Challenges in the early detection of patients with psychotic spectrum disorder or bipolar disorder in rural Grete/Greece: The role of the mobile mental health unit

Background: Early detection and intervention are considered important determinants of long-term outcomes of severe mental disorders. Preliminary evidence has shown that in Crete/Greece in rural areas there is a significant delay in seeking mental health care for patients with psychosis or bipolar disorder. Aims/objectives: The primary aim of this study is to examine: the mean age and percentage of involuntary admissions of patients with psychotic spectrum or bipolar disorder at first admission/visit; and whether these associations were affected over the 10 years of the mobile mental health unit (MMHU) operation (2013–2023). A secondary objective is to analyze demographic and clinical differences between younger and older patients at first admission/visit. Methods: Participants were adults >15 years, diagnosed with psychotic spectrum disorder or bipolar disorder, living within a well-defined catchment-area in Crete/Greece. We compared age of first admission/visit for psychotic or bipolar patients at three time points, specifically years 2013, 2018, and 2023 and differences of patients’ demographic and clinical characteristics based on age of first admission/visit. Results: The average age of first admission/visit for patients with psychotic spectrum disorders ranges from 39.7 to 43.1, while the average age range for those with bipolar disorder is approximately 40.7 to 45.97 years. Notably, there was no reduction of the age of first admission/visit over the ten years of the MMHU operation (2013–2023), whereas there was a high percentage of involuntary admissions. Finally, patients who are single, abuse drugs, and have a higher education are more prone to seek psychiatric help earlier. Conclusions: In rural Crete/Greece the average age of seeking mental care for both disorders was and remains markedly high. The lack of consistent and reliable mental health services coupled with the fear of stigma and cultural characteristics of Greek families and small rural towns, discourages individuals seeking mental health care early.