C&R in Romania

By Andreea Rimbu  

Mental healthcare suffered a great blow when Ceausescu banned psychology departments across România, as psychologists were deemed a threat to the regime. Mental illness was treated with psychiatric medication and nothing more. No talk therapy existed for those patients who would have benefited from psychotherapy, such as those who suffered physical and mental abuse in prisons and detention centers.

In 1949, psychiatric abuse was introduced in prisons as a way to instill terror and destroy the personality of the individual. This aimed to impose conformity and punish those suspected of fascism, treason, or propaganda. These “reeducation” programs , as they became known, were imposed on over 780 detainees, which were tortured, beaten, psychologically abused and threatened. Many others committed suicide to escape subjugation to such tactics, while others became mad and suffered mental illnesses. Rehabilitation would aim to repair the damage caused by the deliberate psychiatric abuse for political reasons during Ceausescu’s regime, yet it took another 14 years for any university to open for students of psychology and introduce psychotherapeutic curriculum. Since then, the number of nurses working in the mental health system is estimated at about 2000, and only a few have any specif ic training in psychiat ry bes ides thei r on- s i te preparations. The number of psychiatric doctors and other mental health staff is undoubtedly insufficient, and the prospects of psychiatric care only diminish the further one get s from the capital.

O Lume Sanatoasa Intro Minte Sanatoasa

România’s GDP allocated to healthcare has lingered a round the 3% mar k , increasing only .2% since 1999, and only 3% of that has been dedicated to mental health alone . WHO statistics place România in third to last place with regards to a budget for mental health. The NGO sector in the field of mental health services is scarce, as are funds and mental health experts . Yet unfortunately, neuro-psychiatric disorders are the second main cause of death, claiming 19.3% of the population. The figures account for an estimate of 1,018 new cases of mental disorders per 100,000 per year.

Another challenging factor in the mental health sector has be en scarcity of legislation related to rights of mentally ill civilians. Such persons face extreme challenges in the employment area. Many workers who leave a place of employment for medical reasons are not guaranteed to retain their work post , or to find a new one. This  is a major contributing factor of suicide , the rates of which are above the EU27 average, and is the main cause of death among Romanian males and second greatest cause of death among Romanian females .

Children and young adults are particularly at risk for mental disorders and suicide. It is estimated that one in five children and adolescents suffer from a mental health problem. This is also true for the many children left alone by families working abroad. A National Strategy for Protect ion and Promotion of Child Rights has been implemented to provide special protection for children separated from their parents .

Unfortunately, the strategy does not cover orphans , who are at an especially high risk of mental illness as a consequence of years of government- sanctioned child neglect and abuse . This type of deep – rooted psychological stress is almost irreparable. It seems difficult to justify that România would allocate the little economic means they have to prevent mental diseases, when a staggering 41.2% of the total population has neither a bath nor shower in their dwelling, and an overwhelming 42.5% have no indoor flushing toilet in their household.

Towards Improvement

Romania has taken huge leaps to improve its mental health care system. International cooperation has played an impor tant role in pushing forward these changes . America, Britain, Japan and Switzerland are some of the most active donors in the area of mental health. A particular UK/Romanian charity known as the “Relief Fund for Romania” has opened a day care center that provides physiotherapy, mobilization programs , and counseling, among other activities, for elderly people, children and the mentally ill . The charity offers several therapeutic programs, such as art therapy for disabled patients, who take part in dance, music, art and sensory training sessions. Estuar, the leading mental health charity in Romanian, provides rehabilitation for adults who want to reintegrate into the Romanian community through similar programs.

In 1990, mental health professionals founded the Romanian League for Mental Health, which was the official organization involved in mental health reform. They formulated the National Mental Health Programme, which engaged prevention and rehabilitation, community psychiatry, legislation and communication with other health care sectors . Since then, mental health care has picked up the pace.

The 1998 National Programme for Mental Health and Prophylaxis in Psychiatric and Psychosocial Pathology confronted the issues of discrimination, lack of coherence between decision-making bodies, poor psychiatric care conditions, and insufficient mental health personnel. The Law on Mental Health Promotion and Protection of Persons with Psychiatric Disorders, adopted in 2002, dedicated a specialized sect ion to persons with mental disabilities, guaranteeing their rights, confidentiality, and recognizing their civil, political, economic, social and cultural rights. The current central institutions involved in the healthcare of the nation are the Ministry of Public Health and the National Health Insurance Fund. The Ministry of Public Health is responsible for the health of the nation through implementation of policies, strategies, health programs, and allocation of funds, while the National Health Insurance Fund administers and regulates the social health insurance system.

Viitorul Ne Surâde

România has taken quite a leap in the field of telemedicine, eHealth and ICT in medicine, which has the potential to accelerate health-care reform. In 2005, România became the first country in Eastern Europe to have successfully performed a robot assisted surgery using the Da Vinci system. By 2008, the Center of General Surgery and Liver Transplantation of the Fundeni Clinical Institute purchased its own Da Vinci system, and the Institute has since performed over 200 robot- assisted surgeries.

In September 2007, România participated in its first telemedicine project – Health Optimum. The goal was to introduce virtual-assisted healthcare services into a wide range of medical specialties – from cardiolog, to psychiatry – as well as offer rehabilitation to those recovering from alcohol problems, monitor the elderly at home and provide general medical advice.

A research program out of Constanta known as “TELEMEDICINE APPLICATIONS IN DANUBE DELTA” and financed by Românian Space Agency, aims to build a unique health care program comprised of mobile telemedicine using a satellite link. The project’s main purpose is to cater to mentally ill people from the Danube Delta region who do not receive adequate care and connect them with trained specialists.

In 2007, a 27 month long project was inaugurated. TELEASIS sought to offer social and medical tele-assistance to elderly persons in their homes, with the hopes of improving lifestyle quality and efficiency in healthcare institutions, and easing communication between patients and healthcare providers.

România and Med c4al l , a Swedish company of telemedicine technology and services, launched Medic4you, the world’s first customer oriented cellular e-health service, which allows patients the ability to engage more closely with their own health and well-being. Doctors will be able to review clients’ medical information, prescribe drugs and offer consultation. Alongside this service, a WristClinic health-monitoring device is supplied, which automatically measures blood pressure, pulse, ECG, cardiac rhythm, level of oxygen saturation, and many other medical features. The envisioned goal is connecting millions of users with health professionals to support wellness and disease prevention.

By 2011, the Românian government expects to provide its citizens with electronic health insurance cards, which will hold personal information about the individual, from blood type, to any information about life-threatening medical diagnoses. It is an important step in computerization, and an even greater leap towards improved healthcare.

Interest and engagement is piquing. Researchers, scientists, and professionals are discussing the future of Virtual Reality environments for pre-surgery planning , rehabilitation medicine, learning, and tele -rehabilitation. The future rests on incoming generations, decision makers and ICT shoulders to make significant improvements, for both mental health professionals and citizens.

Sources:                                                                                                           CureResearch.com, NationMaster.com, World Health Organization, and the British Medical Association

Andreea Rimbu                                                                                                             Editorial Department C&R Magazine                                                     www.vrphobia.eu                                                                                       office@vrphobia.eu