Facets of the socio-economic crisis

1. Facets of the socio-economic crisis on mental health:Comparative data from patients and professionals at de-institutionalized services V. Yotsidi, A. Frangouli, V. Chronopoulos, V. Bochtsou & D. Kroupi Society of Social Psychiatry and Mental Health (SSPMH) ISCAR International Conference University of Crete 16-19June 2016, Rethimnon, Crete

2. Outline • Socio-economic crisis and mental health: risks and protective factors • Method • Results • Current data of mental health personnel • Current data of patients • Comparative data 2016 vs. 2009 • Conclusions

3. Socio-economic crisis & mental health: A «Double bind» phenomenon

4. Demand Increase: Risks from the economic crisis on mental health

5. Supply reduction: Economic crisis and the mental healthcare system • Uncompleted psychiatric reform in Greece, due to delays in planning and implementation deteriorated by the economic crisis (Christodoulou et al., 2012; Fitsiou, Giakras & Sakellaropoulos, 2010) • Sectorisation is unaccomplished and there are still deficiencies in the provision of care for sensitive groups, which results in a consequent lack of accessibility for many citizens (Frangouli & Kleopas, 2015) • Reductions in the budget of public healthcare and the mental health system has resulted in reduction of mental health facilities and number of professionals, in a critical period (Christodoulou et al., 2012; Kentikelenis et al., 2011; Simou & Koutsogeorgou, 2014)

6. The impact of economic crisis on health professionals

7. Protective factors from the consequences of economic crisis • Personal factors of resilience (i.e. positive emotions, meaning making, life satisfaction) • Lower rates of depression (Yotsidi et al., 2014) • Increase of mental health services and resources • Less self-destructive behaviors (Giotakos et al., 2012) • Increase of social networks & social bonds of support • Lower rates of depressive symptoms, containment of anxiety, increase of resilience and self-empowerment (Kawachi & Bergman, 2001; Pollack, Vanepps, & Hayes, 2012; Podsakoff, LePine, & LePine, 2007) • The therapeutic and social role of mental health professionals • Increased community sensitization, increased needs assessment and response, reorientation of services (Lambropoulou et al., 2016; Loewenthal, Malikiosi-Loisos & Athanasiades, 2013; Fitsiou, Giakras & Sakellaropoulos, 2010)

8. Research Questions • What are the effects of the socio-economic crisis on mental health to patients and professionals of community de-institutionalized services? • What are the levels of general health of professionals in relation to socio-economic variables? • Which are the protective factors against the risks from the crisis on mental health for patients and professionals? • Are there differences between the initial phase of the socio-economic crisis (2008-2009) and the current year (2016)? • What are the possibilities for integration of adverse experiences related to the crisis into the therapeutic milieu?

9. Method Sample – Personnel 2016 2009 171 professionals 79% women 65.4% between 31-50 years old 65% at housing services 27.6% nurses & 22.6% special therapists 36.3% from Attica, 35.1% from Thrace, 20.5% from Fokida, 8.2% from Fthiotida • 155 professionals • 81% women • 67.6% between 35-54 years old • 68.5% at housing services • 24.7% nurses & 27.3% special therapists • 64.3% married & 51.9% with children, 63.9% with tertiary education

10. Method Sample – Patients 2016 2010 119 patients 71.2% men 54.8% <50 years old 73.9% at housing services 35,3% from Thrace, 27.7% from Attica, 23.5% from Fokida, 13,4% from Fthiotida • 101 patients • 65.6% men • 76.8% <45 years old • 51.2% basic education • 79.2% single • 100% at housing services • 53% receive services for up to 5 years, 40% from 6-15 years

11. Distribution of the sample (2016) in the four regions of Greece Personnel Patients

12. MethodTools • Professionals’ Questionnaire on the Effects of crisis on mental health (SSP&MH, 2010) • 23 closed-questions & 6 open-questions regarding three axes: (a) the effects of the socio-economic crisis, (b) the protective factors against the risks from the crisis, and (c) the possibilities for integration of adverse experiences related to the crisis into the therapeutic milieu • Patients’ Questionnaire on the Effects of crisis on mental health (SSP&MH, 2010) • Twenty-one 5-point Likert scale closed-questions (& 1 open-question) on the above axes, simple and short, taking into account the needs of the sample.  • General Health Questionnaire (GHQ– 30) (Goldberg, 1972) • 30 items of a 4 point scoring system and it assesses mental well-being. The GHQ-30 yields only an overall total score. It is the most widely validated version with 29 validity studies (Cronbach’s Alpha: 0.78 to 0.95)

13. MethodProcedure Data completion in two different periods: at the initial phase of the socio-economic crisis (2009-2010) and during 2016 Coverage of all types of de-institutionalized community services: hostels, sheltered houses, apartments, mobile units, pre-vocational and vocational programs, KOISPE Representation of different regions nationwide where SSP&MH community services are located: a) Attica, b) Thrace-Alexandroupolis, c) Fokida, and d) Fthiotida. Good response rates: ~ 88% in 2009, 77.1% and 61.2% in 2016 of professionals and patients, respectively Voluntary participation and anonymity of data were ensured

14. RESULTS

15. Degree of threat to the personnel from the crisis on mental health 2009 2016

16. Professionals’ comparative data on the areas of impact from the crisis

17. Professionals’ comparative data on the effects of the crisis on mental health

18. Professionals’ comparative data on the degree that patients perceive the crisis

19. Professionals’ attitude towards the SSP&MH (2009 vs. 2016)

20. Protective factors of the personnel against the crisis on mental health

21. Personnel’s view on the degree of challenges from the crisis on mental health

22. Personnel’s views on the areas of new opportunities from the crisis on mental health

23. GHQ -30 score for the Professionals

24. GHQ -30 score for the Professionals

25. GHQ -30 score for the Professionals

26. Patients’ views regarding the degree of economic crisis influence on the mental health services

27. Effects of the socio-economic crisis on mental health to personal variables

28. Effects of the socio-economic crisis on mental health to therapeutic variables

29. Effects of the socio-economic crisis on mental health to organizational variables

30. Patients’ comparative data on the effects of crisis (2010 vs. 2016)

31. Protective factors of patients against the crisis on mental health

32. Patients’ belief that the crisis has reached to an end – 2016 vs. 2010

33. Conclusions (1) • A more moderate attitude bothby the professionals and the patients towards the “threat”, but also the “challenges”, from the crisis on mental health in 2016 compared to the beginning of the crisis • A professionals’ increased concern in 2016 for the impact of the crisis on mental health to their patients, who are also their focus concerning “the areas of new opportunities” from the crisis on mental health in 2016. On the contrary, less concern about the impact of the crisis on the personal level and their cooperation with the SSP&MH, which appear more stable and positive-laden. • Professionals’ perceived effects from the crisis on mental health appear less rigorous in 2016 compared to 2009, except of the patients’ quality of life variable • Almost four out of ten (40.8%) professionals show indications of distress and decrease in their well-being, with those in Thrace being more at risk.

34. Conclusions (2) • All professionals’ protective factors against the crisis on mental health are increased in 2016 compared to the initial period of crisis. Along with personal sources of resilience towards the crisis, the relationship with their colleagues, their patients and the agency emerge to be of high protective value. • Patients’ fears related to the crisis on mental health appear less intense in 2016 compared to 2010. This concurs with the majority of patients in 2016 stressing thestability of therapists’ help and availability, quality of services and trust to the agency (SSP&MH) • Patients’ protective factors remain stable in 2016 and 2010 with some decreases in their personal skills and the relationships with other patients as sources of defense against the crisis. Again, the role of the therapists prevail as the most important protective factor. • Three out of four patients (76%) believe that the current crisis on mental health has not reached to an end yet.

35. Discussion • Although a more adjusted attitude towards the crisis on mental health has been developed, the crisis still raises anxieties and threats that destabilize professionals’ and patients’ mental health as well as continuity of services. • The role of the relationship at various levels (i.e., therapists-patients, group level, agency level) evokes as the most ubiquitous protective factor that promotes containment and change. • Personal and organizational variables need to be jointly sustained and developed, so as to prevent inequality and promote empowerment in the mental health care system.

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