Children strapped to beds; two patients to a bed; dormitories so small, there’s only room for beds.
These are some of the things the Council of Europe’s anti-torture committee found on an inspection of Romanian psychiatric hospitals last year
The Committee for the Prevention of Torture on Thursday called on Romania to to take urgent action to improve conditions and treatment for psychiatric patients in the country.
The most important issue is reinforcing staff levels in hospitals, the CPT said. In its report, the Committee also advocated for a shift away from institutional care towards establishing mental health services in the community offering adequate social support structures.
The report is based on a 19 to 30 September 2022 visit and focuses on the treatment of patients held in psychiatric establishments and of residents accommodated in residential care centers.
The most dramatic situation was at the Pădureni-Grajduri Psychiatric and Safety Measures Hospital, where 104 patients had to share a bed with another patient.
Patients were crammed into dormitories with almost all the floor space taken up by their beds. In the admission ward, a room of 24m2 was accommodating 18 patients in nine beds.
The CPT said the warehousing conditions of persons with mental disorders and intellectual disabilities found in this hospital may well be considered as amounting to inhuman and degrading treatment.
Overall, patients the CPT delegation met spoke positively about the staff, particularly nursing staff. However, allegations of ill-treatment were received at four hospitals, notably on the male acute ward of Botoșani Psychiatric Clinic and at the Pădureni-Grajduri Hospital.
Ill-treatment consisted of punches, slaps and of being pushed and shouted at by auxiliary staff for minor infractions or accidents or as part of a restraint intervention or punitively in an attempt to control the patients within an often hazardous, disturbed and understaffed environment.
The treatment of psychiatric patients was primarily based on pharmacotherapy and the CPT calls for action to be taken to apply modern multi-disciplinary clinical treatment approaches.
As regards the immobilization of agitated patients to a bed with straps, the CPT states that such a measure should no longer be applied to children.
Instead, staff should be trained in manual restraint techniques and children’s wards should possess calming down rooms. Safeguards surrounding the use of restraint measures such as accurately recording each use and duration should be strengthened.
The CPT also found that hospitals circumvented the provisions of the Law on Mental Health regulating involuntary hospitalization to admit patients on a voluntary basis. Other safeguards such as consent to treatment, patient information and complaint procedures also need to be strengthened.
The CPT visited three public social care centers where many residents spoke positively about staff, and the atmosphere in the centers appeared generally relaxed. Nevertheless, the number of properly trained specialized unit-based staff was insufficient to provide proper personalized care for the large number of dependent residents. More multi-disciplinary staff to provide psycho-social, occupational, and recreational input for residents are also required.
In their response, the Romanian authorities provide information on various measures, taken or envisaged, to implement the recommendations made by the Committee in the visit report, notably through the National Health Strategy 2023-2030 and its Action Plan (see the Romanian version of the response).
(see the English and Romanian versions of the executive summary of the report).
