A Dive into the Romanian Mental Health System: What lies behind some horrors

5 Jan 2010

By Emilia Chiscop

A new disease is threatening Europe. Cancers, cardiovascular disorders or diabetes no longer seem so dreadful. Progress in medicine offers more chances for an early diagnosis, treatment and healing of these diseases that used to have a top position in mortality classifications. The disease of the modern man attacks the mind and soul. It is called depression. Its name sounds so commonplace that its seriousness is sometimes scoffed at. Yet, it affects 13% of Europeans and its prevalence is escalating. Depression is one of the important causes of suicide, and the number of those who put an end to their lives rose to57,000 people in Europe in 2006. In the light of these worrying statistics, the European Union and the World Health Organisation are calling governments to take a joint action to prevent depression and suicide. The Romanian authorities have, however, turned a deaf ear to this call, as mental health is still left out of the public agenda.

Romania is one of the states that lacks a national strategic plan for preventing depression. On the map of the states that do research aimed at assessing the mental health condition of the population, Romania is a "white spot". We hold the last position in Europe concerning public access to homecare services and hold instead the first position regarding access to psychiatric hospitals. This top position is the expression of the fact that diagnosis is belatedly performed, i.e. during seizures, which call for hospitalisation. It is the expression of a lack of prevention and supervision of patients already diagnosed, as well as of a high level of stigmatisation and discrimination. Psychiatric sufferance is an insuperable taboo. In its turn, the mental health system is the victim of such stigmatisation as it is neglected when granting state funds and is marginalised within the Romanian public health system as a whole. Figures shown by the WHO place Romania on the third to last place in Europe concerning the budget allocated to mental health. Romania is one of the very few European countries where the non-governmental sector is almost nonexistent in the field of mental health services. All these negative records were presented by WHO representatives Matt Muijen and Marc Danzon at the European Conference on "Prevention of Depression and Suicide", held in Budapest and attended by European health ministers and mental health experts. Romania was not represented by any Ministry official, only by Dr. Ileana Botezat Antonescu, manager of the National Centre of Mental Health, an institution which coordinates reformation of mental health only at a theoretical level, yet lacking authority and decision-making instruments at the level of concrete action.

Being a poor country, we cannot hope to have the best-performing mental healthcare systems of Europe, but we must acknowledge that beside other much developed states we also find, in this performance classification, two South-East and Central European countries: Slovenia (second place in Europe) and Slovakia (third place). The best-performing mental health system is the Swedish one, while the fourth and fifth places are taken by Belgium and Denmark, according to the data provided by André Joubert, Expert Platform on Depression, Denmark.

"Every year, 63,000 people from the 27 EU states die by committing suicide, which, in ten years, amounts to 630,000 people, that is more than the population of Lisbon or Copenhagen", underscored Zoltan Rihmer, psychiatry professor at the Faculty of Medicine in Budapest, and Danuta Wasserman from the Swedish National Institute for Psychiatry and Suicide Research, director of the National Programme for Mental Health and Prevention of Suicide. It must be noted that on the European map of mortality caused by suicide, Sweden holds a similar position as Romania, with a rate situated between 10-12 deaths per one hundred thousand people. The Swedish government has announced, as early as last year, the "Suicide -zero" policy. National information campaigns have been carried out here about the link between bank debts and mental health risks, and state institutions were set up in order to provide support for debtors. School curricula have introduced courses about mental health and prevention of violence, when it was found that the age at which the first symptoms of depression manifest is during adolescence.

Of course, the example of these good practices is followed in other countries. Twelve European states are developing national programs for the prevention of depression and suicide, and in three of them (Sweden, Lithuania and the Netherlands) national programs were approved by the Parliament as well, which means more legitimacy, more money and more instruments for their implementation. It is true, most of those 12 states are rich ones, whereas Romania cannot afford the whim of investing money in depression prevention when so many issues require urgent action - some will say. However, in Bulgaria, a country where the mortality rate caused by suicide is lower than in Romania, the government undertook a national prevention programme. All this shows that vision and political will are more important than the scarcity of resources. Thanks to strategic thinking and political will, the English government managed, through consistent measures, to reduce the suicide rate by 20% in ten years (1995-2005) – from 9.2 to 7.9 cases per one hundred thousand people - and the figures were lower in 1995 than in present-day Romania. This estimate was made by David Appleby, National Coordinator for Mental Health, England. What we've got here is a difference in attitude: while in Romania the lack of will hides behind the claim that mental health is a luxury in the context of the rampant economic crisis, in Great Britain the approach is the other way round: in times of economic crisis, mental health must enjoy increased attention just because this is the way in which huge costs might be reduced. The British have reached the conclusion that they can save up to 8 billion pounds per year if mental health at the workplace were better managed. It was calculated that in 2001, for instance, 176 million working days were lost due to stress, anxiety and depression. Losses caused by failure to go to work by employees with mental health problems in 2002-2003 amounted to 4 billion pounds.

The current crisis called for new action plans, starting from the idea that unemployment and debts, i.e. direct effects of the crisis, have health implications. Research shows that unemployed people represent a double or even triple suicide risk compared to those who have a job, and the suicide risk rises by up to 70% among people with minor health problems who are excluded from the labour market. Therefore, the British government considers it a priority for employers to accept workers with mental health problems, to change attitudes and tone down stigma. None of these aspects is a priority or even a concern for the Romanian authorities despite the fact that in Romania unemployment - a risk factor of suicide – is above the European average among young people: in the EU, 15.4% of people under 25 are jobless, compared to 18% in Romania.

When asked about when the Romanian authorities will turn their attention to mental health issues, Ileana Botezat Antonescu, manager of the National Centre of Mental Health, is unable give an answer. So far, the only considerable action by the Romanian government regarding mental health reform was taken under EU pressure during the pre-accession period, after the Romanian press gave accounts in 2006 about patients treated in inhuman conditions in Poiana Mare psychiatric establishment, where several suspect deaths were reported. Also in 2006, a new mental health reform strategy was voted on. Yet, nothing has been done since then. Coincidence or not, the mental health section on the web page of the Ministry of Health has not been updated since that same year, 2006.

The World Health Organisation and the European Commission insist on assuming political responsibility. The imperative launched at the Budapest conference is based on worrying figures: in a classification of the most widespread diseases, neuro-psychiatric disorders hold the second place, with a percentage of 19.3%, being surpassed only by cardiovascular diseases (22.9%). But how many know that psychiatric disorders are more widespread than malignant neoplasm, i.e. cancer (11%)? Therefore, the European Union has launched the European Pact for Mental Health, inviting governments to make this field a priority of the health policies. Under this pact, it is expected that the new Romanian government should undertake a mental health national programme relying on a cross-sectoral approach and starting from a study of the mental health state of the population. This would be a first step taken with a view to driving Romania out of the white spots' zone and the negative statistics.

Copyright 2010. Used with permission from Emilia Chiscop.