Romania: new report examines the treatment of patients in detention in forensic psychiatric hospitals

* Council of Europe Committee for the Prevention of Torture issues critical report, https://www.coe.int/ informs     The Council of Europe’s Committee for the Prevention of Torture (CPT) has published a report on Romania in which it urges the national authorities to address serious shortcomings in the treatment and conditions of detention of patients in forensic psychiatric hospitals identified during a visit to the country in 2024.   In the CPT’s opinion, the treatment of some patients in forensic psychiatric hospitals is neglectful and, in certain cases, could amount to inhuman and degrading treatment and an ongoing violation of Article 3 of the European Convention on Human Rights. The purpose of the visit was to assess the treatment and living conditions of forensic psychiatric patients held in the four Romanian psychiatric and safety measures hospitals.   The CPT conducted follow-up visits to Sapoca Hospital, last visited in 2014, and Padureni-Grajduri Hospital, last visited in 2022. Additionally, it visited the psychiatric and safety measures hospitals in Jebel and Stei for the first time.   The visit also provided an opportunity to assess the implementation of the recommendations made by the CPT following its 2022 visit. In the report on that visit, the Committee drew the attention of the Romanian authorities to several serious systemic shortcomings concerning in the country’s approach to forensic mental health. The findings of the 2024 visit provide clear evidence that these shortcomings persist. At Padureni-Grajduri, Stei and Sapoca hospitals, the CPT received numerous credible and consistent allegations of physical ill-treatment of patients by auxiliary staff. The ill-treatment consisted of slapping, pushing, twisting ears, pulling hair, punching, hitting with objects and kicking, including while the patient was lying on the floor. Additionally, in Stei Hospital, the CPT delegation learned of the use of an electrical discharge weapon against patients by auxiliary staff, an incident which was under investigation by the authorities.   The Committee also found a neglectful practice causing death; namely, that in three of the four hospitals visited, post-mortem examinations showed that a total of eight patients had died by choking on their food in the last three years. This suggests that patients at such risk are not being identified and/or measures are not put in place to ensure that they can ingest their food safely.   Regarding material conditions, although some renovations had occurred or were ongoing, patient accommodation areas were generally bleak, untherapeutic, and lacked personalisation, with some being distinctly carceral. In Padureni-Grajduri Hospital, the planned construction of a new patient accommodation block had not yet commenced, and severe overcrowding persisted in all hospital wards, despite recommendations made following the 2022 CPT visit. At least 78 of the 409 patients were required to share beds with other patients at the time of the 2024 visit.   The CPT found that the number of staff caring for the large numbers of often agitated patients remained insufficient to provide the necessary care, treatment and supervision, and to ensure patients’ dignity. Sometimes staffing levels were so low that they could also impact negatively upon the safety of patients by increasing the risks of harm to them, including through neglect and ill-treatment, as well as encouraging excessive resort to restrictive regimes, seclusion, and physical and chemical restraint measures.   The Romanian authorities have provided a detailed response outlining how they have addressed or intend to address the recommendations made by the Committee. In particular, the response outlines the measures taken in each hospital to identify patients at risk of choking and to counter this risk. It also refers to steps already taken in some hospitals, such as targeted training for ward-based staff and increased supervision by management, to prevent the ill-treatment of patients. Further reforms are due to be implemented in the framework of Romania´s National Health Strategy 2023-2030 and its Action Plan, and a specific national Action Plan on mental healthcare, which include the development of community-based mental health services. The CPT will engage in constructive dialogue with the Romanian authorities on these matters.