What the inspectors recorded at Leros

825 patients, eight psychiatrists, one shower per 36 people

On its first periodic visit to Greece, the European Committee for the Prevention of Torture visited the Lepida and Lakki establishments and the hospital for children with special needs. The report was published at the request of the Greek authorities themselves.

At the visit there were 825 patients — 240 women, 585 men — against a nominal capacity of about 900. Many had lived there twenty to thirty years or more. The staff numbered 39 doctors of whom only 8 were psychiatrists, one psychologist, one physiotherapist and 155 nurses, of whom only about seven had three years' training.

The pavilions, the Committee wrote, "can fairly be described as miserable" and "may be likened to large sheds for human beings". Lepida XI held 200 people in four sections of 50, permanently confined to their beds in rooms with no heating whatsoever. One shower served 36 patients in Lepida VIII, 44 in Lakki IV.

What the Committee found — and what it did not. The wording is that it found conditions "akin to inhuman and degrading treatment". That is not a finding of inhuman and degrading treatment, and we do not upgrade it. Explicitly: "The delegation heard no allegations, and gathered no other evidence, of torture relating to the psychiatric institutions visited. Nor did it receive any allegations or other direct evidence of deliberate ill-treatment of other kinds." The Committee attributes the cause to a severe shortage of resources, not to intent. At Leros it observed no physical restraint of patients, although it did see leather straps for that purpose.

And a correction for anyone who has seen the material in circulation: the worst individual scenes in the report — the girl who had lived naked in a dark room for years — are not from Leros. They are from the Attica State Mental Hospital for children at Rafina. The two are widely confused.

[1] CPT, "Report to the Government of Greece on the visit carried out from 14 to 26 March 1993", CPT/Inf (94) 20, §§195–196, 202, 207, 226–233, 254, 278

Who went in, and what obstruction they met

The delegation included psychiatrists and clinicians of international standing. They were not journalists or campaigners: they were specialists whose own expertise qualified them to judge what they saw.

The report also records an obstruction: "the delegation gained the distinct impression that some of the persons working at the Leros psychiatric establishments had been discouraged by the authorities in charge from having any contact with the delegation" — which would breach Article 3 of the Convention.

At the same time the Committee notes "the good intentions and genuine efforts of the staff", and that the nursing staff of Lepida XI had carried out renovation and decoration work on their own initiative.

Conflict of interest of the source: the CPT is not an adversarial inspectorate. It operates on a treaty principle of co-operation and states itself that "the CPT's task is not to publicly criticise States". Its reports are confidential and are published only with the state's consent.

[1] CPT/Inf (94) 20, §§2, 8, 227, 279

Five psychiatrist posts. Two hundred and twenty-five guard posts.

What the institution was on paper, according to the decrees that established it:

By Royal Decree 119 of 10 February 1965 (Government Gazette A 30/1965), the "Leros Colony for the Mentally Ill" was renamed the "Leros Psychiatric Hospital" and its establishment set at 2,650 beds and 625 staff. It had begun with 650 beds in the late 1950s.

By Presidential Decree 620 of 23 June 1981 (Government Gazette A 157/1981), the establishment rose to 2,750 beds. The breakdown of the new posts says what kind of institution it was: 5 Director-Psychiatrist posts, 45 male nurses, 60 practical nurses, 135 cleaning staff — and 225 posts of Patient Guard. Forty-five guards for every psychiatrist director.

In 1987 the bed establishment was cut to 1,500.

And how the people got there: 2,569 patients in 33 group transfers between 26 July 1964 and 15 February 1975 — the largest single transfer 358 people. The admissions register records a total of 5,070 entries by 31 July 2009, across the institution's entire history.

What these numbers are and are not. The 2,650 and 2,750 are statutory bed establishment, not people present. The 5,070 are cumulative entries across decades, not a population. No single-date census was found — see Part X.

And the provenance, declared: the decrees are quoted from a 2009 historical account by two employees of the institution itself, republished by a Dodecanese social co-operative. The gazette issues themselves were not opened at the National Printing House; the decree numbers are given so that anyone can check them.

[60] Goutidis C., Georgiou A., "State Therapeutic Hospital of Leros", historical presentation, August 2009 — Royal Decree 119/10.02.1965 (Gov. Gazette A 30/25.02.1965) · Presidential Decree 620/23.06.1981 (Gov. Gazette A 157) · Gov. Gazette B 182/1987

One hundred and twenty million ECU — and the auditor who wrote that the inmates were fewer because of mortality

Before the CPT there was the EEC. By Council Regulation (EEC) 815/84 of 26 March 1984 the Council approved "exceptional financial support in favour of Greece in the social field": 120 million ECU over five years (Article 4), for vocational training centres in the large urban areas — Athens and Thessaloniki, in the recitals — and for the rehabilitation of people with mental illness and intellectual disability, that is, for the reform of the asylums; the Court of Auditors records that the sum was split equally between the two strands. The sum circulates as "the money for Leros". It was not: Leros was one of the institutions under the second strand, and that is what makes its balance sheet worth reading.

What the auditor found. The European Court of Auditors, in Special Report 5/90 (Official Journal C 331, 31 December 1990), recorded that by 31 December 1988 — the original closing date — 28 million ECU, 23% of the grant, had been paid. On Leros it writes that "the maximum number of patients reached 2 700", that "at the end of 1989 there were still 1 127 mentally ill persons on Leros", and that of the roughly 900 staff "half … are involved in supervisory or maintenance work" — "almost exclusively persons who have no professional qualifications and have been recruited on the spot". And the paragraph for which the report is cited here, 5.14: "From the general point of view of the treatment of patients, the situation has remained unchanged. The reduction in the number of patients interned which has taken place over the last few years is a result of mortality, and not of the introduction of new treatment methods." The conclusion, paragraph 6.5: "The case of the hospital at Leros brings all the risks and difficulties into focus" — inadequate preparation, confused execution, ineffective results.

The Commission's reply, in the same issue. The European Commission did not dispute the description: "The Court's description of the situation on Leros is correct." It added that in 1989 it had "decided to postpone indefinitely the approval of new psychiatric projects", laying down as a condition, among others, "a demonstrable improvement in the condition of patients on Leros", and that "responsibility for living conditions and medical treatment of all patients on Leros remains with the Greek Government". On Leros: "Although failure was encountered in the case of Leros, this was not true of the whole programme."

What happened next, according to the Commission itself. Regulation 4130/88 extended the period of support to 1991 and the deadline for the Commission's final report to 1995, "without affecting the overall amount of financial assistance"; completion, on 30 June 1995, came by Commission decisions. The Commission's final report, COM(95) 668 of 15 December 1995, records 115.3 million ECU committed and 90.6% absorbed, the cancellation of 76 projects that had not started by December 1990, a special two-year action for Leros from December 1990 with the exit of 110 patients to 11 hostels, and by June 1995: about 130 former patients in 14 hostels on the mainland, about 110 in 18 hostels and flats on the island, six cooperatives employing about 90 people, 148 severely disabled children in the former PIKPA ward — and 570 patients who remained inside. The same report writes that the large reduction of the previous decade was due "to a large extent" to the 1982 embargo on long-term admissions "combined with natural morbidity", half the patients being over 60. The Commission, citing the successive reports of its independent team of experts, wrote that "regression to the previous situation in Leros is inconceivable" — and that "the necessary adaptations to the administrative/legal context" were "imperative". Where the institution stood sixteen years later is told by the next two exhibits.

Two numbers that do not agree, and we print both. The Court of Auditors writes "a maximum of 2,700" patients; the Commission's report writes that by the mid-1970s the number "had reached 1,900". Not necessarily a contradiction — they may refer to different years — but neither document cites its source, which is why the peak figure stays in Part X.

[2] Regulation (EEC) 815/84, Article 4 · [79] Regulation (EEC) 4130/88 · [80] European Court of Auditors, Special Report 5/90, §§1.2, 2.3, 5.8–5.9, 5.14, 6.5, and the Commission's reply · [81] European Commission, COM(95) 668, pp. 5, 20, 23, 32–34

The target was to close Leros by 2015. It did not close.

Psychargos B set out expressly to abolish the psychiatric hospitals of Athens, Thessaloniki and Leros by 2015. By the Ministry of Health's own account, six of the nine public psychiatric hospitals were abolished and roughly 4,000 psychosocial rehabilitation places created. But Athens still has two hospitals, Thessaloniki remains, and Leros continues in a different legal form. The 2015 target was not met.

The target also ran head-on into the sovereign-debt crisis: the bailout capped public health spending at 6% of GDP and the public hospital budget was cut by more than a quarter between 2009 and 2011.

And it is not only the Ministry assessing itself. The "discontinuity in funding" and — in the document's own word — the "negligence in implementation" led to intervention by the European Commission and to the Spidla Pact between the Commission and the Greek government. Point three of that Pact: evaluation of the programme by a group of international independent experts. Their report was delivered in 2010; the experts are not named in the Ministry's document.

It acknowledged real progress — a large reduction in beds, the closure of asylums, a proliferation of community services. And it recorded, as the Ministry itself reproduces: planning that was "hasty and without forethought"; development "opportunistic, according to 'business initiatives' rather than real needs"; whole regions — the Peloponnese, Western Macedonia, the Greek islands — without even basic services; "an absence of quality-assurance control mechanisms and systems"; and inpatient wards overloaded with camp beds in the corridors.

[4] Greek Ministry of Health, "PSYCHARGOS C (2011–2020) — Revision plan", November 2011, sections A.1, A.3, A.4 (Spidla Pact) and A.5 (External evaluation)

What is on Leros today

The institution did not close. It operates as the State Therapeutic Hospital – General Hospital – Health Centre of Leros under the 2nd Health Region, and the Ministry of Health does not count it among the country's three remaining psychiatric hospitals — although its own clinicians still publish under the name "Psychiatric Hospital of Leros". The legal designation and the working name diverge.

A 2024 census in the journal Psychiatriki, by six authors of whom five belong to the institution's psychiatric department, reports 212 inpatients with a mean age of 62.4 years, 87 new admissions in the 35 years since the reform began, intellectual disability and psychotic-spectrum disorders at 40% each, and one person hospitalised continuously for 62 years.

Why the population is so old: under the Ministry's own plan, new admissions to Leros from outside the Dodecanese are prohibited, and those still there are now "mainly psychogeriatric cases". The 87 new admissions in 35 years are not incidental — they are policy.

There are also 11 supported-living apartments in settlements around the island, housing 46 residents, four to six per apartment. That is the reform that did happen — partly.

[5] State Therapeutic Hospital – General Hospital – Health Centre of Leros, official site · 2nd Health Region of Piraeus and the Aegean · [6] 2024 census, Psychiatriki