The role of the Mobile Mental Health Units in mental healthcare delivery in rural areas in Greece: current challenges and prospects.

The present paper aims to highlight the importance of Mobile Mental Health Units (MMHUs) in the delivery of mental health services in remote areas in rural Greece. Since the foundation of the first MMHUs in the eighties till nowadays, those services have expanded in many rural areas and there is some evidence that they are effective in the management of patients with severe mental disorders. The care of those patients seems to contribute to a significant reduction in voluntary and involuntary acute admissions and in length of hospital stay. Cost/effectiveness analysis studies have also shown favorable results. Besides their regular clinical work, MMHUs conduct research, such as epidemiologic surveys. Other research explores the care of elderly patients in rural areas and the care of immigrants that permanently reside in Greece. Other research involves the study of psychotic disorders in the rural context, such as the long-term outcome, the patients' functioning, and the long-term treatment with benzodiazepines. Current challenges for MMHUs involve staffing, particularly for those run by public hospitals, and the retainment of highly trained personnel. Other important challenges are related to the aging of the rural population and the refugee/migrant influx. The MMHUs of the islands that initially accept the refugee flow, have already faced an increased number of new referrals. Given the disparities in mental healthcare between rural and urban areas, further enhancement of the MMHUs' operation is required, as well as continuing training of their workforce. Research at the national level is needed and could be the basis for the design and staffing of new services. The establishment of valid and broadly accepted clinical indices to measure treatment outcomes would facilitate research and ensure the recording and evaluation of the MMHUs' work and their effectiveness as well; and would highlight their utility within the contemporary health system.

Assessment of the Mobile Mental Health Units' effectiveness in Cyclades islands.

In Greece, the provision of mental health shows inefficiencies in remote and inaccessible areas due to the lack of appropriate structures and access to healthcare. The purpose of this study was to assess the effectiveness of the Mobile Mental Health Units (MMHUs) in Cyclades with and without MMHUs' operation based on Real-World Evidence (RWE). The study population consisted of 724 people who visited the MMHUs of the western and northeastern Cyclades in 2015. The data derived from the patients' medical records of EPAPSY classified by International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) and the Global Assessment of Functioning (GAF) scale. The analysis revealed that 60.9% of the participants were women and the average age was 50.1. 50.4% of the people who visited MMHUs without referral from primary health care professionals and 18.8% with referral. The calculation of effectiveness was based on DALYs (Disability-Adjusted Life Years) and was performed according to the World Health Organization methodology. In the specific population, there are no recorded deaths caused by mental disorders and thus DALYs are equal to Years Lost due to Disability (YLDs) with MMHUs' operation. 18% of the population was diagnosed with mood disorders (F30-F39) and morbidity burden 9.49 (YLDs), while 17.5% of the patients were diagnosed with neurotic, stress-related and somatoform disorders (F40-F48) and corresponding morbidity burden 4.53 (YLDs). Our results revealed that the effectiveness of MMHUs corresponds to 17.98 Disability-Adjusted Life Years (DALYs) averted in 2015. The mood disorders and the neurotic, stress-related disorders have shown a high morbidity burden. Advanced age, non-permanent employment, existence of psychopathology in the family and referral on patients' own will were found to significantly affect the mental health status of the participants. The implementation and expansion of flexible and alternative community-based interventions, such as MMHUs, constitute a best practice both for obtaining higher clinical outcomes and for facing regional inefficiencies related to population's access to healthcare.

Culture shock and social support: a survey in Greek migrant students.

BACKGROUND: Culture shock is a form of psychological distress associated with migration. Social support has been identified as significantly related to the onset, course and outcome of many psychological disorders. AIM: The aim of this study was to examine the relationship between culture shock and social support, in terms of size, diversity of the social network and quality of support received, in Greek students, in the UK. METHOD: A total of 133 students completed 3 self-administered questionnaires: Culture Shock Questionnaire, Social Support Questionnaire and General Health Questionnaire (GHQ-12). RESULTS: Gender and the quality of support received were found to be strongly associated with culture shock. Furthermore, culture shock was significantly positively related to the level of current dysphoria and diminished with time. CONCLUSION: Social support is an important factor associated with the degree of culture shock and should be taken into consideration in order to protect against or help to overcome this kind of psychological distress experienced by migrants.