The international initiatives of the collaboration between the Aristotle University of Thessaloniki School of Medicine, the Panhellenic Medical Association and the World Psychiatric Association, concerning mental health during the COVID-19 outbreak.

During the coronavirus disease 2019 (COVID-19) pandemic, all European countries were hit, but mortality rates were heterogenous, with some countries being hit very hard, while others including Greece had a much lower death rate during the first wave of spring 2020. The ultra-fast application of measures was probably the reason of this outstanding success. This outbreak is expected to trigger feelings of fear, worry, and stress, as responses to an extreme threat for the community and the individual. In addition, changes in social behavior, as well as in working conditions, daily habits and routine, are expected to impose further stress, especially with the expectation of an upcoming economic crisis and possible unemployment. In Greece, where the lockdown was extremely successful in terms of containing the outbreak, worries concerning the possible adverse effects on mental health were also predominant. A collaboration concerning mental health during the COVID-19 outbreak was established, between the Aristotle University School of Medicine, the Panhellenic Medical Association and the World Psychiatric Association. Two large multinational studies were launched, one concerning the general population and one university students. Students' mental health is an area of special interest, both because of the vulnerability of this age group as well as because any disruption during the time of the studies has profound long-term consequences in the lives of the individuals, and this might trigger feelings of fear, worry, and stress. According the results from the Greek arm of the students' study, during the lockdown, two-thirds of university students reported at least 'much' increase in anxiety, one third in depressive feelings and in 2.59% concerning suicidal thoughts. There was also a worsening of quality of life and deterioration of lifestyle issues. Major depression was present in 12.43% with an additional 13.46% experiencing severe distress. Beliefs in conspiracy theories enjoyed wide acceptance ranging from 20-68%, with students of law, literature, pedagogics, political sciences and related studies manifesting higher acceptance rates. Female sex and depression/dysphoria both independently but also in interaction were related to higher rates of such beliefs. The results of the Greek arm of the general population study suggested that during the lockdown, clinical depression was present in 9.31%, with an additional 8.5% experiencing severe distress. Increased anxious and depressive emotions (including subclinical cases) were present in more than 40% of the population. In persons with a previous history of depression, 23.31% experienced depression vs. 8.96% of cases without previous history, who were experiencing their first depressive episode. Family dynamics suggested that fewer conflicts and better quality of relationships were surprisingly related to higher anxiety and depressive emotions, higher rates of depression and distress, and greater rates of suicidal thoughts. Eventually, spiritual and religious affiliation could protect the individual from the emerging suicidal thoughts. As correlation does not imply causation, the results suggest that conspiracy theories could be either the cause of depression or on the contrary a coping mechanism against depression. After taking into consideration that also in the family environment the expression of anger seemed to be a protective factor, the most likely explanation could be that the beliefs in conspiracy theories are a coping and 'protective' mechanism against the emergence of depression. These studies were among the first published, they went deeper in the data collection and even led to the creation of a model with distinct stages for the development of mental disorders during the lockdown. The analysis of the international data will probably provide further insight into the prevalence of mental disorders and the universal but also culturally specific models and factors pertaining to their development. At the time this editorial was in press, more than 40 countries representing more than two thirds of earth's population were participating with more than 45,000 responses already gathered.

Mental health care in Italy: Basaglia's ashes in the wind of the crisis of the last decade.

BACKGROUND AND AIMS: The purpose is to highlight the legal and ethical principles that inspired the reform of mental health care in Italy, the only country to have closed its psychiatric hospitals. The article will also try to verify some macro-indicators of the quality of care and discuss the crisis that the mental health care system in Italy is experiencing. METHODS: Narrative review. RESULTS: The principal changes in the legislation on mental health care in Italy assumed an important role in the evolution of morals and common sense of the civil society of that country. We describe three critical points: first, the differences in implementation in the different Italian regions; second, the progressive lack of resources that cannot be totally attributed to the economic crisis and which has compromised application of the law; and finally, the scarce attention given to measurement of change with scientific methods. CONCLUSION: Italy created a revolutionary approach to mental health care in a historical framework in which it produced impressive cultural expressions in many fields. At that time, people were accustomed to 'believing and doing' rather than questioning results and producing research, and this led to underestimating the importance of a scientific approach. With its economic and cultural crisis, Italy has lost creativity as well as interest in mental health, which has been guiltily neglected. Any future humanitarian approach to mental health must take the Italian experience into account, but must not forget that verification is the basis for any transformation in health care culture.

Community forensic psychiatric services in England and Wales.

Forensic psychiatry is an established medical specialty in England and Wales. Although its origins lie in the 19th century, the development of secure hospitals accelerated in the late 20th century. Services for mentally disordered offenders in the community have developed most recently and it is these services, which are the focus of this article. We have looked broadly at community services and have included criminal justice liaison and diversion services in our remit. We have also considered partnerships between health and justice agencies as well as mental health and criminal legislation. We consider the limited research evidence in relation to community forensic services and the discussion this has provoked.

Socioeconomic and lifestyle factors associated with depressive tendencies in general Japanese men and women: NIPPON DATA2010.

BACKGROUND: The gender-specific characteristics of individuals at an increased risk of developing depression currently remain unclear despite a higher prevalence of depression in women than in men. This study clarified socioeconomic and lifestyle factors associated with an increased risk of subclinical depression in general Japanese men and women. METHODS: Study participants were residents not receiving psychiatric treatments in 300 sites throughout Japan in 2010 (1152 men, 1529 women). Multivariable-adjusted odds ratios (OR) and 95% confidence intervals (95%CIs) for socioeconomic factors and lifestyle factors were calculated using a logistic regression analysis. RESULTS: Risk of depressive tendencies was significantly higher in men who were single and living alone (OR, 3.27; 95% CI, 1.56-6.88) than those married. The risk was significantly lower in women who were not working and aged ≥ 60 years (OR, 0.39; 95% CI, 0.22-0.68) and higher in men who were not working and aged < 60 years (OR, 3.57; 95%CI, 1.31-9.72) compared with those who were working. Current smoking was also associated with a significantly increased risk of depressive tendencies in women (OR, 2.96; 95% CI, 1.68-5.22) but not in men. CONCLUSIONS: Socioeconomic and lifestyle factors were associated with an increased risk of depressive tendencies in general Japanese. Related factors were different by sex.

Paradigmas en estallido: epistemologías para una ¿post?psiquiatría / Shattered paradigms: epistemologies for a post?psychiatry

Las epistemologías feministas y poscoloniales han hecho importantes aportaciones a múltiples campos teóricos. La postpsiquiatría, en tanto que nacida durante el periodo posmoderno y orientada a rehacer parte de la teoría y la práctica psiquiátrica, es uno de los campos donde otras miradas y la experiencia de otros paradigmas asimismo cuestionados y ampliamente debatidos resultan enriquecedoras. A partir de puntos de conflicto paralelos se estudian las analogías y diferencias entre los distintos campos teóricos, buscando qué soluciones puede incorporar la psiquiatría contemporánea si quiere definirse como postpsiquiatría (AU)

Feminist and postcolonial epistemologies have hugely contributed to different theorical fields. Postpsychiatry, as a field born during the postmodern period, and also intended to restore some part of the theory and praxis that sustain contemporary psychiatry, is one of the areas where the consideration of different approaches and the experience from other questioned and even rejected paradigms could prove illuminating. Starting from parallel points of conflict we investigate the analogies and differences between different theoretical fields with the aim of finding solutions which contemporary psychiatry could incorporate in order to be defined as postpsychiatry (AU)

O potencial terapêutico de uma oficina no território: autonomia e noção de pertença / El potencial terapéutico de un taller en el territorio: la autonomía y el sentido de pertinência / The therapeutic potential of a workshop in the territory: autonomy and sense of belonging

Objective: This study describes the therapeutic potential of a workshop in the territory for users of the Psychosocial Care Center and discuss the proposed therapy workshop and user interaction with the territory. Methods: Descriptive and exploratory research. The data resulted from participant observation and interviews as two coordinators. Thematic kind of content analysis was used for data processing. Results: As a result we obtained two thematic categories: Pool and the territory, and Benefits of a Pool Workshop. Conclusion: The workshop held in the territory allows the user to see himself/herself as part of it and also reframe the ways of living in that territory. The notion of belonging, social acceptance and citizenship are keys in building the social subject.

Objetivo: Descrever o potencial terapêutico de uma oficina no território para os usuários de saúde mental e discutir a proposta terapêutica da oficina e a interação dos usuários com o território. Método: Trata-se de estudo descritivo-exploratório. Os dados resultaram da observação participante e das entrevistas com os coordenadores, sendo utilizada a Análise de Conteúdo do tipo Temática para o tratamento dos dados. Resultados: Apresentaram-se duas categorias temáticas: Piscina e o território; e Os benefícios da Oficina de Piscina. Conclusão: A oficina realizada no território permite que o usuário se perceba parte dele e, ainda, ressignificar as formas de viver naquele território, bem como a noção de pertença, de aceitação social e cidadania que são fundamentais na construção do sujeito social.

Objetivo: El presente estudio describe el potencial terapéutico de un taller en el territorio, para los usuarios del Centro de Atención Psicosocial y discutir el taller de terapia propuesta y la interacción del usuario con el territorio. Método: La investigación descriptiva y exploratoria. Los datos de resultado de la observación participante y entrevistas como dos coordinadores. Tipo temático de análisis de contenido fue utilizado para el procesamiento de datos. Resultados: Como resultado se obtuvieron dos categorías temáticas: Piscina y el territorio; y Privilegios taller. El taller realizado en el territorio permite que el usuario se da cuenta parte de ella y también replantear las formas de vivir en ese territorio. Conclusión: La noción de pertenencia, aceptación social y la ciudadanía son clave en la construcción del sujeto social.

Community Protection versus Individual Healing: Two Traditions in Community Mental Health.

This article identifies two major traditions that drive the mandate for a community mental health care system-community protection and individual healing. It discusses the historical antecedents of these two traditions and how these traditions relate to different visions of what the "common good" means. It then discusses how they both operate in the current US-based system, creating inherent conflicts and tensions, and gives specific examples from the personal and professional experiences of the authors. The article proposes ways to reduce the tension and discusses what sacrifices and compromises this resolution would entail for the US community mental health system. Copyright © 2017 John Wiley & Sons, Ltd.

[(Community) psychiatry, a parenthesis?]. / La psychiatrie (de secteur), une parenthèse ?

Beyond an a priori antagonism between these two notions, alienism and mental health cultivate analogies as to the place to which they assign mental health. Is community psychiatry not therefore simply a parenthesis in the history of psychiatry? The question is raised therefore regarding the place given to subjectivity and complexity. What must be done to ensure that this parenthesis of community psychiatry does not close? It is perhaps a case of making use of the tools which institutional psychotherapy has developed to keep the community psychiatry spirit alive.

Policies and Consequences: How America and Psychiatry Took the Detour to Erewhon.

In the mid-1960s, federal legislation provided psychiatry with funds for construction and initial staffing of local community mental health programs and funded university psychiatry departments to support research, innovations, and education in social-community psychiatry. Psychiatry gained resources for treating diseases and for addressing the disabilities that accompany mental illnesses. Abrupt losses of federal funding in the following decades, combined with restrictive insurance reimbursements and the expanding influence of the pharmaceutical industry, undermined psychiatry's abilities to address the needs of persons with severe mental illness. The author describes the perverse shift in social priorities that has occurred-with persons who have chronic mental illness housed in jails and heightened public perceptions that mass murders are the acts of persons with mental illness.

[Deinstitutionalization in Italian psychiatry - the course and consequences Part I. The course of deinstitutionalization - the activity of Basaglia's group]. / Deinstytucjonalizacja psychiatrii wloskiej - przebieg i skutki Czesc I. Przebieg deinstytucjonalizacji - dzialalnosc grupy Basaglii.

Psychiatric reform in Italy consisted of the implementation of legislative changes derived from anti-institutional experiments conducted by Franco Basaglia and his group in the 60's and 70's of the 20th century. The activity of Basaglia's group was an integral part of the European reform movement of that time, which profited from the economic, cultural and political prosperity for changes in psychiatry. Italian antipsychiatry has led to the most radical experiment in deinstitutionalization in history. It involved the whole public sector of psychiatry and across a quarter-century resulted in a grand social debate on the situation of the mentally ill and the need for systemic change of their treatment and care. Inspired mainly by phenomenological analysis, Basaglia opted for close emphatic contact with the mentally ill. While the British, French and American anti-psychiatrists contested the psychiatric care system as such, the Italian radicals made an approach to disassemble it from the inside and successfully gained social support for the process of deinstitutionalization. Basaglia promoted his ideas across Europe, including the World Health Organization (WHO) forum.

[Deinstitutionalization in Italian psychiatry - the course and consequences Part II. The consequences of deinstitutionalization]. / Deinstytucjonalizacja psychiatrii wloskiej - przebieg i skutki Czesc II. Skutki deinstytucjonalizacji.

The Italian mental health care is based on Law 180 (it. Legge 180), also called Legge Basaglia, from the name of the author of the reform, Franco Basaglia. It was adopted on May 13th 1978. The new legislation resulted from the actions of a strong anti-psychiatric movement and it brought about a major change in the organization of psychiatric care. The reform and its consequences were widely studied by the researchers, especially in the United Kingdom and the United States of America. The authors point out many successes of the reform, especially in its beginning. They seek the sources of its failure in a faulty and incomplete implementation. Legge Basaglia completely changed the structure of mental health care in Italy, finally bringing psychiatry back to medicine and the general hospitals, as well as promoting community-based psychiatry. Deinstitutionalization in Italy was not related to an increase in compulsory psychiatric hospitalizations, suicide attempts by the mentally ill, nor did it raise the number of crimes committed by them. It also did not cause common trans-institutionalization, with the transfer of patients to the private sector, as predicted by its opponents.

Mervyn Susser and community psychiatry.

Mervyn Susser's contributions to community psychiatry from 1957-1968 comprised a creative and significant phase of his career, though less well known than his other work. This included work in Salford, a town next to Manchester, where he developed a programme to improve community health (including mental health care), as well as a programme of research on mental disorders. The publication of his book, Community Psychiatry: Epidemiologic and Social Themes (1968) attempted to set the stage for the practice of psychiatry in the community and to establish a future direction for development of the field.