The Mobile Mental Health Unit of Kefalonia, Zakynthos, and Ithaca, "METAVASI," stands as a shining example of support and care in the field of mental health. Through a multidisciplinary network that operates with flexibility and immediacy, the unit addresses both severe psychiatric illnesses and mild disorders. In the following interview, Mrs. Aikaterini Garbi, the scientific director of the unit, talks to us about its operation, challenges, and social impact.
Read the full interview with Mrs. Garbi, published on thekefalonianglobe.com.
- Let’s start with a brief overview of what the Mobile Mental Health Unit of Kefalonia, Zakynthos, and Ithaca does. What is its main goal?
First, let’s mention that the Mobile Mental Health Unit is funded and supervised by the Ministry of Health. It is one of several mental health units in operation. The main purpose of the unit is the prevention of mental health issues, while also providing treatment and addressing serious mental health problems in children, adolescents, and adults. In other words, the unit serves people of all ages, covering a broad spectrum of mental health concerns.
When we talk about serious mental health problems, we refer to psychoses such as schizophrenia, bipolar disorder, and severe depression. Additionally, there are cases involving milder mental health issues that fall into the category of neuroses.
In recent years, we have observed an increase in requests from elderly individuals, a trend seen across the country. Usually, it is not the elderly individuals themselves who approach the unit but family members, such as spouses or children. Relatives often seek support for psychological issues or diagnostic help, as it is not always clear whether the problem is dementia or other psychological conditions.
The more severe the mental health problem, the less likely the individual is to seek help on their own. This is a critical point that demands our attention. The seriousness of the condition often makes it impossible for the patient to take the initiative. In such cases, the approach to the mental health unit is usually made by a close family member 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, are typically more aware of their condition and are motivated to help themselves, which is why they seek out mental health units.
Mild mental health issues that are addressed include:
- Significant losses (bereavement),
- Panic attacks,
- Accumulated stressors,
- Developmental problems in children,
- Behavioral issues,
- Family conflicts.
- What does a Mobile Mental Health Unit mean?
The Mobile Mental Health Unit operates on two main pillars:
- Community Awareness Initiatives
The Mobile Unit must be known within the local community. This means a significant part of our work involves informing and raising awareness about the unit’s existence and function. It’s crucial for individuals who interact with many citizens—such as teachers, doctors, pediatricians, police officers, priests, and others—to know how to direct someone to the unit when necessary.
Through meetings, discussions, and awareness-raising events, we strive to maintain constant contact with the community and address emerging issues.
- Community Interventions
The most important aspect of our work is that our services are offered directly within the community. A significant part of our operation involves home visits and interventions, especially in cases where the patient cannot visit the unit due to their condition or because they live in remote areas.
The Mobile Unit has a consistent presence in areas such as:
- Ithaca
- Lixouri
- Poros
- Erissos
- Livathos
This flexibility is what makes the unit “mobile.” It is not a static service limited to a single physical space. Instead, it adapts to the 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 began operating in Kefalonia and Ithaca, the Mobile Mental Health Unit has served approximately 3,500 patients. Among them, 253 patients suffer from bipolar psychosis.
The unit is staffed by a multidisciplinary team, including:
- Psychologists,
- Social workers,
- A nurse,
- A child psychiatrist,
- A psychiatrist.
The team covers all necessary specialties to address both severe and mild mental health issues.
Currently, the unit is in the process of expanding its staff, aiming to hire at least four additional people. This expansion is deemed necessary to meet the increasing needs of the region and to continue providing high-quality mental health services.
- What is the approach of the Mobile Mental Health Unit when patients are unwilling to cooperate? What role does the family play in these cases?
This was a very common phenomenon during the early years of our operation, primarily due to inexperience and because we did not fully understand the sector and the reality of the situation. There were many cases where the process would not progress. Often, a family member would start the process, trying to bring in the person suffering, but neither we nor the relatives could persuade the individual during the initial phase.
As a result, after carefully studying specific cases and initiating recent research, we recognized the need to completely change our approach .
Now, we place significant emphasis on the person seeking help, meaning the relative or close friend who reaches out. 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 who makes the request to:
- Realize the problem,
- Understand their attitude toward the problem,
- Find ways to apply gentle but effective pressure to encourage the individual suffering to engage with the service.
Once this is achieved, both the relative and the patient enter a collaborative process. This collaboration is essential for ensuring the treatment flows correctly and produces the desired outcomes.
- How does the Mobile Mental Health Unit operate?
When a request is made, a member of the staff takes responsibility for monitoring the case, acting as a point of contact . The role of the point of contact includes:
- Gathering information about the patient’s condition.
- Maintaining communication with the patient and offering support on any arising issues.
- Consulting with the psychiatrist when further medical intervention is required.
The Role of the Psychiatrist
The psychiatrist is responsible for diagnosing the illness, prescribing medication, and monitoring its effectiveness. Once the psychiatrist is involved, there is close collaboration between the psychiatrist and the point of contact to ensure effective patient follow-up.
Even when the psychiatrist is not physically present at the unit, excellent communication and teamwork within the group ensure any gaps are covered. This operation demonstrates that while the psychiatrist’s physical presence is ideal, good coordination and teamwork can still deliver quality care to patients.
- Can you tell us about the scientific research the Mobile Mental Health Unit has participated in?
The Mobile Mental Health Unit has participated in important research highlighting its role in addressing severe mental illnesses such as psychosis and bipolar disorder.
Psychosis
Psychosis plays a pivotal role in the patient’s life. The longer treatment is delayed, the more the individual remains immobilized, living in a world of fear. The lack of appropriate intervention affects not only the patient but also their entire family.
Bipolar Disorder
Individuals with bipolar disorder are often more functional. They work, build families, and continue their lives. However, when they do not receive timely treatment, their condition can become significantly challenging, with serious consequences for their opportunities and quality of life.
- 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 when patients sought help.
We found that, as in global trends, when it comes to the onset of mental illness—mainly during adolescence or early adulthood—the stigma is so strong, and the fear so great, that individuals and families often avoid mental health services. This delays the critical period for effective intervention, leaving patients to rely solely on pharmacological treatment from private doctors. This delay has severe repercussions on the individual’s functionality, as valuable time for substantial intervention is lost.
- Research on Reducing Involuntary Hospitalizations
Our first published research focused on the effectiveness of the Mobile Unit in reducing involuntary hospitalizations. We examined a sample of 176 recorded hospitalizations among approximately 100–108 patients. Only 30 were voluntary hospitalizations, while 146 were involuntary. We observed a 45.9% reduction in hospitalizations following the initiation of the Mobile Unit’s treatment. This finding is particularly significant, as it demonstrates that:
- Pharmacological treatment,
- Family support and education,
- Comprehensive social support for the individual, lead to a substantial decrease in relapses and involuntary hospitalizations.
- Do you have statistics on the most common mental health issues in 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 for psychosis,
- 1.6% involved bipolar disorder,
- 18% presented emotional disorders,
- 24% had anxiety disorders,
- 14.6% involved parental counseling,
- 10.6% involved psychoeducation for parents,
- 6.8% fell into other categories.
We prioritize severe psychiatric illnesses, even though we cannot always fully meet the area’s increasing demands. Unfortunately, due to limited resources, we cannot cover all local needs. When prioritization is necessary, cases involving severe psychiatric illnesses take precedence. This requires clear prioritization, especially regarding the psychiatrist’s involvement, which is crucial for addressing these cases.
- Why do some patients discontinue their cooperation with the Mobile Mental Health Unit?
- Refusal of Treatment Due to Stigma
The main reason for discontinuation is the intense social stigma associated with mental health issues. This leads many patients to refuse treatment, making collaboration with the unit difficult.
- Frequent Changes of Psychiatrists
A second reason relates to frequent changes in psychiatrists within the unit. These changes, caused by external factors, have been a significant drawback for the unit. To address this issue, the “point of contact” takes on the responsibility of maintaining continuity in the patient’s care, building a closer and more stable relationship. This ensures collaboration with the unit remains consistent, even if the psychiatrist has to leave.
- Negative Family Attitudes
The negative attitude of the family toward treatment is another significant factor. To overcome this obstacle, we have modified our strategy, focusing on collaborating with the family.
- What is the importance of the Mobile Mental Health Unit for residents of remote areas? How does its existence affect the daily lives of islanders in Kefalonia and Ithaca? And what are the greatest challenges you face in providing services to these areas?
With Ithaca, we’ve had difficult times. We are trying to find ways to improve our intervention there. In recent years, we have achieved better integration into the local community, although challenges such as staff transfers persist. It’s not easy for someone to remain in Ithaca, but we now have a stable presence every week, which allows us to respond to the most serious requests.
As for the impact of our work, we focus on improving the lives of patients. For this reason, we have undertaken initiatives that promote openness and fight stigma. We have created artistic groups, such as choirs, both in Ithaca and Lixouri. These activities have a positive impact and enhance the social inclusion of individuals with mental illnesses. With more staff, we believe we can further strengthen our intervention in Ithaca.
The Challenges
There are significant shortages in general. In the past, there was a social cooperative focused on the professional integration of individuals with mental health problems, but it unfortunately closed in 2011. This was a major loss. In fact, when I took the initiative to keep it running, I faced challenges that were not my responsibility.
There are also serious housing issues. For example, we have patients living with their elderly mothers. In these cases, when the mother can no longer care for them, a serious issue arises about what will happen to these individuals.
Unfortunately, in recent years, we have observed a withdrawal and a reduction in state involvement in this sector. We believe that the government’s recent decision to shift funding from the state budget to the National Organization for the Provision of Health Services (EOPYY) will have a very negative impact. This move is likely to destabilize the entire system.
- Finally, how has the local community responded to the services you provide? Have you seen changes in attitudes toward mental health issues?
Let me share some indicative examples. First of all, individuals from the local community who in the past would not or could not dare to seek help have now begun to approach the unit.
It is also remarkable that more and more requests are coming from younger individuals who are more functional. For me, this is a sign that the community has embraced the Mobile Unit and trusts it.
Another example is that we have opened the General Assembly of our Non-Profit Organization (AMKE) to include people who have seen our work and want to help. The assembly now includes, for instance, doctors, pharmacists, and relatives of individuals who benefit from our services. Essentially, it’s a "friends' group" that supports our work. This approach also promotes transparency, which is particularly important to us. We aim to avoid misconceptions and demonstrate that there are people in Greece who are doing meaningful work because they truly believe in it, without personal gain.
To conclude, in 2019, we organized an event that brought together parents, relatives, and community members. It was a significant moment, serving as a celebration of coexistence, inclusion, and raising awareness about stigma.
This event left a positive impression, and we are now considering repeating it with a larger celebration to bring even more people together. Our goal is to strengthen coexistence and continue combating the stigma surrounding mental health issues.
Conclusion
The Mobile Mental Health Unit, operated by the non-profit organization "METAVASI," has proven that with dedication, transparency, and collaboration, significant steps can be taken to fight stigma and improve the quality of life for patients.
You can visit the "Metavasi" website by clicking on the link.
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