Greece is a gateway to the EU for refugees and asylum seekers coming from the Middle East region, Asia, and Africa. It also holds the fourth place among all EU countries in terms of the number of first-time asylum seekers it has received (Eurostat, 2021). According to data from the UN High Commissioner for Refugees, 120.000 refugees and asylum seekers are hosted in our country today. And although the effective management of refugee inflows constitutes an issue of critical importance for the European Union (EU) and a top priority on the political agenda of the member states, it is at the same time the most controversial issue for the majority of the Greek citizens (70%).
As a result of a host of factors, refugees and asylum seekers in Greece have very problematic access to healthcare, mental healthcare, and social welfare services, although they constitute a population with the greatest collective mental health trauma. In their vast majority, they have experienced warcrafts, torturing, separation from, and loss of their loved ones, violence, various forms of exploitation and living in precarious conditions in the host country. The most frequently recorded psychiatric issues that they face are depression and post-traumatic stress disorder (PTSD), associated with organized crime, tortures, abolition of human rights, resettlement, and traumatic migration (Langlois et al., 2016).
The “Community Based Intervention for Mental Health Care of Asylum-seekers and Refugees in Greece” program has been implemented since 2019 by the Association for Regional Development and Mental Health (EPAPSY) in collaboration with the United Nations High Commissioner for Refugees (UNHCR), and it focuses on 3 innovative domains:
- Community Psychosocial Workforce in the Attica Region
- Samos Peer Support project
- Psychosocial Support Helpline of Pan-Hellenic reach
It is the first time in Greece that the traditional practices of psychosocial support provision by mental healthcare professionals have not been followed but replaced instead by the active inclusion of members of the refugee communities in every step of the psychosocial intervention. The unique innovation of this intervention lies on the provision of mental health support services by refugees/asylum seekers to other refugees/asylum seekers, under the training and supervision of experienced professionals.
The team of Community Psychosocial Support Workers (CPW’s) consists of 12 refugees/asylum seekers, who have been trained in the use of psychosocial intervention tools and offer their services to their adult peers in their native language (Farsi, Arabic, French, Urdu, Lingala, Ukrainian/Russian and English ). This way, they form a type of a bridge between the refugee communities and the professional/institutional mental health care provision. The role of the CPWs is to conduct an initial assessment of the problems faced by the refugee community, determine the needs, provide emotional support through active and empathetic listening, provide training in coping strategies for everyday problems, refer the incidents to and liaise with specialized support centers and assist in the empowerment and social inclusion of their peers.
The pilot Samos Peer Support project consists of a team of fieldworkers who train teenagers and young adults who reside in the refugee camps in basic mental healthcare skills, so that they later become mentors to their younger peers. After the training, all participants are able to act as facilitators of self-help groups in their community. The project aims to strengthen the mental resilience of the participants through the exchange of shared lived experiences, and the offering and receiving of support with the means that the community already possesses.
The PSS Helpline was called upon to compensate for the reduced accessibility of the vulnerable refugee population to the available healthcare services during the Covid-19 pandemic. Under the constant guidance of mental healthcare professionals (psychologists, social workers) and clinical supervisors, the CPWs provided during the lockdown valuable services, answering practical questions, providing direct emotional support, assessing callers’ needs and redirecting them to the appropriate support services of the community.
Documentation of the results and benefits of the program
Number of beneficiaries
A total of 763 people, 338 men (45%) and 425 women (55%) have benefited from the CPW program, while 1948 people, 1164 men (60%) and 785 women (40%) have received significant help from the Psychosocial Support Helpline. Their ages ranged from 18 to 90 years, with an average age of 35 years. The countries of origin of the refugees/asylum seekers were mainly Afghanistan (35%), Syria 19%, Iran 14%, Iraq (14%) and the Democratic Republic of Congo (13%). From April 2022, the program also welcomes refugee populations from Ukraine.
The results of the clinical evaluation that was conducted with the administration of specifically designed questionnaires to program participants, before and after the intervention, indicate an average reduction of 7.5 points in the anxiety levels of the target population (scale 1 to 21) and a reduction of 7 points in the depression levels (scale 0 to 27) of the program participants.
According to the program evaluation that the UN High Commission conducted through focus groups of program participants who displayed a high degree of vulnerability, it was reported that the sharing of problems with people with similar lived experiences, strengthens one’s emotional resilience and creates hope for the future. Moreover, the emotional bond that is formed between the CPWs and the beneficiaries creates a “family” feeling that increases trust and security, helping the beneficiaries to respond more effectively to the daily challenges they face.
According to their personal testimonials:
«It helps me… It has a good effect on me… I need to have someone to talk to these days. Now, there is hope! /…/ S. (CPW) is by our side, talks to us. I can share my problems. S. shows me the way to solve the problems that I face» (Woman, 32 y.o., Afghanistan)
“ CPWs are helping angels. /…/ Just like my older siblings, my family, there is someone to show me the way, someone to talk to, someone to hold my hand and walk along…» (Woman, 40 y.o., Afghanistan)
«I had a constant headache. I haw taking a lot of drugs. Ever since I talk to J. (CPW) my stress level has decreased. I haven’t taken a single pill a longtime now» (Woman, 50 y.o., Afghanistan)
«I was in despair! I was thinking of harming myself. I wanted this all to end. But when I called, I started to relax little by little. My CPW gave me the courage to go on! » (Man, 33 y.o., Syria)
The CPW program in Greece was distinguished as a “Model of Implementation and Innovation” by the United Nations High Commissioner for Refugees, who decided to adopt this methodological approach in all psychosocial interventions in the refugee communities in the future. Its documented success led to the expansion of the program in the Ukrainian refugee population in Athens and Thessaloniki. In September 2021, members of the American Congress visited the program’s premises in Greece, considering it as an example of innovation and excellence in its domain.