Two years after Attica’s catastrophic earthquake, the country’s largest psychiatric hospital, the Psychiatric Hospital of Attica (PNA) at Dafni is still trying to heal wounds that have seriously affected the country’s already ailing mental health services. On October 4, the PNA opened six new buildings to replace those damaged in the quake. Five of the buildings are to house patients and one is for hospital support services. Three have been open for some time and a fourth is to go into operation this month. Today the hospital has around 650 patients with another 550 chronic cases accommodated in 15 hostels 20 apartments and two hotels, the Krystal and the Rivoli. The hospital in Dafni is on emergency duty twice a week. Earthquake damage The head of the PNA’s board of directors, Katerina Apostolou, told Kathimerini what the psychiatric hospital experienced with the quake in September 1999. On the afternoon of September 7, about 1,000 of the hospital’s 1,400 patients became ‘homeless’ as 70 percent of the buildings suffered damage, she said. The staff’s superhuman efforts ensured that there was no panic. Patients lived for three days in tents on the hospital grounds. On the third day, 150 of the patients were moved to a building we rented in Pikermi and the rest crowded into the buildings that had not been damaged. In December of that year, 220 patients were moved to the two hotels, added Apostolou. Asked to comment on criticism the hospital has received over this arrangement, she said, The end justifies the means. This move acted as a kind of process of deinstitutionalization and rehabilitation, as these patients were the first to be able to move into the hostels, boarding houses and apartments. By April 2000, when three of the hospital’s buildings had been repaired (15 percent of all facilities) about 550 patients were living with the 400 who had not been moved, she said. Apostolou also pointed out the serious problems the hospital faced due to overcrowding. Of course, after the earthquake, we could no longer provide emergency duty, creating problems for the Dromokaiteio Hospital and the psychiatric departments in state hospitals. The year 2000 was a very critical time for mental health in Greece, she said. After the quake, hospital and Health Ministry engineers made an initial inspection and then the Public Works Ministry engineers assessed which buildings could be repaired. What impressed us was that the damaged buildings were of varying ages, construction type and were situated in different parts of the complex. Then the planning process began and was carried out in cooperation with the staff, the doctors and the Health Ministry. We decided that the 500 beds should be purely psychiatric and that the chronically ill should be rehabilitated into the community. On that basis, and given the urgency of the work, we decided to set up six prefabricated heavy-duty buildings of a total area of 13,500 square meters with 270 beds. The buildings were completed last June, she said The PNA has only one building (No. 19) whose fate is still undecided. One of the most serious problems being faced by the PNA is the lack of staff. To cope with and care for its 1,200 patients dispersed around the hospital, its hostels and apartments, there is a total of 1,400 employees to cover all sectors. The proportion of nursing and medical staff is naturally high. According to Apostolou, one of the more serious problems is the small number of specialized psychiatrists. The Health Ministry’s recommendation for the PNA is that we have 48 specialists, yet we have only nine. One of the reasons for this is that psychiatrists of the future prefer psychiatric wards in general hospitals. On the other hand, fewer doctors want to specialize in psychiatry these days. We suggest that psychiatrists be required to spend part of their training period at the PNA, which provides the full range of treatment from primary care to rehabilitation, she added. There are 22 vacant medical posts at the hospital, but 70 new nursing posts soon to be filled are expected to make a considerable difference. Attica Psychiatric Hospital’s goal The aim of the Attica Psychiatric Hospital (PNA) is to in no way resemble an asylum but to treat patients for as long as their illness requires hospitalization. Apostolou emphasized that the hospital has to try and ensure that stays are reduced to a minimum so that patients do not become institutionalized. At the same time, we will make every effort to rehabilitate the chronically ill, transferring them gradually to smaller units within the community. A basic prerequisite is the development of primary mental healthcare units so that cases can be diagnosed and dealt with early on. Each psychiatric unit should have responsibility for a specific geographical area, she said. No patients who were not residents of Attica have been admitted to the PNA since the earthquake, a practice which the hospital wants to continue. Another serious problem for society in general is the increasing need for specialists in geriatric psychiatry, given the increasing age of the general population. The PNA is the only hospital with a geriatric psychiatry department. I think, however, that the best way to deal with this problem is to set up municipal residences for the aged, Apostolou said. Particular attention needs to be given to the question of criminal patients, added Apostolou. People who have committed a crime and have been judged not to have been responsible for their actions are acquitted of the crime and committed to a psychiatric hospital, usually the PNA. At the moment, the PNA has 65 criminal patients and we are not, of course, a penal institution, she concluded.