Involuntary psychiatric hospitalizations in Greece: Contemporary research and policy implications.

Involuntary psychiatric hospitalization is a contested issue in mental health care provision. Despite indications of very high rates of involuntary hospitalizations in Greece, no valid national statistical data has been collected. After reviewing current research on involuntary hospitalizations in Greece, the paper introduces the Study of Involuntary Hospitalizations in Greece (MANE), a multi-centre national study of the rates, process, determinants and outcome of involuntary hospitalizations, conducted in the regions of Attica, Thessaloniki and Alexandroupolis, from 2017 to 2020, and presents some preliminary comparative findings regarding the rates and process of involuntary hospitalizations. There is a major difference in the rates of involuntary hospitalizations between Alexandroupolis (around 25%) and Athens and Thessaloniki (over 50%), that is possibly related to the sectorized organization of mental health services in Alexandroupolis and to the benefits of not covering a metropolitan urban area. There is a significantly larger percentage of involuntary admissions that end in involuntary hospitalization in Attica and Thessaloniki compared to Alexandroupolis. Reversely, of those accessing the emergency departments voluntarily, almost everyone is admitted in Athens, while large percentages are not admitted in Thessaloniki and in Alexandroupolis. A significantly higher percentage of patients were formally referred upon discharge in Alexandroupolis compared to Athens and Thessaloniki. This may be due to increased continuity of care in Alexandroupolis and that might explain the low rates of involuntary hospitalization there. Finally, re-hospitalization rates were very high in all the study centers, demonstrating the revolving-door phenomenon, especially for voluntary hospitalizations. The MANE project came to address the gap in national recording of involuntary hospitalizations, by implementing, for the first time, a coordinated monitoring of involuntary hospitalizations in three regions of the country with different characteristics, so that a picture of involuntary hospitalizations can be drawn at national level. The project contributes to raising awareness of this issue at the level of national health policy and to formulating strategic goals to address the problem of violation of human rights and to promote mental health democracy in Greece.