The scandal at the Placement Center in Slobozia, Ialomița County, where three children were found with string in their hands, is far from over. The police have already opened three criminal files for committing the offenses of bad treatments applied to the minor, misappropriation and abuse in service. Investigators are now trying to find out the reasons behind these abusive practices. Two psychiatric doctors explained for the “truth” that the immobilization of a mentally ill patient is a medical procedure provided in the mental health law and has nothing to do with the abuses that took place in the center of Slobozia.
Hospitals of mental illness are experiencing underfunding and lack of staff. Archive
Mechanical content is a medical practice that is used only in exceptional, maximum emergency and is applied according to certain very clear provisions, explained for “Adevărul” Dr. Claudiu Florian, a pediatric psychiatrist within the “Alexandru Obregia” Hospital in the Capital.
“Mechanical content applies under medical supervision”
Mechanical content is the last solution that can be used to protect health, body integrity or even the patient’s life, the doctor explained.
“But even then, a protocol must be respected. In the case of children, for example, the mechanical content is made in 15 minutes. Specifically, the patient is immobilized for a quarter of an hour, after which it is re -evaluated. If the doctor considers that the condition of the child has not improved, the procedure is resumed. However, during this time, the patient is constantly monitored. The doctor or the assistant stands next to him, and periodically he takes the pulse, tension, temperature, we make sure that everything is in parameters ”, also stated Dr Claudiu Florian.
“If the situation requires it, the patient can also receive a proper medication to help him calm down. But, so, this method is the last instance, if the patient’s condition is not remedied with any other intervention ”.
This is how things are presented in a hospital, where the mentally ill child is most often accompanied by parents or tutors. What happens in the placement centers, in the family -type boxes, where the little one has neither mother nor father? It is sometimes subject to abuse difficult to imagine. “There are many situations when children suffering from certain mental problems become very impulsive, they do not have a very clear concept of consequences, they can get harm or harm others. But, from respecting a protocol regulated by the law of mental health to abuse,” the doctor considers.
“To bind the patient with string is an abuse”
The law of mental health regulates this practice for both adults and children. This is also the reason why the employees of the horror asylums say, usually, that they did not fail, they have no fault, they respected the law and the protocol. “However, we talk about a last -year -old practice, it is not used only if it is necessarily, for very short periods of time and when all the other variants are exhausted. Usually, the management of such crisis situations is done first trying with the patient, the relationship with him, we discuss, we talk to the conversations.”
There are also cases in which the patient in the middle of a crisis of anger is detached from the reality around him, cannot be communicated with him, does not react to dialogue, is aggressive with others or resort to self -help behaviors. “Then and only then the doctor appeals to physical content and, possibly, to the administration of emergency medication. But we are not talking here about the bed tie, as is the case with an abuse. Because there are rules here, a whole procedure. Certain regulated tools are also used. You cannot use anything that falls in your hand … soles or things like this. In such situations, we are talking about abuse and I hope we will never meet such cases. ”
This drastic measure, especially if applied to children, produces, most of the times, indignation. “But what people need to know is that it applies when nothing else works and can be life savior. It seems an aggressive procedure against the patient, but it is not. On the contrary. It protects it, calms it. The patient who is in the middle of a crisis is not very aware of what is happening around him, nor his own actions. He’s not aware of the things he does. In a moment of anger he loses a little contact with the immediate reality. He does not realize that he is put in a situation of danger. ”
Specialist: “The ones from the center were totally overcome by the situation”
Psychiatrist Adrian Horga, the medical director of the Psychiatry Hospital in Ștei, Bihor County, treats adults.
The specialist told us that, in their case, the mechanical content is carried out for a maximum of two hours. “The procedure is used in crisis situations, which cannot be managed in otherwise in the supreme interest of the patient. The pathology of severe mental delay consists of unpredictable behavioral disorders, very difficult to anticipate. I am patients Which hit with the head of the walls, which bite their lips to the blood, which bite their fingers or hands, have an aggressive, violent, unpredictable behavior. They have zero tolerance to frustration, and anger attacks are often impossible to anticipate. ”
This is the reason why you manage such situations becomes difficult to impossible if you do not have a qualified human resource. “Often, employees who work directly with these patients become superficial, unmotivated, routine, exaggerate certain procedures, resort to abuses ”.
Regarding the case of children related to the bed at the center of Ialomița, the doctor Adrian Horga does not believe that the employees had the intention of doing bad patients. They were simply completely outdated. “Overcome. This is the word. Without sufficient resources. Without staff, without means. I could take the idea further by saying that more guilty than these employees are even higher level factors. All this issue must be interpreted as a system deficiency ”.
Solutions
What to do? “Maybe the Romanian state should be more involved ”, considers Dr. Adrian Horga. Caring for a child with such special needs, of a patient suffering from severe cognitive mental deficiencies should be a multidisciplinary one, the doctor believes. It is necessary, he says, to supplement the number of nurses and nurses. “Unfortunately, we are limited by financial resources and lack of qualified personnel. A child with such needs should be in the care of four, if not five specialists. ”
And these people should be chosen “on the eyebrow”, because the job is a vocational one. “You want to practice it, you like what you do. The medical assistant and the caretaker, those who come into direct contact with these patients daily, must be a higher degree of empathy. Because, unfortunately, no matter how good you think you are as a man, when you reach certain situations that dehumanize, over time you will transform, episodically, into a mini-bud. Because this is, after all, the human condition. I mean a kind of defense instinct, conservation that we develop in crisis situations and which sometimes dehumanizes us. This is why the psychic patient needs special people next to him. Young people, dedicated, empathetic, with inexhaustible resources. This is not a job. You go to work, work and take a salary. Here everything is about vocation ”.
And not only specialized medical professionals, but also volunteers, people outside the system, adds the specialist. “Pedagogues, psychologists, psychotherapists, speech therapists, chineotherapists, designers, ergotherapists, etc.”.
However, in addition to the lack of human resource, the system is also very badly funded, says Dr. Adrian Horga. “A solution that could eliminate the mechanical content, this forced, involuntary immobilization of the patient in crisis, would be the arrangement in each hospital or psychiatric unit of an antitralum room. A room where the patient should be accommodated for a certain period of time and that does not allow it to self-muttle. I refer to silicone, sponge, soft plastic or textile.
Until he receives this money for modernization, in the psychiatry centers but also in the social ones “bed legacy” is practiced and will be practiced for a long time. Even if, as specialists recognize, this procedure could be eliminated.
