Interview with Ileana Stoica and Emil Bolcu
Psychiatrist Ileana Stoica and psychologist Emil Bolcu, both working at the Mental Health Centre in Timisoara (a separate, distinct section of the County Hospital), are advocates of community psychiatry.
They visit patients at home, to talk with them and their families and to hand out medication. ‘We really should have social workers on our team’ says Stoica. ‘It is unusual for psychiatrists and psychologists to make home visits. But as long as we don’t have the money to appoint social workers and specialized nurses we just do everything ourselves. That has been the only way to make a start. We have to show how it works and what the results are.’
In various places in Romania experiments with this working method had been set up already. Stoica: ‘This happened in isolation from other attempts and our system of health care was not open to this approach to psychiatric care. In 2006 the Ministry of Health has made a new structure, which officially opens the possibility of community psychiatry. So far only a few centres put it into practice. Unpaid, on a voluntary basis.’
Structure and financial support still have to be fought for. ‘There is a very strong tendency to continue working in the old way’ says Bolcu. ‘Not only among therapists, but also among patients and their families. People are used to bring family members with mental health problems to the hospital. Understandable, since it takes the burden off their shoulders and offers security to the patient. Through frequent contact with the families and continuous support we can convince them of the possibility to keep the patient balanced within his own environment by medication and talking sessions. Cooperation with the family is very important. Emil Bolcu offers courses to families and friends of psychiatric patients. ‘I would like to see a strong interest group of families and clients arise. An independent organization, a NGO.’
The number of admissions to the Clinica is going down since Stoica and Bolcu and two other colleagues spend a lot of their free time on community psychiatry. Evidence that treatment in this way costs less than admission to the hospital will possibly convince the authorities to finance the necessary facilities for community psychiatry.
Emil Bolcu does not really like to use the cost efficiency argument. ‘This treatment is just more humane. You can see it by observing the patients, that should be sufficiently convincing.’
To do this job well they need an accommodation not connected to the Clinica de Psyhiatry. ‘It is confusing and stigmatizing for the patients to have to come to the hospital for help’ says Stoica. ‘There has to be a shelter where the door is always open. Where someone in a crisis can receive initial treatment and can come and go freely thereafter. People just cannot imagine that it is possible: to keep your child at home and overcome the crisis with help that is not connected to hospitalization.’ So far the only way to convince families is to make home visits. ‘We reach good results through convincing the parents’ says Stoica. ‘I win their trust by giving them insight in the treatment. “Let’s see how it goes when you keep him at home with this medication”, I say. The parents of one boy who had frequently been taken into hospital agreed to try. After a week he was quite better. “My God” the parents said, “we have always brought him to the hospital when he was like this. Now he is at home and you have managed to get him better already.” ’
Emil Bolcu: ‘New clients, who are treated at home from the start and do not get used to hospitalization, will get accustomed to the idea. By and by it will have to become normal and be clear that people can live better and be more satisfied in this way. It will always be important to spend a lot of time on the families. To handle the medication and to gradually accept that someone is handicapped, they will need support.’
