Conclusions

Abstract

During a visit to Romania in November 1991, one of the authors was invited to assess psychiatric care at an institution in Transylvania. The institution concerned was based at Galda De Jos, high in the mountains, and housed around 350 patients with 130 staff, many of whom were untrained, as Ceaucescu had banned all nurse training during his dictatorship. The director and senior psychiatrist, Dr Baldean, was rightly proud of the work carried out at the institution after the revolution of 1989. Until the west was free to send medicine he had managed his extremely violent patients by using restraints, and felt pleased that appropriate medication had lessened the use of these restraints. Conditions described prior to the revolution were terrible; with no water, drugs or trained staff, Dr Baldean strove to work among the mentally ill sent there from a large catchment area. When asked about the use of seclusion he frowned and shrugged. He did not understand. When asked if he locked patients alone in a cell or room he was aghast. ‘We don’t do such things here’ he explained. ‘We don’t lock people up when they are upset.’ Dr Baldean went on to explain that he had an inner locked area where absconders and extremely violent people were placed together and could be better observed, but no-one was locked up aloné — and this in a country purported to have very poor standards of psychiatric care.