Psychiatric Bulletin (1990), 14, 134-135

Banished to a Greek island

ROSALIND RAMSAY, Registrar in Psychiatry, University College and Middlesex School ofMedicine, London WIN 8AA

In October, public attention focused on psychiatrists requests for assistance. In 1983 a commission of gathering for the Eighth World Congress in Athens. European medical experts and economists was Was psychiatry still being abused for political pur• formed in Brussels to advise the EC on reform ofthe poses in the Soviet Union (Bloch, 1990)? And were Greek psychiatric sector. mental patients elsewhere being mistreated? At the The commission visited Leros. British economist Stadium of Peace and Friendship overlooking the Alan Maynard recalls, "The island was like a prison; Aegean Sea, delegates had the chance to meet and the sentence was life, and at death the patient's fate talk about these important issues concerning human was to be loaded on to the back ofa lorry and buried rights and human dignity. in an unmarked plot" (Maynard 1989). There Perhaps the most animated discussions centred on appeared to be no trained staff and no management the outrage surrounding the nearby island of Leros, ofany consequence. Although Leros was "the most which hit the British public in September. Writing in frightful experience", there were equally disturbing the Observer, journalist John Merritt revealed the conditions in other facilities in Thessaloniki and "hidden scandal" ofthis Greek island which, only an Daphni and on Corfu. Altogether these facilities hour's flight from Athens is used "as a dumping contained almost 10,000 lost souls. ground for those the world wishes to forget" The team proposed stopping the flow of new (Merritt, 1989). patients into such 'bins' as well as training staff and The Colony of Mentally III on Leros was estab• providing community care so that current inmates lished just over 30 years ago, taking over the exten• would have the chance to leave. It devised pro• sive military installations left on the island by the grammes for each site over a four-year period with Italians from the Second World War. It soon funding coming from the European tax payerand the expanded, accepting hundreds ofpatients from over• Greek government. Irish psychiatrist Professor Ivor crowded institutions in Athens and Thessaloniki. By Browne emphasised the importance of having 1970, following further large 'transportations' of Greek-led intervention. Leros posed some unique patients from mainland Greece there were over 2,000 problems as a small island where many ofthe locals inmates. However, the number oftrained staffto care were heavily dependent on the hospital for their for the growing- patient population remained livelihood. Thecommission suggested a special econ• unchanged. Director of the women's unit, Dr omic programme for the island as a whole. Over the Katherina Karanikolas, would have welcomed following couple ofyears it also recommended send• additional assistance in her work, but explained that ing a number ofmedical task forces with staffcoming most Greek psychiatrists were reluctant to isolate from Ireland, Italy and the Netherlands to work with themselves on a small island. Instead, the handful local psychiatrists on Leros. of trained doctors and nurses relied increasingly on In 1986, news about Leros (Ekdawi, 1987) alerted local help in patient management. the attentionofDrNick Bouras, a Greek psychiatrist Throughout this time over the last 30 years, Greece now working in London. Colleagues in Athens were has been in a state of political turmoil, facing com• keen to involve him in their work. Mter waiting over plex social andeconomic problems. Fifteen years ago a year he finally obtained permission from the Greek the Generals were overthrown and a democratic authorities to visit the island. Meanwhile, health government installed. Soon afterwards, the country officials in Athens were co-opting local psychiatrists, applied to join the European Community. In the including Dr George Papageorgiou, to work there. rest of Greece psychiatrists faced problems in their Bouras and Papageorgiou were both shocked by the work similar to those on Leros resulting from the state of mute, nude and deeply regressed patients; inadequate provision for mental health care. they began a detailed survey to get more factual Unfortunately, Greek political leaders failed to ask information on them. Using an adapted form ofthe for help with developing the country's mental health Community Placement Questionnaire they assessed services, so that this troublesome area was not patients' level ofdependency as a first step to prepar• included in the Treaty of Rome in 1979. Yet, the ing for their care in the community (Bouras et ai, in European Social Fund was later able to respond to press).

134 Banished to a Greek island 135 In 1988 there were 1,200 patients on Leros. Their Foreign delegates attending the Athens meeting mean age was 54 years andover two-thirds were men; were moved by the plight ofpatients on Leros and in 840/0 hadcome from other hospitals and the majority some ofthe other Greek hospitals. They called for a had been on the island for at least 20 years. Fifty-five motiontotheGreekgovernmentexpressingtheircon• percent were psychotic, a high proportion had men• cern, recognising that although an excellent start has tal handicap while fewer had significant physical beenmadeinsomeareas, therewasstillanurgentneed handicap. Almost half were on no drug therapy. A to continue and expand these projects forming a fully few had no apparent mental illness. Eighty-one per fledged mentalhealthservice throughoutthecountry. cent had no contact with their families. The team Resources were essential to provide adequate man• were clearly dealing with a highly disadvantaged agerial structures at local and central levels. Only by group of isolated chronic patients. However, staff developing a comprehensive community based men• suggested 360/0 ofthem could live outside the hospi• tal healthservice will theoldinstitutionssuchas Leros tal while researchers put this figure even higher, esti• become obsolete. mating 46 % ofthe inmates could live independently Away from Athens, debate about how to help the or in sheltered accommodation. Greeks provide more humanitarian care for their Now staffhave begun to improve basic living con• chronically institutionalised patients continues. ditions. Starting on notorious Ward 16, they have Leros is emerging as an important symbol expressing moved some of the 135 patients into small villas so the dissatisfaction felt over the predicament ofmen• that they can "look at each ofthem as a person, not tally ill people throughout the world. Four weeks as a collection ofsymptoms". Patients are relearning after the WPA Congress, members ofthe Society for forgotten social anddaily living skills. The hospital is Greek Studies in London discussed the challenge of at last starting to change. Papageorgiou has been Leros. The institution raises not only practical issues keen to engage the support of islanders working in but psychological ones too. By the process of the institution and tried setting up sensitivity groups 'islandisation', people are physically isolated, while for them as well as providing an informal teaching psychologically, the mad can be contained and for• programme. gotten within a compartment or island in the human In other parts ofGreece similar moves are occur• psyche. Successful 'de-islandisation' demands ring. Community mental health centres are opening greater acceptance ofdeviant behaviour. and psychiatric clinics are being set up in general In a wider context, the rest of Europe and the hospitals. The role of the old long-stay mental United States have faced tremendous hurdles devel• institutions is less clear. oping care for their mentally sick, interrupted by Commission psychiatrist Ivor Browne suggests the brief periods of optimism when significant progress original timeframe for reforms in mental health ser• seemed to be happening, most recently in the 1960s vices in Greece was perhaps unrealistic, given that with the first tentative moves from hospital to com• other European countries have been grappling with munity based care. Yet there are still major problems moves into the community for the past 30 years. The with new systems ofcare established over the last 30 Greek government's sluggishness in spending EC years. It will be essential to help the Greeks benefit money on community mental health is an indication from lessons hard learnt elsewhere. ofthis. By 1988 they had spent less than a third ofthe EC grant from four years earlier and had to ask for the project to be extended. Browne stresses the need References for the Greek government to develop a global mental health strategy to implement changes while allowing BLOCH, S. (1990) Athens and Beyond: Soviet psychiatric local groups the autonomy to put plans into action. abuse and the WPA. Psychiatric Bulletin, 14, 129-133. Atpresent, medical staffare hindered by the constant BoURAS, N.,CLIFFORD, P. &WEBB, Y. (eds). De-institutional• isation and Patients' Needs Assessment: The Leros changes in government, discontinuity in leadership Challenge. London: NUPRD. (in press). leading to lack of central planning. Unfortunately, EKDAWI, M.Y. (1987) Asylum ofLeros (letter). Psychiatric the central administration is unwilling to relinquish Bulletin, 11,275. any power so that the decision making process has MAYNARD, A. (1989) Misery oflost souls on holiday island. seized up. As Browne points out, foreign advisers Health Service Journal, 99, 1213. provide an added impetus, but overall responsibility ME1uuTr, J. (1989) Europe's guilty secret. Observer, 10 remains in Greek hands. September, 1, 17.