Treatment of Bipolar Disorder by a Community Mental Health Service in a Rural Catchment Area in Greece: Treatment Engagement and Outcomes.

BACKGROUND: The course of bipolar disorder (BD) may be disabling on several occasions, whereas management of BD may be challenging due to poor treatment adherence and high service-disengagement rates. Such challenges in the treatment of BD may be even more relevant in rural settings. In rural Greece, treatment of mental disorders may be almost exclusively delivered by the interdisciplinary Mobile Mental Health Units (MMHUs). The objective of the study was to explore treatment of BD by a MMHU in a rural setting in Greece. METHODS: All medical records of BD patients that have been examined by the MMHU of Ioannina and Thesprotia (MMHU I-T) over a 17-year period (2007-2023) were assessed retrospectively. The studied outcomes were 1-year treatment engagement; treatment engagement at the study endpoint; and changes in hospitalizations and length of hospital stay in treatment-engaged patients. RESULTS: From a total of 62 examined patients, data was analyzed for 48 cases. The 1-year engagement rate was 81.3%, which dropped to 52.1% at the study endpoint, with a mean follow-up of 7.2 ± 4.0 years. Treatment-engaged patients were more likely to receive a mood stabilizer than disengaged patients. In treatment-engaged patients a significant reduction in total and voluntary hospitalizations was observed, whereas involuntary admissions remained unchanged. Length of hospital stay was significantly reduced after treatment engagement. CONCLUSIONS: The results of the study are in line with previous research in Greek rural settings. The impact of the care by MMHUs on involuntary admissions in BD patients warrants further study. Future research should be multi-centered, with prospective design, and should address additional outcomes.