All of us, who experienced during the ’80s the beginning and the expansion of the so called psychiatric reform in Greece, perhaps remember the perplexity and the ambivalence with which we talked about it at that time. It was a great financial opportunity, but in a land which was socially totally unprepared to grasp this chance and transform it to a viable psychosocial practice. Even the mental health professionals could not exactly understand what they had to do. The society was trapped in the traditional ideas regarding the dangerousness of the so called mentally ill, the biological basis and the incurability of mental “illness”. On the one hand, the professionals tried under pressureto organise some new psychosocial structures by imitating what they had seen during their trips in Europe. The society on the other hand, refused to accept the residential rehabilitation services for chronically mental ill people and those people in the community. Even the chronically institutionalised psychiatric patients refused to get rehabilitated in this quick and unfamiliar pace, which was imposed by the European Committee. In many cases they were forced to move in rehabilitation centres before they were ready to do so. Some of them died a few days after their transport to the new units. A tragic and grotesque situation in the name of a humanitarian progress.
We used to say then, that the reform is not progressing and meets many obstacles in the society, because – instead of coming out as a real social request – it was imposed from above as a European directive which had to be obediently followed. The European community found out that our land was retrograde and it threatened with interventions from outside, if something did not happened inside. Later on, Europe threatened with withdrawing the money, if the funds were not absorbed quickly enough. Europe threatened in general, but it remained of course always politically correct, because its requests were nevertheless in line with the human rights and the modern trends in the progressive psychiatry of that time. The only things that were not considered were the pace of progress and the needs of the society itself.
Thus, in a historically very short time, the Greek mental health sector changed dramatically. Many new psychosocial structures were created: residential settings for chronic psychiatric patients, day centres, mental health outpatient clinics, psychiatric units in general hospitals, rehabilitation centres, mental health centres, and so on. The psychiatric hospitals were closed down or shrunk. Many changes took place. All these changes were very welcome. And they took place very quickly, surrounded by anxiety and insecurity; without a solid social basis underneath.
I belong to the generation of this reform, to the young professionals who discovered at that time, their professional identity and a kind of social vision and aspiration in the ideas of deinstitutionalization and social inclusion of the mental ill –victims of social racism. This is a generation, which moved without realizing it from a cruel and oppressive institutional way of thinking, to a humanitarian and oppressive (privileged) way of thinking.
A few years later we stood before a new impasse. The critical voices among us recognized under the so called reform the old system in disguise. Now we had better buildings, fewer people in a room, better intentioned and more interested psychiatric staff. Nevertheless, the institutionalized people were further institutionalized. After the first phase of training in the basic social skills, they were still –just like in the hospital– obliged to swallow kilograms of neuroleptics and other psychiatric drugs, they had to accept an absolute control over their lives, they had to be monitored and criticized in their own apartments, in their thought, in their decisions, in their development. They were controlled in every step of their life and very often deprecated, because they were not »accessible» in the way that the professionals would like them to be. The ideas of the incurability of mental illness, of the necessity of psychiatric medication and of the inability of these people to make decisions for their own lives were not disputed at all. As long as they were obedient to the expectations of the professionals, they were a good example of a well-functioning mental health system and the European funding was appropriately utilized. If that was not the case, they disorganized the whole system with their stubborn disobedience. The professionals were burnt out, Europe wanted its money back, the society reacted in a strangely inconsistent way.
“The undone reform”, so we called this hectic and stressful project, that was to be extended but something made it so difficult.
As time went by, the critical voices became more and louder and said that things didn’t go right and the people went on living in institutionalized circumstances with a humanitarian mask. But there was no answer. Everybody went on believing that these people were a priori unable to cope with their lives on their own. Therefore, they were doomed to be ‘’dragged’’ by irritated professionals. The only thing we didn’t talk about was their real emancipation from the mental health system and their self definition. A very expensive system had been built based on the vulnerability theory and the pharmaceutical industry, which offered a life without big changes, a life of unhappiness for the service users and a dead end for the professionals, who had lost their aspiration and vision.
At this historical moment the Greek Observatory for human rights in mental health field began its meetings in 2003. We tried to articulate in a consistent way a critical attitude towards alternatives. A mere negation of the system as well as of the reform was not enough for us. We wanted to share with the society a new vision. Since 2003 professionals in mental health, lawyers, students, journalists, users and survivors of psychiatry, their relatives, citizens, we share in Thessaloniki concepts which in the beginning seemed utopian but today are discussed normally among many people. We talk about an alternative understanding of psychosis, about crises without psychotropic drugs and without psychiatry, about independence from psychiatric drugs, we talk about self help, alternatives to psychiatry, a movement to psychiatric will, about participation of users and survivors in the decision making centers, we talk about networks of cooperation and solidarity, about the role of the pharmaceutical industry, about support practices during crises at home…
And then came the financial crisis.
The masks fell in one night. Residential units began to shut down without prior notification, without negotiations, exactly as they were founded. Some residents have already gone back to psychiatric hospitals; some others are waiting for this to happen. In some cases, the residents pay on their own with their rents the expenses of the buildings, their home. Drug rehabilitation programs are currently being funded with 50% less money than before. The undone reform reveals now its absent foundation. And the society which was initially against the reform, stands up surprised in front a criminal state without understanding how all these attacks are possible. There are homeless people everywhere, literally and symbolically. The abandoned residents of the rehabilitation units, next to the unemployed and disbanded citizens, who are losing their jobs in order to pay the international banks, as well as political and scientifically homeless professionals in mental health field, who look for a new vision in order to protect their existence.
At the moment in the mental health sector, as well as in Greek society as a whole, a system collapses dramatically; a system which we rejected many years ago and we wished that it collapses. We must remember this detail. There is a serious danger that we as a society, due to fear and financial insecurity at the present time, will start demanding the maintenance of structures which violate human rights and which are beyond any concept of help and support in mental health care. We intend to avoid this danger. The truth is that what collapses now is exactly what we wanted to destroy ourselves. The psychiatric system collapses and at the same time the financial logic behind collapses too. It is the financial logic of a state, which feeds psychiatric monsters with the money of the pharmaceutical industry.
The political answer to the shutting down of the mental health units cannot be to request that they shall open again: biologically orientated acute units, aiming at a symptomatic ‘’cure’’, with mechanical restraints, neuroleptics, absence of psychotherapy and any other therapeutic approach, without any support to the families, oppressive interventions to the emotionally distressed. Residential units similar to small asylums without any perspective for the people to participate in their own lives, people filled with chemicals and the despairing idea of an everlasting illness – no, that is not what we want, even if it brings work positions and financial security for the staff of these units.
We need support to develop new systems, which give an effective and not a criminal answer to the psychic pain or any unusual experiences. It’s good that the system collapses. The problem is that what’s coming back is the old psychiatric model, where the extreme medicalization is only route. We must intervene. This time without money.
We are standing in front of a violent psychiatry or an absence of a welfare state, without money. Just like 30 years ago. There are no money and the psychosocial needs are greater due to the despair of the generalized unemployment, due to the shock of the political betrayal from the inside, due to the fear to stay alone without the funding system of the last decades. Like 30 Years ago. What is different is us. We are different from the people 30 years ago. And the society too, because it has learnt 30 years long to live with the so called mental ill people in the community.
We know what we want. And we must practice it now, because there is no other perspective. We have to work for structures meeting the real needs of the people, without state control. We only need a small peripheral financial support from the state. We don’t want more. Because if the state doesn’t give more it cannot ask for more, cannot oblige people to take psychiatric drugs, to give up their dignity, to abandon the right of making decisions for their own lives.
Today we have the chance to experience a kind of freedom from the psychiatric control and the violent repression of human emotions and thoughts, because due to the crisis, the people can remain out of the psychiatric system. The crisis creates an empty space, and this can filled with new practices. This demands to get out from a culture of dependency on external funds and directives and to get in another freedom culture of creativity, self responsibility and work for a society which passes to us and to the future of our children. This is not easy but it gives perspective, hope and a feeling of dignity.
What this means in mental health field: there are three dimensions. Support networks in the community, which 1). prevent crisis and its escalation 2). ‘’hold’’ the person in crisis until it has been deescalated, without violence and psychiatric drugs 3)offer support after the crisis, so that the person can regain control over their lives.
- An expanded network of self help groups in every city: The support of self help groups and self help initiatives seems to be the only answer to the ailing state. In particular now that it canno longer offer it’s insidious reassurance and calls for a return to the old psychiatric hospitals or threatens with homelessness.
- Teams that will be able to intervene during crises. These mobile crisis intervention teams, will be present during the crisis and support the system within which the crisis develops in those ways that are necessary for the system. (e.g. Open Dialogue Approach [Seikkula], Soteria model or the Berlin Runaway House). Whenever possible, these teams should consist of both experts by experience and mental health professionals with a critical perspective and intervene–when contacted—either at the »patient’s» home (Open Dialogue) or somewhere else; where the person would be able to calm down without the presence of his family (Runaway houses, Soteria houses etc.). Wherever the aforementioned self help groups can provide such support, have the required experience and are willing to do so, they could also be part of this crisis intervention scheme.
- Joint teams of social support with regards to issues of poverty, healthcare provision and education.
In Thessaloniki, 2 social medical centres have recently been established in order to cover the need of the increasing numbers of the uninsured. A similar initiative is taking place in Athens. These self-sustained centres rely solely on donations from citizens, doctors and pharmacists (i.e. medications, medical equipment and consumables). They are located in a space provided by another social initiative and they are operated by medical professionals who work on a voluntary basis for a few hours a week following appointments.
In the context of other social initiatives, free classes are offered to children from low income families of both refugees. Support is offered with regards to their homework, as well as learning foreign languages, music, dance etc.).
In Thessaloniki (a city of 1 million people) function at the Moment about 9 occupation or rented places with these characteristics.
For almost five years, a significant citizens’ movement has been renting large buildings within which a wide range of initiatives regarding mental health have found a vital space. (The Observatory, The hearing voices network of Thessaloniki, the assembly for people that work in mental health, a support group for people that want to come off psychiatric drugs and other self-help groups which are currently being formed).
Other initiatives and groups are focused on environmental issues, the wildlife, biological agriculture, culture, clothing exchange, photography, cinema, theatre, library, a café/bar, a playground etc.). Most importantly, all the above are completely self-sustained and are kept active by the very people that are actively involved in these initiatives.
These spaces, which increase in number both in Thessaloniki and in Athens, are entirely funded through the incomings of their cafés, where a coffee or drink cost one Euro. It’s worth mentioning that the average maintenance cost of such buildings is 5,000 Euros. Thus, one realises that the number of citizens actively involved in such initiatives, is indeed impressing.
The observatory offers free support for people that want to come off psychiatric drugs and intervention during crises at peoples’ homes (through shifts on a rota basis). Moreover, it facilitates and/or organises support networks comprising of the person’s personal support systems. At the same time it is planning the foundation of a Runaway House, in order to provide refuge in case the person wishes to remain away from his home and/or his family. All these have, so far, been realised, with no money at all. Although this can’t be a permanent and final solution, it shows that the provision of services does not necessarily require huge sums of money; provided that the existing human resources are being utilised.
We are the most important element that will enable change and it’s time for us to realise it. We are the capital. We are part of a generation that is sufficiently educated in order to have knowledge, views, the skills and the political ethos in order to resist; putting forward suggestions against the enslavement and the abasement of our lives. We are also part of a generation that had been living in prosperity and without fear guiding our lives. These are important advantages that we should take into account and make full use of.
I don’t want to be misunderstood. I do not imply that the state shouldn’t protect and promote its’ citizens psychosocial needs in an effective way. Neither that an independent mental health system without the state’s support should be established.
A publicly funded Healthcare system is of fundamental importance and I am fully supportive of it. The public character of Health Services should be the aim of every society. Ideally, the State should respond to this need and establish public services which meet its’ citizens needs. As regards Mental Health Services in particular, this has never happened in any country as far as I am aware. The State supports solely medical approaches, in full alliance with the pharmaceutical companies (and has not even been consistent with this)–the only exception to this perhaps being the Open Dialogue in Finland. A state which is driven by the pharmaceutical industry and the biomedical lobbies cannot be an ally in such a radical shift regarding the understanding of Mental Health, such as the one that the Recovery movement and the other alternatives in the field, are aiming at.
At this historical moment, both at a European level and undoubtedly in Greece we are in a social war situation. We shouldn’t let our valuable human resources wane due to passivity or simply wait for the State’s grants. There is no doubt that if these grants and sources of funding ever come back, will still be restricted to the old well-known biomedical model. We ought to take all the necessary steps, to realise all these things that we consider fundamental, so that society can achieve good enough standards of mental and physical health, that will enable its’ members to reconstruct a world that is falling apart. We shouldn’t let psychic pain be managed once again with psychiatric drugs, asylums and mechanical restraints.
We should gather our strength as a society and realise our visions; that’s the greatest challenge of our times, in a historical moment when nations are once again humiliated. As I said earlier, we are the most important element that will render change possible, since we have the knowledge and it’s easier than it was before to unite. We ought to utilise any financial support through both public and private funding, making it clear at the same time that we won’t let them have any influence regarding our philosophy of our actions. Freedom has never found a fertile ground in economic dependence. It always emerged from peoples’ need to protect their dignity. At least that’s the case in my country.
I am sorry that my speech could not be less political, but the acute social situation in my country does not allow me such a luxury. Thank you very much for your attention.
Anna Emmanouilidou (Cork, Ireland, 2011)