SMI) in most Western countries. The implementation of the original ACT model may be particularly challenging in rural and remote communities with small and dispersed populations and lack of adequate mental health services. Rural programs may have to adapt the model and modify the ACT fidelity standards to accommodate these limitations, and this is the rationale for the introduction of more flexible, hybrid ACT models. In rural Greece, the so called Mobile Mental Health Units (MMHUs) are well-established community mental health services. For patients with SMI that have difficulties engaging with treatment services, the new hybrid ACT model has been recently launched. The objective of this manuscript is to present the recently launched hybrid ACT model in rural areas in Greece and to explore the challenges and limitations in its implementation from the experience of a team of mental health professionals with ACT experience. Referral criteria have not been strictly set, but the number of previous relapses and hospitalizations is taken under consideration, as well as the history of poor treatment adherence and disengagement from mental health services. The main limitation in the implementation of the hybrid ACT service is that it has been introduced in several areas in the absence of a pre-existing community mental health service. This may impact referrals and limit focus on the difficult cases of patients with SMI, thus making the evaluation of the model inapplicable. Full article
(This article belongs to the Special Issue Community Psychiatry in Rural Greece: The Role of the Mobile Mental Health Units)
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