ATHENS — Greece’s decade-long economic crisis has taken a heavy toll: Hundreds of thousands of jobs were lost, incomes were slashed and taxes were raised. Hopes for the future were dashed.
For Anna, 68, the crisis had particularly devastating consequences. Her husband, a retired bus driver, killed himself in a park two years ago at age 66 after a series of pension cuts deepened his despair.
“He kept saying, ‘I’ve worked so many years. What will I have to show for it? How are we going to live?’” said Anna, who asked that her full name not be published to protect her family’s privacy. After two years of therapy, she now volunteers to help others struggling with mental health issues.
Depression and suicide rates rose alarmingly during the Greek debt crisis, health experts and studies say, as the country’s creditors imposed strict austerity measures that cut wages, increased taxes and undermined the ability of health services to respond to a crisis within a crisis.
“Mental health has deteriorated significantly in Greece, with depression being particularly widespread, as a result of the economic crisis,” Dunja Mijatovic, the Council of Europe’s commissioner for human rights, said in a November report. That has led to overcrowding at psychiatric hospitals and clinics and a 40 percent increase in suicides from 2010 to 2015, the report said.
For those fighting the problems on the ground, the trend does not seem to be abating. The mental health organization Klimaka reported a 30 percent rise in calls to its suicide hotline last year, and a comparable rise in visits to its day center.
“The financial crisis has increased people’s vulnerability to suicide,” said Kyriakos Katsadoros, Klimaka’s director. “Some even ask about euthanasia.”
Suicide rates in Greece remain relatively low for Europe, with five suicides per 100,000 people compared with a regionwide average of 15.4, according to World Health Organization data for 2016, the most recent available. The rate of increase is high, however. It spiked from 3.3 per 100,000 to 5 between 2010 to 2016.
The highest annual increase came in 2015, the year strikes and social upheaval reached a climax as Greece’s leftist-led government wrangled with the country’s international creditors over the terms of a third bailout.
The suicide rate then dropped in 2016 and 2017, police figures show, only to rise again in the first 10 months of 2018, according to police figures that also show that suicides among those ages 22 and under more than doubled.
Many suicides in Greece go unreported because of the Orthodox Church’s reluctance to provide burial services to those who take their own lives, although the church’s stance is changing, nongovernmental organizations say.
The Greek Health Ministry set up a committee of mental health experts in November to prepare awareness campaigns, as well as plans to train general practitioners to better detect depression and other mental health issues. In the meantime, the health system’s struggles to address the problem are evident.
At Evangelismos, one of the capital’s largest state hospitals, dozens of patients were being treated in the corridors of the psychiatric ward during a visit in April, “an unacceptable situation,” the Council of Europe’s anti-torture committee said in a report published in June.
In the summer, the hospital’s workers’ union complained to a prosecutor that the clinic was accommodating twice the maximum capacity, with foldout beds set up in corridors and in doctors’ offices.
“It’s like a stable,” said Dr. Ilias Sioras, president of the union, adding that people in all states — “catatonic and psychotic” — were being treated in the same space.
Dromokaiteio Psychiatric Hospital in Athens is also overcrowded, with admissions up 12.3 percent in 2017 and staff members regularly staging strikes denouncing the conditions. And at Dafni, the Attica Psychiatric Hospital, which takes only very serious cases, “the impact of the economic crisis is reflected in the admissions,” said the director, Spiridoula Kalantzi, citing a 9.6 percent increase in 2017.
The Council of Europe report noted that “unemployed persons, bankrupt businessmen, or parents who have no means of taking care of or feeding their children” were among new admissions to psychiatric units, most age 40 and older with no previous signs of mental illness.
The Health Ministry ran a pilot program at hospitals in Athens last year aimed at ensuring all areas of the capital have at least one psychiatric hospital or clinic operating as a walk-in center at any given time, helping admissions to “stabilize” at Dafni and Dromokaiteio last year. Three new clinics opened in Greek hospitals in 2018, the ministry said, and there are plans for 16 more.
In the meantime, much of the burden falls to Greece’s three main psychiatric hospitals — Dafni, Dromokaiteio, and the Psychiatric Hospital of Thessaloniki — which in addition to providing health care fills the void left by cuts to social services.
“Apart from the psychiatric cases, we have social cases, too,” said Dr. Nektarios Drakonakis of Dafni. “People come, they say, ‘I don’t have a home, I don’t have papers, I don’t have relatives, I don’t have anywhere to go.’”
A 2016 law providing free access to health care for uninsured patients has been an invaluable safety net, said Ms. Kalantzi, the Dafni director.
“When the delirium begins, many lose control of their finances, and then lose their insurance,” she said.
But the spike in demand for psychological and psychiatric help coincided with dwindling staff levels and slashed budgets. Annual state spending on mental health was halved over 2011 and 2012, and it has been trimmed further each year since then. Austerity measures required hiring freezes, even as hundreds of workers retired.
“I’m on my own, I don’t have anyone under me to help me,” said Dr. Christos Tsopelas at Dafni, adding that two doctors typically treat 35 to 40 patients, and that there was a severe shortage of nurses.
A nurse at a halfway house died during a night shift recently, and 12 patients were alone until the morning, he said.
Volunteers like Anna do their best to fill the gaps. Theodoros Megaloeconomou, a psychiatrist and former clinic director at Dafni, works at two centers in Athens, helping all sorts of people, many unemployed or in debt.
“Many just come for the medication,” he said, noting that use of antidepressants had doubled since before the crisis.
Even if the Greek government manages to address weaknesses in the health care system, health experts note that the main reasons behind the mental health crisis are very much alive.
“As long as there is unemployment, insecurity and debt, the products of the financial crisis, this problem will not go away,” said Dr. Sioras, the union leader. “I fear it will get worse.”