Marchionatti Lauro Estivalete, Schafer Julia Luiza, Karagiorga Vasiliki Eirini, Balikou Panagiota, Mitropoulou Andromachi, Serdari Aspasia, Moschos Giorgos, Athanasopoulou Lilian, Basta Maria, Simioni André, Vicenzi Julian, Kapsimalli Efstathia, Tzotzi Alexandra, Mitroulaki Sotiria, Papanikolaou Katerina, Triantafyllou Kalliopi, Moustaka Dimitra, Saxena Shekhar, Evans-Lacko Sara, Androutsos Christos, Koumoula Anastasia, Salum Giovanni Abrahão, Kotsis Konstantinos
Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, Athens, Greece.
Global Programs, Child Mind Institute, New York, NY, United States.
Front Health Serv. 2024 Dec 11;4:1470053. doi: 10.3389/frhs.2024.1470053. eCollection 2024.
The mental health system in Greece faces challenges to complete its transition to a community-oriented model, having significant concerns for child and adolescent care due to lower coverage and service gaps. This component of the mental health system has not been comprehensively evaluated.
We conducted a review of the mental health care system for children and adolescents in Greece. For a field assessment, we directly collected data from mental health services to map availability and distribution. We analyzed the needs of human resources using professional register data and the national census.
The National Health Care Service (ESY, ό ύίς) is the public health system in Greece, characterized by public governance but significant private participation. Although ESY aims for universal care, gaps in population coverage and high user fees create barriers to access. Embedded within ESY, the mental health system is shifting towards a community-oriented structure since the psychiatric reform. For children and adolescents, there is a developing framework for regionalization and community services, including day centers, inpatient facilities, outpatient departments, and school-based psychoeducational facilities. However, services lack coordination in a stepped care model. Patient pathways are not established and primary care rarely involves child mental health, leading to direct access to specialists. Services operate in isolation due to the absence of online registers. There is no systematic performance monitoring, yet some assessments indicate that professional practices may lack evidence-based guidelines. Our mapping highlighted a scarcity of public structures, with an unbalanced regional distribution and many underserved areas. Child and adolescent psychiatrists are predominantly affiliated with the private sector, leading to professional gaps in the public system.
Our assessment identifies an established framework for a community-oriented, universally accessible mental health system, yet several barriers impede its full realization. These include an inconsistent primary healthcare system, a shortage of specialists in the public sector, imbalanced service distribution, lack of coordination among providers, underfunding, and absence of quality monitoring. We propose interventions to promote child and adolescent mental health in primary care, coordinate patient pathways, establish standards of care, and monitor performance.
希腊的心理健康系统在向以社区为导向的模式转型过程中面临挑战，由于覆盖率较低和服务差距，儿童和青少年护理问题备受关注。心理健康系统的这一组成部分尚未得到全面评估。
我们对希腊儿童和青少年心理健康护理系统进行了综述。为进行实地评估，我们直接从心理健康服务机构收集数据，以绘制服务的可及性和分布情况。我们利用专业注册数据和全国人口普查分析人力资源需求。
国家医疗服务体系（ESY）是希腊的公共卫生系统，其特点是公共治理但有大量私人参与。尽管ESY旨在提供全民护理，但人口覆盖率方面的差距和高昂的用户费用造成了获取服务的障碍。自精神病学改革以来，心理健康系统在ESY内部正朝着以社区为导向的结构转变。对于儿童和青少年，正在形成一个区域化和社区服务的框架，包括日间中心、住院设施、门诊部和学校心理健康教育设施。然而，服务在分级护理模式中缺乏协调。患者就医路径尚未建立，初级保健很少涉及儿童心理健康，导致患者直接找专科医生。由于没有在线登记系统，各服务机构孤立运作。没有系统的绩效监测，不过一些评估表明专业实践可能缺乏循证指南。我们的调查结果突出显示公共机构稀缺，区域分布不均衡，许多地区服务不足。儿童和青少年精神科医生主要隶属于私营部门，导致公共系统存在专业缺口。
我们的评估确定了一个面向社区、全民可及的心理健康系统的既定框架，但有几个障碍阻碍其全面实现。这些障碍包括初级医疗保健系统不一致、公共部门专科医生短缺、服务分布不均衡、提供者之间缺乏协调、资金不足以及缺乏质量监测。我们建议采取干预措施，以促进初级保健中的儿童和青少年心理健康，协调患者就医路径，制定护理标准并监测绩效。
