Breaking the Stigma: The "METAVASI" Mobile Mental Health Unit Changes Lives in Kefalonia, Ithaca, and Zakynthos

The Mobile Mental Health Unit of Kefalonia - Zakynthos - Ithaca "METAVASI" is a shining example of support and care in mental health matters. Through an interdisciplinary network that acts with flexibility and immediacy, the unit covers both severe psychiatric illnesses and mild disorders. In the following interview, Ms. Aikaterini Garbi, scientific director of the unit, talks to us about the operation, challenges, and social impact of this initiative.

Read below the interview given by Ms. Garbi to thekefalonianglobe.com. 

• Let's start with a few words about what exactly the Mobile Mental Health Unit of Kefalonia - Zakynthos - Ithaca does. What is its main goal?

Initially, let's say that the Mobile Mental Health Unit is funded and supervised by the Ministry of Health and is one of the various mental health units that exist. The main purpose of the unit is the prevention of mental health issues, while also providing treatment and addressing severe mental health problems in children, adolescents, and adults. In other words, the unit addresses all ages and covers a wide range of mental problems.

When we refer to severe mental health problems, we mean psychosis such as schizophrenia, bipolar disorder, and severe depressions. At the same time, there are also cases of milder mental health issues, which fall into the category of neuroses.

In fact, in recent years there has been an increased number of requests from elderly individuals, a trend observed throughout the country. Usually, it is not the elderly themselves who turn to the unit, but their family members, such as their spouses or children. Relatives seek support for both psychological issues and diagnosis, as it is often unclear whether the problem concerns dementia or other psychological issues.

The more severe the mental health problem, the less likely the person is to seek help themselves. This is a critical point that requires our attention. The severity of the condition often makes it impossible for the patient themselves to take the initiative. In these cases, the mental health unit is approached by someone close, such as a relative or caregiver, who recognizes the need for help.

On the other hand, individuals with mild mental health problems, such as anxiety or mild emotional disorders, usually have an awareness of their condition and wish to help themselves, which is why they turn to mental health units.

Such mild mental health issues may include:

• severe losses (grief),
• panic attacks,
• accumulation of stressful events,
• developmental problems in children,
• behavioral problems,
• family issues.

• What does Mobile Mental Health Unit mean?

The Mobile Mental Health Unit has two main axes of operation:

1. Community Awareness Actions
   The Mobile Unit must be known in the local community. This means that a large part of our work is to inform and raise awareness in the community about the existence and operation of the unit. It is important for people who come into contact with a large number of citizens, such as teachers, professors, doctors, pediatricians, police officers, priests, and others, to know how to direct someone to the unit when necessary.

Through meetings, discussions, and information activities, we strive to be constantly in touch with the community and address specific issues that arise.

1. Community Interventions
   The most important part of our work is that our services are offered directly to the community. A large part of our operation includes home visits and interventions, especially in cases where the patient cannot come to the unit, either due to their condition or because they live in remote areas.

The Mobile Unit has a stable presence in areas such as:

• Ithaca
• Lixouri
• Poros
• Erisos
• Livathos

This flexibility is what makes it “mobile.” It is not a static service limited to a physical space. Instead, it adapts to needs and goes where the patient is, providing support directly at their location.

• How many patients has the Mobile Mental Health Unit of Kefalonia and Ithaca served since its establishment?

Since 2007, when it started operating in Kefalonia and Ithaca, the Mobile Mental Health Unit has served approximately 3,500 patients. Of these, 253 patients suffer from bipolar psychosis.

The unit is staffed by an interdisciplinary team, which includes:

• psychologists,
• social workers,
• nurse,
• child psychiatrist,
• psychiatrist.

The team covers all necessary specialties for addressing both severe and milder mental health issues.

Currently, the unit is in the process of increasing staff, with the aim of hiring at least four more people. This reinforcement is deemed necessary to meet the growing needs of the area and to continue providing high-level mental health services.

• What is the Mobile Unit's approach when patients are unwilling to cooperate? What role does the family play in these cases?

This was a very common phenomenon in our early years of operation, mainly due to inexperience and because we did not fully understand the field and what was actually happening. There were too many dropouts. Often, a relative would start the process, try to bring the suffering individual, but many times neither we nor the relatives could convince the person in the first phase, resulting in the cooperation process not moving forward.

Therefore, after careful study of specific cases and within the framework of a research project we have recently started, we have understood the need to completely change our approach.

Now, we place great emphasis on the person seeking help, i.e., the relative or close friend who makes the request. This person is usually the one closest to the patient and can play a crucial role in the process.

Our approach focuses on helping the person making the request to:

• realize the problem,
• understand their own attitude towards the problem,
• find ways to exert gentle but effective pressure/stance, so that the suffering person comes closer to the service.

Once this is done, both the relative and the patient enter a cooperation process. This process is essential for the treatment to flow correctly and achieve the desired results.

• How does the Mobile Unit work?

When a request is submitted, a staff member takes responsibility for monitoring the case, acting as a point of contact. The role of the point of contact is to:

• Gather information about the patient's condition.
• Maintain contact with the patient and support them with any issues that arise.
• Communicate with the psychiatrist in cases where further medical intervention is required.

The role of the psychiatrist

The psychiatrist undertakes the diagnosis of the illness, the prescription of medication, and its monitoring. From the moment the psychiatrist is involved, there is close cooperation between them and the point of contact, ensuring effective patient monitoring.

Even when the psychiatrist is not physically present at the unit, excellent communication and cooperation within the team ensure that any gaps are covered. This operation demonstrates that, although the physical presence of the psychiatrist would be ideal, good understanding and teamwork can offer quality care to patients.

• I would like to talk a little about the scientific research in which the Mobile Unit has participated.

The Mobile Mental Health Unit has participated in significant research highlighting its contribution to addressing severe mental illnesses, such as psychosis and bipolar disorder.

Psychosis

Psychosis plays a decisive role in a person's life. The longer therapy is delayed, the longer the person remains sidelined, living in a world of fear. The lack of appropriate intervention affects not only the patient but also the entire family.

Bipolar disorder

Individuals with bipolar disorder are often more functional. They work, start families, and continue their lives. However, when they do not receive timely treatment, the situation can become quite difficult, with serious consequences for their opportunities and quality of life.

1. Research on the First Episode of Psychosis

Our most recent research focused on the first episode of psychosis. In collaboration with other mobile mental health units, we collected data on the age of onset and the attendance of patients at the units.

We found that, as on a global scale, when it comes to the onset of a mental illness – mainly near adolescence or early adolescence – the stigma is so intense and the fear so great that individuals and families do not turn to mental health services. Thus, a very significant period of time is lost for the person experiencing the first psychotic episode to receive serious and appropriate help. Instead, they are limited to pharmacological treatment from a private doctor. This delay has serious repercussions on the person's functioning, as crucial time for meaningful intervention is lost.

1. Research on Reducing Involuntary Hospitalizations

The first research we published concerns the effectiveness of the Mobile Unit in reducing involuntary hospitalizations. There we saw that in a sample of patients with psychosis who had a documented history of 176 hospitalizations, the patients were approximately 100 - 108, and this was our sample. Only 30 were voluntary hospitalizations and 146 were involuntary. We saw that there was a 45.9% reduction in the number of hospitalizations after the Mobile Unit's treatment began. This finding is extremely important, as it proves that:

• Medication,
• Family support and education,
• And overall social support for the individual,
  lead to a significant reduction in relapses and involuntary hospitalizations.

• Do you have statistics on the most frequently encountered psychopathological diseases in the areas of Kefalonia and Ithaca?

According to this year's data, from January to October 2024, 376 patients were served in Kefalonia and Ithaca. Of these:

• 20% sought help due to psychosis,
• 1.6% concerned bipolar disorder,
• 18% presented with emotional disorders,
• 24% had anxiety disorders,
• 14.6% concerned parental counseling,
• 10.6% parent psychoeducation
• 6.8% concerned other categories.

We prioritize severe psychiatric illnesses, although we do not always have the capacity to fully meet the increased needs of the area. Unfortunately, due to limited resources, we cannot cover all local needs. In cases where a choice needs to be made, priority is given to cases of severe psychiatric illnesses. This requires clear prioritization, especially regarding the contribution of the psychiatrist, who is crucial for addressing these cases.

• For what reasons do you observe that some patients discontinue their cooperation with the Mobile Mental Health Unit?

1. Refusal of treatment due to stigma

The main reason for discontinuing treatment is the strong social stigma associated with mental health issues. This leads many patients to refuse treatment, making cooperation with the unit difficult.

1. Changes in psychiatrists

A second reason is related to the frequent changes of psychiatrists in the unit. These changes, due to external factors, were a significant disadvantage for the unit. To address this problem, the “point of contact” undertakes to maintain continuity in the patient's care, building a closer and more stable relationship, so that cooperation with the unit remains stable, even if the psychiatrist needs to leave.

1. Negative family attitude

A negative family attitude towards treatment is another significant factor. To overcome this obstacle, we have modified our strategy, focusing on cooperation with the family.

• What is the importance of the Mobile Unit for residents of remote areas? How does its existence affect the daily lives of islanders in Kefalonia and Ithaca? And what are the biggest difficulties you face in providing services in Kefalonia and Ithaca?

We've had a difficult time with Ithaca. We are trying to find ways to improve our intervention there. In recent years, we have achieved better penetration into the local community, although we still face problems, such as staff transfers. It is not easy for someone to stay in Ithaca, but now we have a stable presence every week, which allows us to respond to the most serious requests.

Regarding the impact of our work, we are interested in improving the lives of patients. For this reason, we have taken initiatives that promote outward orientation and combat stigma. We have created artistic groups, such as choir groups, both in Ithaca and Lixouri. These activities have a positive impact and enhance the social inclusion of people with mental illnesses. With more staff, we believe we will be able to further strengthen our intervention in Ithaca.

The difficulties

There are generally significant shortages. In the past, there was a social cooperative concerning the professional integration of people with mental health problems, which unfortunately closed in 2011. This is a major wound. In fact, because I took the initiative to keep it active, I faced problems that were not my responsibility.

There are also serious housing issues. For example, we have patients living with their elderly mother. In these cases, when the mother can no longer care for them, a serious question arises as to what will become of these people.

Unfortunately, in recent years we have observed a contraction and withdrawal of the state in this area. Now, what we believe will very negatively affect both mental health services and services caring for addiction patients, is the fact that the state is trying to relieve the state budget of responsibility and shift funding to EOPYY. We believe this will completely disrupt the entire system.

• Finally, how has the local community reacted to the services you provide? Have you seen changes in attitudes towards mental health issues?

I will give you a few indicative examples. First of all, individuals from the local community who in the past would not have been able or would not have dared to ask for help have started to turn to the unit.

It is also noteworthy that more and more requests come from younger people, who are more functional. For me, this is a sign that society has embraced and trusts the Mobile Unit.

Another indicative sign is that we have opened the General Assembly of the AMKE, in which people who have seen our work and want to help participate. For example, doctors, pharmacists, and relatives of individuals who benefit from our services participate in the assembly. This is essentially a "friends' group" that supports our work. In this way, we also promote transparency, which is particularly important for us. We want to avoid demonizations and recognize that in Greece there are people who do something meaningful because they deeply believe in it, without personal interests.

In closing, I would like to specifically mention that in 2019 we organized an event in which parents, relatives, and community members participated. It was a significant moment, as it served as a celebration of coexistence, inclusion, and awareness against stigma.

This event left positive impressions, and now we are thinking of repeating it, creating a larger celebration that will bring even more people together. Our goal is to strengthen coexistence and continue to combat the stigma surrounding mental health issues.

Closing

Admittedly, the Mobile Mental Health Unit AMKE "METAVASI" has proven that, with dedication, transparency, and cooperation, significant steps can be taken to combat stigma and improve the quality of life of patients.

You can visit the "Metavasi" website by clicking the link.