In order to better understand the gravity of the tragedy in Sibiu, where a young woman was killed by her boyfriend with mental problems, psychologist Radu Leca explained the risks we expose ourselves to when we are in the company of a person with mental illness who does not treat
No patient can be hospitalized without his consent. Source: archive
They look just like us, talk just like us and act as normal as possible. You can see them on the street, behind the wheel of the car, in traffic, you can meet them on vacation or even at work. I don't stand out. At first glance, they seem like healthy, responsible people you can trust. In reality, however, there are people with mental problems, many of them dangerous and who at any moment could put our lives in danger. And this happens because, instead of being hospitalized in specialized clinics or forced to take drug treatment, they are left free on the street.
A 24-year-old man from Sibiu killed his girlfriend in an apartment in the city. A deep wound in the neck area was fatal to the woman. Vasile Ștefan, who had been discharged from the psychiatric hospital last year, fled the scene of the crime but was caught by the police a few days later. His testimony is shocking: he killed Florentina out of jealousy and after administering a cocktail of drugs. Everything, against the background of older mental problems that his relatives, friends and girlfriend knew about. The latter, who decided to stay by his side to help him overcome psychosis and depressive episodes, paid with her life.
The law protects the patient's right, but not our life
No one could prevent the tragedy. Why? The law is clear: no person can be hospitalized without their consent. And the mentally ill are no exception. Basically, we want to, we don't want to, we are forced to accept him among us. With one exception. “If the respective patient has a crisis, the relatives, friends, relatives can admit him without his consent in a specialized center”, psychologist Ovidiu Telegescu explained for “Adevărul”. “It is 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”, said Cosmin Andreica, 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, 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 family doctor, the psychiatrist, 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.
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. Discharge will be carried out when the patient is improved in terms of symptoms. He can be discharged at his request or that of his family against medical advice. The attending physician discharges the patient upon request, if the criteria for involuntary admission are not met. Mental illness is unpredictable, improvement in symptoms is determined by adherence to treatment. Upon discharge, the patient receives, in addition to the prescription, a medical letter for the continuation of drug treatment”.
But these patients, many of them, do not continue the treatment at home. They are not required to do so. And the consequences can be among the most serious. They become aggressive, violent, and this could endanger our lives. Even so, they are set free, only under the responsibility of their families. And that's because of the loopholes in the system, the loopholes, the legislative gap. Due to the fact that in Romania there are very few psychiatrists, very few nurses working in such specialized clinics. The number of beds is also low, while the psychiatric wards of hospitals are full. Moreover, those hospital dormitories that once existed have disappeared. “He does not stay in the hospital for more than a month. Patients are sent home for treatment. The medication is administered on an outpatient basis. And the problem arises when these people do not follow the prescribed treatment, the recommended doses, they do not return for evaluation”, continues the psychologist Ovidiu Telegescu.
In order to better understand the seriousness of the situation, psychologist Radu Leca explained to us the risks we expose ourselves to when we are in the company of a schizophrenic person who, although he needs it, does not give his consent to be hospitalized. The specialist says that when he has a fit, this person can become a real weapon himself. “A 60-pound schizoid person who gets angry, who loses his temper, can knock down eight massive men, about two meters and 120-140 kg each. Popularly speaking, it is the power of the madman. He has a power and strength, out of the ordinary. What's more, a schizophrenic patient in a manic episode, in a psychotic episode and who is out of control can put his hand through you and get out of you with any organ you have.” shows the psychologist.
A patient with mental problems is generally taken into the records of the family doctor and a specialist doctor. Apart from relatives, the latter is the only one in a position to decide whether the patient should be hospitalized. But, beware! It's a long way from having to to being admitted. And 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 still, let's not deny the abuses that took place in those centers, because they existed and were not few at all“, claims Ovidiu Telegescu. Today, the mentally ill is treated quickly in the hospital and sent back home. And here, often, no one is waiting for him. Or no one takes care of him. And what happens is a natural consequence of neglect: the patient becomes a real danger to those around him.
According to statistics, there are currently almost 800,000 mentally ill people who we can walk past without suspecting anything. But, beyond their polite smile, their benevolent intentions, a future criminal may be hiding.
According to a UNICEF study, 22,000 children and adolescents are living with a diagnosis of mental illness, but the real figure may be much higher due to underreporting. Most disorders begin in childhood, adolescence or young adulthood. Moreover, due to stigma and poor education on the subject, many of the sick remain undiagnosed, according to the report of the Economic and Social Council. A problem pointed out in this report is that in Romania there is an average of 12 psychiatrists per hundred thousand inhabitants, the European one being 17.
Solutions
Radu Leca is of the opinion that we need a law by which these people are taken into the records of social workers. “The social worker should see a certain number of schizophrenic 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 schizoid people, but they are very few. Maybe there should be more.” Last but not least, says the psychologist, Romanians need campaigns to raise awareness of the dangers of schizophrenia and other types of illnesses that produce anger and aggression. Cosmin Andreica, the president of the Europol union, also spoke to us about taking these people into account. “Until 2000-2001, there were records but also inter-institutional communication. Every policeman knew within his reach what mentally ill people he had. That helped him to intervene, to know how to do it. The policeman knew what the person in question reacted to: to alcohol, to the uniform, to being taken with beauty, to a firmer action, that is, he adapted his mode of action according to the patient's history. However, from 2012 until now there has been no communication in this regard”.
A person suffering from a serious mental illness needs support from the family. “If the family does not get involved, it can lead to real tragedies. Like the one from Sibiu, for example. The authorities place the responsibility on the shoulders of the family. But, most of the time, the relatives can't cope”, the psychologist Ovidiu Telegescu also specified.
But, he also states, the family often chooses to hide the problem. “Either they think that these crises will pass by themselves, or they try not to stigmatize the person in question because a diagnosis of this kind can exclude them from society. This attitude is also fueled by the fact that the patient, at least at the beginning of the disease, can hide the symptoms, can disguise a normal behavior, which deceives us.
Population health education is another solution that could solve, over time, the problem of these people with mental illnesses. “Romanians must be educated, made responsible. Let's not forget that the sick return to their families and they ignore their needs. Many times I don't understand them, I don't know what to do, they are afraid. people need to know the risks that these serious mental illnesses involve, to know that it's okay to do something like that”. Ovidiu Telegescu is of the opinion that if we do not start an education in this regard as soon as possible, we will face the same big problem in 30 years. Or maybe even worse.
The bottom line? People with serious mental illnesses are passed around by the authorities like a ping-pong ball between their own families and hospitals. A continuous coming and going without any resolution. Because neither some nor others manage to face the situation. Because neither some nor others manage to cope with the situation, and the sick end up, sooner or later, among us again.
