Romania is now in a period of transition from communism to democracy. Geographically, Romania, like other Eastern European countries, is on the border between the Western world and the Middle East and Asia; until December 1989 it was behind the ‘Iron Curtain’.
It covers 237 500 km2, divided into 42 districts. In 2002 it had a population estimated to be 21 795 000. The unemployment rate was 10.5%. Fourteen per cent of the general population were over the age of 65. The infant death rate was 17.3 per 1000 and life expectancy at birth was 67.6 years for males and 71.1 years for females. The gross domestic product per capita (GDP) expressed in purchasing power parity (PPP) is US$6041, and total health expenditure is 2.60% of GDP. The proportion of the national budget spent on the health system is 4%, and around 2% of the total health budget is for mental health. There are 189 physicians per 100 000 population.
Mental health services
Nationally, there are 908 psychiatrists (4.16 per 100 000 population), of whom 260 are child psychiatrists (1.19 per 100 000 population). They all work in the public health sector, although some also work in private ambulatory clinics. There are also psychologists and social workers in the mental healthcare system.
Most psychiatric services are provided by hospitals and out-patient clinics attached to the Ministry of Health. There are 38 psychiatric hospitals and many psychiatric departments in the general hospitals (a total of 17 079 beds) as well as day hospitals (1222 beds) to care for patients with both acute and chronic mental illnesses; in addition there are 166 beds for patients with drug dependency. There are also 65 mental health centres for adults and children with mental illness. There are no private psychiatric hospitals.
The special needs of people with mental illness have not always been recognised and respected by the generic health services. However, a mental health law was passed in Romania only in August 2002 (Monitorul oficial al Romaniei, XIV, 589). This was the first step towards reform of the mental health services and care system. In chapter 4 of the law, the forms of specific mental health services existing in Romania are listed, along with care standards for people with mental disorders.