Supervisors info:
Μαρίνα Οικονόμου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπουσα
Αθανάσιος Δουζένης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Παναγιώτης Φερεντίνος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: despite the pronounced improvement that has occurred in the last decades in treating major psychiatric disorders, especially, but not exclusively, concerning psychosis, there still is a greater need for more and better results. The consequences of the incomplete scientific and governmental response to the challenges, posed by the serious mental illness, reflect on the mentally ill person him/herself, his/her carer and their quality of life, but also carry an important and multidimensionally negative impact towards society as a whole. The invention of antipsychotics, the social and political deinstitutionalization wave, practically replaced by the dehospitalization procedure, the incomplete Psychiatric Reform and the insufficient support, both in quantity and quality, of the ideals advocated by the Community Psychiatry, have led to a new state of order. The mentally ill person, less protected in the community context, faced even more difficulties in responding to the obstacles placed, not only by the mental illness, but also by a stigmatizing society, within which he/she sought his/her freedom. The non-compliance of therapeutic guidelines, those concerning the drug consumption or those foreseen, based on the biopsychosocial model, has emerged as an insurmountable barrier in the search for hope. As a response to a dead end situation, already more than 75 countries worldwide implemented programs of Community Treatment Orders (CTO), in multiple psychiatric and legal variations. The results of the international literature, following many years of CTO implementation abroad, have been and still are inconsistent, in spite of the considerably supportive opinion expressed by psychiatrists, the generally positive attitude of the carers, the ambivalent reaction of the patients, but also the radically negative tendency of those who approach the issue by taking into account moral and legal parameters, mostly connected to the human rights.
Objective : the central aim of the conducted research is investigating, detecting, recording and processing the attitudes and the views of the psychiatrists, related to different parameters of the CTO issue. The research is conducted two years after a law including a CTO program and concerning forensic patients (article 69, Greek Penal Code) was adopted and only a few months after a law preschedule, which includes another CTO program with expanded implementation framework, was officially put under public dialogue.
Material and methods : in order to cover the needs of the research, a 20 questions, anonymously, self-completed questionnaire was formed by the researcher. In the first eighteen questions the participants could respond either by giving an ΄΄Agree΄΄ or ΄΄Neither agree, nor disagree΄΄, or ΄΄Disagree΄΄ or ΄΄Do not know/Do not amswer΄΄ reply. In the last two questions the responder had to choose which one of the six and five answers respectively expressed his/her views more precisely. The questionnaire went through a trial procedure (ten psychiatrists took the questionnaire, observations were made, followed by adjustments). From 26-6-2019 until 5-9-2019, a personal contact was made with each one of 119 working in state hospitals psychiatrists, who participate in the involuntary examination and hospitalisation procedures and 81 psychiatrists from the private sector (including university professors) randomly selected from the electronic Medical Association of Athens list. The questionnaires were sent via ΄΄Googledocs application΄΄ and came along with an ΄΄Investigator statement of confidentiality΄΄.
Results: 200 psychiatrists (119 from the Greek National Health System and 81 from the private sector) were asked to be sent to their e-mail address a CTO questionnaire. Out of the 119 psychiatrists from the Greek National Health System, 115 (96.64%) agreed and 76 (response rate of 66.09%) finally responded, out of which 49 (64.47%) were from the Psychiatric Hospitals and 27 (35.33%) from the General Hospitals’ Psychiatric Clinics. All 81 psychiatrists from the private sector agreed to be sent a CTO questionnaire to their e-mail address and, finally, 61 (75.31%) responded. The total number of psychiatrists, who responded to the questionnaire, reached 137 (out of 200) and the respective response rate was 68.5%. The majority of the participating psychiatrists in our research have expressed positive and optimistic views concerning the parameters that are connected to the possible application of the CTO in our country, while not accepting the association of the CTO to the “perpetuation of violent institutional practices”. On the contrary, the majority of the participants believe that its implementation could lead to the reduction of relapses, the limitation of the “revolving door” phenomenon, the number of homeless, aimlessly walking around psychiatric patients, the high rates of victimisation, the rare violent and/or criminal acts they commit, which basically derive from their abandonment, the raw exploitation by the mass media and the emerging invalidation of every attempt to reduce the stigma, but also the expansion of social stigmatisation, the self-stigmatisation and the number of suicides. They believe that, through the CTO, the critical deterioration of mentally ill people’s functionality can be avoided and the burden of carers can be limited, factors which could have a direct impact on their quality of life. They presume that it may contribute to the decongestion of psychiatric clinics and the amelioration of the provided health services. They disagree on the possibly negative impact of the CTO on the relationship between the doctor and the patient, on the replacement of medical care and support with threats and coercion, as well as on the reduction of the psychiatric patients’ voluntary access to the mental health services, although a part of them remains skeptical. They oppose to the views that disagree with the CTO, which doubt the accuracy of diagnoses of psychiatric disorders or highlight the short-term and long-term risk of the unwanted side-effects that derive from drug administration. They present the combination of the CTO with psychosocial interventions as a primary thesis. They conclude by stating that the complete application of the principles of the Community Psychiatry in Greece is not feasible due to political and economical reasons and, given the need for urgent intervention in current cases, the CTO may be a temporary solution and sooner or later lead - through the reduction of hospital expenses - to a greater empowerment of the Community Psychiatry and the decrease of CTO’s application.
Conclusion: the attitude and the views of psychiatrists who participated in our research, related to the implementation of the procedures included in the CTO in Greece, are extremely positive. The equally positive attitude of psychiatrists in countries where the CTO has already been implemented, but also the contradictory results appearing in the in the international literature, concerning its application, should be neither underrated, nor overrated. Given the differences that exist between the various CTO programs and each country‘s distinctive characteristics, further research and evaluation of the CTO’s application perspectives in Greece, focusing on a totally specific form of implementation, is considered absolutely necessary.
