A mentally ill man attacked a woman, an employee of a hotel in Craiova, the other day. The attacker did not know the victim, and the assault was committed without a specific reason. The man had recently been discharged from the hospital on his sister’s signature. The attack comes just a few days after another, which ended tragically. Last week, a 20-year-old woman from Bacău was killed by a neighbor, who stabbed her. And in this case, the aggressor had been discharged from psychiatry on his grandmother’s signature. “Adevărul” reporters spoke with several specialists in the field who commented on the situation of mentally ill people, found the “culprits”, but also the solutions to the problem.
In Romania, there is no service for tracking the evolution of the disease and adherence to treatment. Archive
Mentally ill people can only be hospitalized with their consent, just like any other patient in Romania. With one exception, explains psychologist Ovidiu Telegescu. “If the mentally ill patient has a crisis, relatives, friends, relatives can admit him without his consent to a specialized center.” In this case, we are talking about an emergency admission. “For example, the relatives of such a patient, sick and recalcitrant, call 112. The police move to the scene and, if they cannot communicate with the person in question, the crew can admit them against their will to the psychiatric hospital, in a ward of psychiatry, clinic, etc. But after he calms down, after he is given treatment, the doctors can let him go. If the man has overcome the crisis, there is no longer any reason for him to stay in the hospital. This can happen after a day, two, three, it depends. And the patient returns home”also declared Cosmin Andreica, the president of the Europol union.
Emergency hospitalization of such a patient can also be done at the request of other entities. Dr. Alina Violeta Ungureanu, the manager of the Săpoca Psychiatric and Safety Hospital, stated that there is a certain procedure for involuntary hospitalization. “When it is a psychiatric emergency, that is, the patient represents an imminent danger to himself or to other people, he does not have the capacity to understand the need for treatment, nor does he have relatives or legal representatives. The request for involuntary hospitalization can be made by the psychiatrist, by the representatives of the local public administration, the police, the gendarmerie, the firemen, as well as by the prosecutor. Likewise, the civil court, whenever it assesses that the state of mental health of a person undergoing trial could require involuntary hospitalization, may request his hospitalization”. shows Ungureanu.
A patient with mental problems is generally taken into the records of the family doctor and a specialist doctor. Apart from the relatives, the latter is the only one in a position to decide whether the patient should be hospitalized. But, in the hospital, once he arrives, he doesn’t stay long. “It wasn’t like that before. There were rehabilitation, recovery centers where these people were admitted long-term. Sometimes even with years. But, nevertheless, let’s not deny the abuses that took place in those centers, because they existed and they were not few at all”. psychologist Ovidiu Telegescu claims.
As for discharge, there are also a few steps to follow. The patient is not released from the hospital until the doctor has decided that his condition has improved. “Depending on the evolution of the patient’s condition, the attending physician sets the date of discharge, in agreement with the patient and his family. The discharge will be carried out when the patient is improved in terms of symptoms”says Dr. Violeta Ungureanu.
However, the patient can be discharged without the doctor’s approval. “The attending physician discharges the patient upon request, if the criteria for involuntary admission are not met.” But there are situations when the doctor does not give his consent, and the patient goes to court. Dr. Bogdan Rusu, a psychiatrist at the Pucioasa city hospital, Dâmbovița county, explained to “Adevărul” that the discharge of a mentally ill patient should only be decided by specialists. But, on the other hand, the situation is very delicate because “we are talking about human rights and freedoms. Although the decision should be purely medical, it raises the issue of human rights that must be respected. We’re talking about a deprivation of liberty, though.” says the doctor.
The system, underfunded and full of hiccups
Dr. Bogdan Rusu draws attention to the fact that the mental health system is underfunded, and the lack of money comes with sometimes serious consequences. “Psychiatry is not the kind of specialty that we can necessarily assimilate with another disease. Here we don’t have a condition that lasts a certain number of days after which you are discharged. But, even so, with us there is a length of hospitalization. Abroad, for example, there are situations when mentally ill patients are kept in hospital for longer periods of time”.
Another consequence of underfunding is the lack of beds in hospitals, but also of doctors, nurses and auxiliary staff. “There are situations where there are places blocked by patients who cannot be discharged because they represent social cases”. Then, there is a lack of inter-institutional communication, cooperation between state institutions. “Everyone has their own order, they work according to a certain law, and somewhere in this safety net there are large meshes”, says Dr. Rusu.
He explained that the law is lame. “It was originally well thought out, but the reality has changed. For example: in the Mental Health law there is a chapter related to the transport of the patient from home to hospital. It says there that the patient is transported by ambulance and accompanied by a police crew who records in the admission application how the patient behaved during the transport. In practice, however, the police do not deal with such things anymore. They just accompany the ambulance. I come, as it were, behind her. Moreover, even the relatives are not allowed to accompany the sick person in Salvare. Practically, although the law says one thing, in reality it happens completely differently. The patient is in the ambulance only with the medical assistant”. The law should be rethought in such a way that it fits the reality of today.
The solution: the establishment of community psychiatric centers
The doctor Bogdan Rusu raises a big alarm signal: the patient’s family, the relatives who discharge him on the signature should even assume that signature, that declaration on their own responsibility. “People really should take it on. Let them be explained very clearly what this assumption means. I’ll give you an example: discharge someone on the signature. The man, however, falls on the street and dies. But the criminal file is opened in the name of the doctor, going on the idea that he could have prevented the discharge, however. Nobody answers us. We disclaim absolutely everything without actually assuming it. If I, a doctor, discharged a patient and then something happens to him, I assume it. It’s my fault. And I suffer the consequences. When it’s the family’s fault, who supports them?”, asks the doctor.
Dr. Rusu believes that such tragedies as those of the last few days could be prevented by establishing community psychiatric services, as they exist in other states. “Let’s say you have a patient admitted to the hospital, you treat him, then you discharge him. His condition is much improved. However, if the condition he suffers from requires outpatient treatment, careful monitoring of this patient is needed. There should be so-called mobile teams to visit him frequently and monitor his situation. At least once a week. And psychiatrists do not necessarily have to be part of these teams. There may be various other health professionals who have previously taken a course, been trained in this, know what to look out for. For example, during a home visit you can see pills left in a bottle or sealed bottles, etc. These mobile teams have to talk to the patient, check their health, watch for certain signals that something is wrong with them and report them.” said the doctor.
In reality, in our country, things are completely and completely different. “And the psychiatric patient, and the cardiology patient, and the diabetes patient, consider themselves to be getting the prescription, buying their treatment, and self-administering it. But things are not always like this”. Once discharged, the patient returns to the family, but, says doctor Bogdan Rusu, the families of these people don’t worry too much either. “Hospitals discharge them, but they should come back for control. Let’s say after 30 days…but during this period no one monitors them”.
The idea is reinforced by the psychologist Radu Leca. He is of the opinion that we need a law by which mentally ill patients are taken into account by social workers. “The social worker should see a certain number of patients each week. To keep them in mind, to monitor them. Then all these people should be entered into a database, let’s know about their existence, about the disease they suffer from and its evolution. We know that there are specialized centers for such patients, but they are very few. Maybe there should be more,” the psychologist believes.
