This report provides a compendium of good practices to promote voluntary measures in mental health care and support. It draws from practices submitted to the DH-BIO Secretariat by delegations representing the 47 Member States of the Council of Europe (COE) as well as civil society stakeholders. The compendium fulfils the aim set out in the DH-BIO Strategic Action Plan on Human Rights and Technologies in Biomedicine 2020-2025 to:

assist member States [by developing] a compendium of good practices to promote voluntary measures in mental healthcare, both at a preventive level and in situations of crisis, by focusing on examples in member States.

 

The practices may directly aim to reduce, prevent, or even eliminate coercive practices in mental health settings, and others will indirectly result in similar outcomes by advancing the general aim to promote voluntary mental health care and support.

The compendium is not meant as an exhaustive list of leading practices in COE Member States. Instead, it is meant as an initial step toward compiling practices aimed at promoting voluntary mental healthcare and support, and reducing and preventing coercion in mental health settings. More generally, the materials promote compliance with the Convention on the Rights of Persons with Disabilities (CRPD), notwithstanding debates about coercion in mental healthcare which will be noted in Part 1(B) of the report.

Back Mental Health Mobile Units – Greece

In Greece, Mental Health Mobile Units aim to reduce involuntary hospital admissions by working to keep individuals, particularly those in remote and rural areas, connected to their family and communities (Submission 27). According to Mental Health Europe (Mental Health Europe, 2019, p.7):

From the foundation of the first Unit in 1981 to the inclusion of Mobile Units in Greek law, more than 25 units have been founded and are still operational all over Greece. Mobile Units are now used as a basis for the provision of mental health services and the protection of the rights of mental health users, particularly in small and remote prefectures.

Reportedly, the local community, other health services as well as key individuals (local authorities, police department, and prosecutors) do not merely assist, but actively participate in the work of the Mobile Units, securing the person’s right to remain an active member of the community. By allowing persons to stay in their communities and offering services as close to the user’s home as possible, the Mobile Units ensure stability and continuity of care. Factors for success are prevention, information of local inhabitants, timely interventions, therapeutic treatment and maintaining contact with both the family of the user as well as the community. The Mobile Units treat individuals as a bio-psycho-social whole, meaning that they deal with social or work-related issues whilst taking the necessary steps for users to access appropriate treatment if they choose. Comparisons of data with prefectures where no Mobile Units are in place show that the percentage of involuntary hospitalisations is much lower (Submission 27).

According to one 10-year review of the practice:

The MMHU I-T and other similar units in Greece are a successful paradigm of a low-cost service which promotes mental health in rural, remote, and deprived areas. This model of care may be informative for clinical practice and health policy given the ongoing recession and health budget cuts. It suggests that rural mental healthcare may be effectively delivered by integrating generic community mental health mobile teams into the primary care system (Peritogiannis et al., 2017, p.556).

Another study indicated that hospitalisations were reduced significantly among those who used the service: ‘within the first 2 years of operation of the [mobile unit] hospitalizations of treatment engaged patients were reduced significantly by 30.4%’ (Peritogiannis et al., 2011).

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