- Scientific Community: The Ministry of Health’s bill titled “Completion of Psychiatric Reform,” submitted to Parliament in July 2024, is considered dangerous and outdated.
- All for the money. Behind the lofty rhetoric about respecting the rights of people with mental disorders is an effort to minimize government spending on mental health.
- Closures ahead. By 2025, public and free rehabilitation programs such as KETHEA, “18 ANO,” “ARGO,” “IANOS,” and “DIAPLOUS,” which have made a significant impact in effectively treating addiction, will be closed.
- Afroditi Retziou, President of the Federation of Hospital Doctors’ Associations of Greece and psychiatrist at Thriasio Hospital: “Psychiatric reform is a strategic directive of the European Union that has been implemented in our country for 30 years, with tragic consequences for patients. All governments have consistently neglected this specific group of patients”.
- Mavra Aslanoglou-Dokorou joined the 18 ANO program in June 2015 and completed it in June 2016: “For me, it’s like my home is being closed.”
- The psychiatric hospital of Dafni is collapsing: Bed occupancy is at 100%, while vacancies for medical and nursing staff are at or above 50%.
- Thomas Dimoulas, President of the Workers’ Union at Dafni Psychiatric Hospital: “In 2010 there were 1,016 nurses, today there are only 575. How can there be only two nurses for 30 or 32 patients?”
- Varvara Mouchtouri, psychologist at the Counseling Center of the Alcoholism Unit (Dafni): “Requests for hospitalization have increased, more people are seeking help, and there is a long waiting list. The program will continue, but we don’t know how it will function. Many staff members are resigning because of the new legislation.
By Alexandros Pigadas
Mental health reforms under the banner of “psychiatric reform” have been underway in Greece since the mid-1980s. However, the results of these changes, promoted by successive governments, have dashed the hopes of those who envisioned a shift away from institutionalized care towards social-community psychiatry. The promises of dismantling the institutional model of mental health care and adopting a holistic approach to mental health treatment remained largely unfulfilled. It quickly became apparent that behind the lofty rhetoric about shifting the focus from institutional to community-based care, combating stigma, and respecting the rights of people with mental disorders, there was a covert effort to minimize government spending on mental health.
Private entrepreneurs and NGOs are providing an increasing share of mental health care. Responsibility for care is also being transferred to families and so-called “informal” providers. Legislative measures have facilitated the expansion of the private sector, with public psychiatric hospitals being closed under the pretext of eliminating institutional care, while private psychiatric facilities have proliferated.
According to the Organization for Economic Cooperation and Development (OECD), private hospital spending increased from €1.98 billion in 2009 to €2.53 billion in 2011. The National Action Plan for Mental Health 2022-2030, with its 10 intervention pillars funded by the Recovery and Resilience Facility and EU Structural Funds, advocates outsourcing not only mental health services but also more than 50% of residential solutions to NGOs, private entities and civil society organizations (e.g. units for early psychosis intervention, assessment and transport of patients for involuntary hospitalization).
In July 2024, the Ministry of Health submitted a bill to Parliament entitled “Completion of Psychiatric Reform”. Since its first publication, the proposed legislation has been widely condemned by the scientific community and society as both dangerous and regressive.
While “psychiatric reform” traditionally implies a shift from asylum-like care to community-based treatment aimed at deinstitutionalizing patients, the bill in question shares little with this philosophy beyond its title. In fact, it does the exact opposite, jeopardizing the well-being of thousands of psychiatric patients and people struggling with addiction, as well as the future of related structures.
The explanatory report accompanying the bill claims that it seeks to “complete the psychiatric reform initiated by Law 2716/1999,” which “remains pending to this day. This law laid the groundwork for the downsizing of public institutions and the shifting of state responsibility under the guise of “deinstitutionalization”.
Psychiatric hospitals and programs to be abolished
According to the law above, which has now entered into force, the remaining specialized psychiatric hospitals and psychiatric clinics of general and university hospitals throughout the country will be integrated into a unified and comprehensive network of cooperating structures, units, and services, called the National Mental Health Services Network. At the same time, as of January 1, 2025, the Psychiatric Hospital of Dafni and the Psychiatric Hospital of Thessaloniki will be closed.
In addition, the prevention centers will be closed as their operation is not guaranteed beyond 2027 and the bill does not mention the future of their employees. Public and free therapeutic programs, including KETHEA, “18 ANO”, “ARGO”, “IANOS” and “DIAPLOUS”, which have left a significant mark on the effective treatment of addiction, will also be terminated.
This means a significant reduction of services for both patients and staff. The current state of psychiatric hospitals in Greece in 2024 is indicative of the crisis: in the largest specialized psychiatric hospital in the Balkans, not even an electrocardiogram can be performed. Dafni has been without a cardiologist since October 29, leaving staff unable to care for patients in need of cardiac care adequately.
Revealing Statistics
Today in Greece, according to data from the Ministry of Health, there are a total of 3 Psychiatric Hospitals (down from 11 in 2009), 41 Psychiatric and 7 Child Psychiatric Departments in General Hospitals (many of which exist only on paper), 24 Mental Health Centers, 22 Community Mental Health Centers for Children and Adolescents, 30 Mobile Units, 88 Day Centers, 30 Social Cooperatives with Limited Liability, 501 Psychosocial Rehabilitation Units, and 39 Private Psychiatric Clinics, with 64% of these concentrated in Attica, Thessaloniki, and Larissa.
Between 2009 and 2018, the private psychiatric sector significantly increased its share of hospital beds at the expense of public facilities. For instance, in 2007, Greece had a total of 53,888 beds, of which: 37,574 were in public hospitals, 1,607 in nonprofit private legal entities, and 14,707 in private clinics. By 2015, the total number of beds had dropped to 45,945, with: 29,856 in public institutions, and 15,208 in private clinics. This represents an increase in the private sector’s share of total beds, from 27.3% in 2007 to 33.1% in 2015. By 2018, the situation had become even more skewed, with a total of 7,062 beds, of which: 1,356 were in public hospitals, and 5,706 in private clinics.*
Chronic neglect
The president of the Federation of Associations of Hospital Doctors of Greece and psychiatrist at Thriassio Hospital, Afroditi Retziou, emphasizes that “psychiatric reform is a strategic direction of the European Union that has been implemented in our country for 30 years, with tragic consequences for patients. There has been chronic neglect of this specific group of patients by all governments, as public psychiatric hospitals have been closed, resulting in the closure and loss of hundreds of beds. Currently, there are about 4,700 private psychiatric beds in Attica, compared to only 900 public beds within the National Health System (NHS)”.



The President of the Hospital Doctors notes that this situation leads to the phenomenon of the “revolving door”, where patients repeatedly cycle in and out of psychiatric clinics due to the lack of the necessary development of community structures to ensure their smooth reintegration. The same disastrous situation prevails in mental health centers throughout Greece.
Funds directed to NGOs and private institutions
At the same time, Ms. Retziou notes that the vast resources that the government will receive from the Reconstruction Fund to improve public access to mental health services will be allocated to NGOs and private institutions that will provide rudimentary, temporary services. In contrast, she says, “These funds should be used to hire permanent staff, develop mental health centers, and create infrastructure.
In addition, free prevention and rehabilitation services for drug, alcohol, and gambling addiction will be provided by merging the authorized prevention and treatment bodies – many of which are integrated into the public health system (such as KETHEA, 18 ANO, IANOS, Diaplous, etc.) – into a single organization. This new body, the National Organization for the Prevention and Treatment of Addiction, will operate as a private legal entity with financial autonomy.
“Unfortunately, we have seen from past programs that once they ended, there was no continuation or support from the state budget. Structures closed and patients were pushed to the gates of public psychiatric hospitals. Our experience also comes from other EU countries where patients end up homeless, incarcerated, or marginalized. In essence, we are adopting a harm reduction approach, depriving addicts of the chance to fight for a drug-free life,” she stresses.
Regarding the so-called psychiatric reform of the late 1990s, she explains that the state has always been absent because “specialized mental health services are expensive. The psychiatric reform law passed at the time stipulated that no new structures should be developed in the public health system and that there should be a coexistence between the public and private sectors. Of course, as history has shown, this only led to the shrinking and degradation of the public sector to the benefit of the private sector,” she concludes.
Huge shortages
Speaking about the shortages in the mental health sector, she emphasized that the problem is even more acute compared to the situation in the National Health System (NHS) because it is a neglected sector. For the state, psychiatric patients are costly and, until a few years ago, were not considered “usable”. This meant that they could not enter the labor market or contribute to production. As a result, there is a huge shortage of nurses. An example of the current situation on the ground is that in the hospital of Thriassio, there are no occupational therapists, there is no mental health center in the area, and there are no rehabilitation structures.
“It’s like my home is closing”
Mavra Aslanoglou-Dokorou, a trans woman and member of the LGBTQ+ community, entered the 18ANΩ program in June 2015 and completed it in June 2016. As she describes, she was able to recover through the collective efforts of the program and has been sober for nearly 9.5 years.
She wonders how such an effective program, one that brings real results to the community, could be shut down. “I’ve built relationships with the group, learned consistency and accountability, developed my skills, and learned how to function differently. Why would all that change?” she asks.
“To me, it feels like my home is closing. Therapists are already telling patients that soon we may not be here. It’s tragic what’s happening. Mental health is a public good, and it’s so contradictory to destroy something that works so well,” she says.
She also emphasizes the critical role of therapists, who go above and beyond every day to ensure these outcomes and treat her like family. She points out that when there have been material shortages, the staff itself has stepped in to make up the difference. Meanwhile, there is a deep sense of uncertainty among patients about the program’s impending closure.
Dafni on the verge of collapse
At the same time, the situation at Dafni Psychiatric Hospital is dramatic. This is a psychiatric facility that receives patients from all over Greece on a daily basis. The bed occupancy rate is 100% and the vacancy rate for medical and nursing staff is approaching or exceeding 50%!
According to data revealed by the Hospital Workers’ Union, the situation in 2019 is as follows:
In the same vein, reports from Thomás Dimoulás, president of the workers’ union at the Dafni psychiatric hospital, highlight that before the economic crisis, specifically in 2010, there were 1,016 nurses, while today there are only 575. He also refutes the government’s claims about hiring in the public health sector, saying that only 7 new hires have been made since 2020, resulting in a revolving door of staff. As he puts it, “The average age of the staff is over 50, as most of us have been here for over 20 years, and hiring is done sparingly. There is a new generation that wants to work, but they cannot because there are no jobs. The hospital has enormous needs; we are talking about the largest psychiatric hospital in the Balkans. We receive patients from all over Greece and often have to work double shifts to meet the demand. We are certainly owed time off, holidays, and money, but these are insignificant for the government”.
He goes on to say that in 2023 there were 4,472 admissions from all over Greece, 16% of them from other regions, while a total of over 85,000 people visited the hospital. In addition, 16,000 people visited the outpatient clinics, and 23,136 individual therapy sessions were conducted. This immense workload was managed by only 46 psychiatrists and 65 interns.
68% of admissions are involuntary (admission and stay for treatment in an appropriate psychiatric facility without the patient’s consent) and 6% come from the regions. It is worth noting that only 13.8% of patients in this category who are discharged from hospitals are referred to community mental health facilities, while 32.2% remain without a referral proposal.
Unqualified staff
The situation at Dafni has been tragic for years, according to Mr. Dimoulas, who says that even the staff themselves are at risk because of the hospital’s understaffing. Is it possible to have only 2 nurses for 30 and 32 patients?” he asks. The hospital has workers on three-month contracts, part-time workers, and even people from the 55-67 program, which provides full-time jobs for unemployed people of that age. How feasible is it to rely on unqualified staff when someone comes into this age group with no work experience – how can they learn in just a few days? It should also be noted that these are temporary programs, so these people will eventually stop working, leaving the hospital vulnerable again,” he points out.
The government’s approach is harm reduction
Regarding the mental health bill, he mentioned that the government is integrating hospitals (Dafni and the psychiatric hospital in Thessaloniki) along with mental health centers and addiction rehabilitation centers into a network where NGOs, non-profit companies, and private individuals will enter the profit-making game in the field of mental health. He gave the example of an NGO in Nea Ionia that closed down after one year of operation because it ran out of money from the recovery fund, and also mentioned that the psychiatric clinic “Kastalia” had closed down. The patients from both psychiatric hospitals were transferred to Dafni and Dromokaiteio, he pointed out, emphasizing the negative impact of the involvement of private individuals on both the patients and their families.

The government’s approach is harm reduction, not full treatment of the addict. The closed programs (18 Ano, addicted women, physical detoxification, alcohol detoxification, gambling rehabilitation) that take place in Dafni are all dry, last 2 years, and do not use substitutes. The goal is to treat the patient completely, which requires continuous monitoring. Hospitalized patients and those undergoing treatment build relationships of trust with each other. The specific bill contradicts this by allowing the National Organization for the Prevention and Treatment of Addiction to transfer workers to other units as needed.
Encouraging the transfer of workers
Specifically, paragraph 2b of Article 30 states: The personnel who, at the time of the promulgation of this law, work in the therapeutic units, departments, and programs referred to in paragraph 1 of Article 29, with a contract of employment of indefinite or fixed duration under private law, may be transferred, with the simultaneous transfer of their position in the case of permanent employees under private law, to the National Organization for the Prevention and Treatment of Addiction, upon their request, which must be submitted within two (2) months from the date of the entry into force of this law to the competent directorate of the relevant regional health authority; for the transfer, the relevant confirmatory acts shall be issued by the President of the National Organization for the Prevention and Treatment of Addiction, which shall be valid for all legal consequences as of January 1, 2025.

Based on the above, employees with a permanent or temporary contract of employment under private law in the therapeutic units, departments, and programs referred to in paragraph 1 of article 29 (“18ANO”, “Ianos”, “Methexis”, “Argo”, “Diaplos”) will have no other option than to transfer to the National Organization for the Prevention and Treatment of Addiction upon request, as provided for in paragraph 2a of article 30 for permanent employees of the same therapeutic units and departments. If they do not make this request following the law, they will lose their jobs. However, on September 19, 2024, an information document was issued by the Ministry of Health, signed by Deputy Minister Mr. Themistocleous, and given to the employees on September 26, 2024 (four days before the initial deadline for submitting requests, which was finally extended to November 1, 2024). The document stated that if these employees did not submit a request to the National Organization for the Prevention and Treatment of Addiction, they would be transferred to the competent regional health administrations. This purely informative document does not override Law 5129/24, a fact that has caused concern among the hundreds of workers who work under this employment status in the affected organizations.
Tragic understaffing in the emergency room
A nurse working in the emergency room of Dafni Hospital gives her perspective on the situation. They emphasize that until 2020, the number of admissions and arrivals was high, but the pandemic limited these due to strict measures, causing fewer people to seek care. The nurse also points out that 90% of her work is administrative, done by just one person due to severe staffing shortages. She says, “We all do everything and we have no support from the administration. Regarding patient cases, the nurse mentions, “They are more complicated now, and after the pandemic, we started to see a lot of young people with psychosis, which is the most worrying”.

Regarding the hospital’s staffing situation, the nurse points to massive shortages. Specifically, in the emergency room, 10 people are working, but only 7 are functional, whereas ideally, 20 people should be working. “We permanent staff are the minority. Since the Covid-19 pandemic, we’ve been working with support staff and workers from the O.A.E.D. programs. We work grueling shifts; in the summer of 2023, we worked 8 shifts in 7 days – usually, it’s 5 shifts a week. Since the memorandums, we’ve been prohibited from hiring. We haven’t had a permanent employee in over 10 years.
No permanent recruitment since 2006
Evangelos Poullis, a psychologist at the 18ANΩ alcohol detoxification unit in Dafni, explains that the program, which is currently part of the public health system, will become a legal entity under private law, with a board of directors appointed by the government.
Discussing the new conditions that will prevail, he emphasizes that the program will lose its autonomy, substitution treatments will be promoted, and OKANA (Organization Against Drugs), which advocates substitution treatments, will lead the program.

Mr. Poullis explains that “of the 45 psychologists currently in the program, only 5 or 6 will follow, while the others will remain in the network. This means that they will cover different needs wherever they arise, whether in Attica, Rhodes, or wherever they are sent”.
“As of January 1, 2025, Dafni will be abolished. There is no organizational plan for the future; we don’t know where anyone will work, what the conditions will be, the salaries, nothing. Imagine that I have started a therapeutic group for two years, but in January I don’t know where I will be. They forced the doctors to choose between working in the National Organization for the Prevention and Treatment of Addiction or being automatically transferred to the Regional Health Authorities. Nurses and specialized therapists had to stay in the National Organization for the Prevention and Treatment of Addiction because otherwise they would be left without a job,” he stresses.
At the same time, he points out that the National Organization for the Prevention and Treatment of Addiction has minimal staff, yet it is equated with private detox clinics. Of course, he says, “We are talking about flexible working relationships, hiring people on freelance contracts, while at 18ANΩ we are working with less than 50% of the staff. There are only 8 nurses instead of 20, while the last recruitment took place in 2006 when I was the last employee without a flexible contract.
A long waiting list for rehabilitation
The statements of Barbara Moukhtouri, a psychologist at a counseling center in the Alcohol Detoxification Unit of the Psychiatric Hospital of Athens, are in line with these concerns.
She mentions, “There has been an increase in requests for hospitalization, more people are seeking help, and there is a long waiting list. The program will continue, but we don’t know how it will work. There have been many resignations because of the new law. There is uncertainty among the staff and there will be mergers of programs. We don’t know who will decide where each person will go. The government encourages private initiatives in detoxification. The closed program is expensive but effective.
The government’s policies do not promote prevention, treatment, or social reintegration. This bill is in addition to all the previous laws that essentially abolish public health in favor of private health companies that profit from and exploit human suffering.
At the same time, the map of prevention and treatment of addiction is completely changed, with the elimination of dry programs, a blow to public and free rehabilitation, continued understaffing and underfunding, a downgrading of prevention and awareness, with a focus on an integrated psychosocial approach based on the needs of the community, while on the one hand, there is an attack on labor relations and continuity of treatment (prevention-treatment-reintegration), and on the other the possibility of further intrusion of NGOs in the field of addiction treatment.
At a time when the situation in psychiatric clinics is becoming increasingly precarious for both patients and staff, asylum-like conditions are escalating due to the tragic lack of psychosocial support services in the community as well as in reintegration. At a time when social and economic blockages are deepening and the need for psychological support and prevention-rehabilitation is growing, this law has come to deliver the final blow.
*Health Atlas of the Ministry of Health (Health Infrastructure – Access February 2022)
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