The state of psychiatry in Greece.

Greek psychiatry is presently in a transitional period. Following a large-scale reform effort that started in the mid 1980s, de-institutionalization and establishment of numerous community services has been achieved to a great extent. However, sectorization, development of primary care policies, inter-sectoral communication and long-range planning have not been achieved and deficiencies in the provision of care for children, adolescents, old people, individuals with autism, with intellectual disabilities and with eating disorders as well as deficiencies in forensic psychiatric services have been identified. Thus, the Greek psychiatric reform is an unfinished reform. The financial crisis that has recently hit the country has had a serious impact on the population and especially on vulnerable groups such as individuals with psychiatric disorders. Continuation of psychiatric reform to its desired extent has become problematic. This situation calls for re-orientation of the national mental health strategy towards more realistic and priority-orientated goals, i.e. securing a satisfactory level of function of the existing services, persisting in the implementation of the basic targets of psychiatric reform, creating the necessary infrastructure but avoiding the creation of expensive facilities of secondary importance.

Diachronic trends of employment outcome of prevocational training in psychiatric rehabilitation.

BACKGROUND: Although many rehabilitation programmes of prevocational training for chronic mentally ill persons living in the community have been funded, there is scarce literature about the diachronic trends of their long-term employment outcome. Thus the aim of the present study was to compare the 2-year employment outcome of three groups of chronic psychiatric outpatients, having attended similar prevocational rehabilitation programmes in different periods of time. METHODS: The first group (1984 to 1986) comprised 67 rehabilitees, the second (1988 to 1989) 53 rehabilitees and the third (2000 to 2001) 56 rehabilitees. The three groups were compared with regard to employment follow-up achievements and hospitalisation rates assessed at the end of the 2-year follow-up period by a constructed overall index, encompassing employment qualitative and quantitative characteristics. RESULTS: The third group compared to the first and second ones presented a worse employment outcome. No differences were found among the three groups with regard to hospitalisation rates. CONCLUSIONS: There has been a decline in the employment outcome of prevocational training during the current decade. This decline can be attributed to contextual adverse factors such as unemployment, a more demanding labour market and disability allowances offered by the state (the 'benefit trap'). Moreover, the training itself may be 'old-fashioned' enough, thus providing the trainees with inadequate skills to obtain and maintain a competitive job.

Parental attitudes and opinions on the use of psychotropic medication in mental disorders of childhood.

BACKGROUND: The limited number of systematic, controlled studies that assess the safety and efficacy of psychotropic medications for children reinforce the hesitation and reluctance of parents to administer such medications. The aim of this study was to investigate the attitudes of parents of children with psychiatric disorders, towards psychotropic medication. METHODS: A 20-item questionnaire was distributed to 140 parents during their first contact with an outpatient child psychiatric service. The questionnaire comprised of questions regarding the opinions, knowledge and attitudes of parents towards children's psychotropic medication. Sociodemographic data concerning parents and children were also recorded. Frequency tables were created and the chi-square test and Fisher's exact tests were used for the comparison of the participants' responses according to sex, educational level, age and gender of the child and use of medication. RESULTS: Respondents were mostly mothers aged 25-45 years. Children for whom they asked for help with were mostly boys, aged between 6 and 12 years old. A total of 83% of the subjects stated that they knew psychotropic drugs are classified into categories, each having a distinct mechanism of action and effectiveness. A total of 40% believe that there is a proper use of psychotropic medication, while 20% believe that psychiatrists unnecessarily use high doses of psychotropic medication. A total of 80% fear psychotropic agents more than other types of medication. Most parents are afraid to administer psychotropic medication to their child when compared to any other medication, and believe that psychotherapy is the most effective method of dealing with every kind of mental disorders, including childhood schizophrenia (65%). The belief that children who take psychotropic medication from early childhood are more likely to develop drug addiction later is correlated with the parental level of education. CONCLUSION: Parents' opinions and beliefs are not in line with scientific facts. This suggests a need to further inform the parents on the safety and efficacy of psychotropic medication in order to improve treatment compliance.