A Long Road

A Country Report

Mental Health Services in the

Republic of
Moldova

May 2004

© InterMinds

InterMinds, PO Box 23121, Edinburgh EH6 4YL Scotland, UK

Email: mailto:InterMindsPK@aol.com
www.InterMinds.org

Tel: + 44 131 467 0117

Recognised as a Scottish Charity by the Inland Revenue

Scottish Charity Number SCO 28897

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 Foreword.

This is the third in our series of Country reports. It is the first to be written by
someone with detailed and local knowledge of the situation in Moldova. The fact
that the writer wishes to remain anonymous should tell us all something about the
prevailing situation in Moldova. Although written in less than perfect English the
writer conveys both their concern for the situation and sheds light on practises that
are of grave concern for those of us working with Human Rights issues. The report
warrants careful reading.

Peter Kampman
Director, InterMinds
20 June 2004

2
Preface

In writing this report, I have given myself an opportunity to convey some of my

impressions about Moldova and the people that I have had the opportunity to meet. I
still feel the warmth of first meetings and the hospitality of my Moldovan hosts. I have
tried to make sense of some of the contradictions that I have experienced in Moldova.
Some of them similar to other countries in the east of Europe and some which
particularly stood out in the context of Moldova.

I have tried to convey, along with certain facts/figures and official statements, my
personal impressions and feelings, sometimes contradictory in nature, but in general -
optimistic. Optimistic thanks to the commitment and enthusiasm of the people I met.
This allowed me to see and feel the future in a different light. One of the most important
impressions was the energy of the team that are our partners in Moldova, the NGO
“Moldova Philantropie”. They have given me a glimpse of their country of which they are
rightly proud.

In the appendix I list the people working in "Moldova Philantropie" to whom thanks are
due for their kindness and hospitality, which allowed me to learn much about their
country and helped to build the confidence that is required to achieve the tasks we have
planned together.

Introduction

Moldova, her people and their mental health, is a situation of grave concern.

Three visits to Moldova (November 2002, February and March 2003) have served as
the basis of this report.

During these visits as a local representative of "InterMinds" who lives and works in
Eastern Europe, I had the opportunity to familiarize myself, in detail, with the state of
mental health services in Moldova and, at the same time, with the culture and the spirit
of her people.

Before my arrival in Moldova my understanding of the country, gleaned from various

sources, including the book “Playing the Moldovans at Tennis” by Tony Hawks, were
uncoordinated. I had heard much about Moldova from Romanian colleagues, with
whom I have had many years of involvement. Many expectations were fulfilled and
there were both surprises and pleasures.

The atmosphere and conditions in which people are kept in psychiatric hospitals did not
surprise me. Conditions were bad in Chisinau and somewhat more civil in Balti. Nor
was I surprised during meetings with all kinds of officials, from the Mayor of the City of
Chisinau to the personnel of the Ministry of Health. The outward appearance of these
officials contrasted dramatically with the reality that Moldova is officially the poorest
country in Europe.

Those NGOs, the representatives and the operating conditions that I have managed to
see, presented a varied picture. Some of the people and organisations were noticeably
mobilized for work; others gave the impression of just waiting for something to happen
and appeared passive. Occasionally I had the sensation that the person in charge was

3
concealing his/her personal financial interests in the supposed goals of the work of the
NGO.

However I do hold the confidence that Moldova has potential and that there are people
who can contribute to social, economic and political change, even if these changes are
slow in coming. I had a definite sense of the growing economic prospects, aided by
inward investment in Moldova.

Political, Economic and Social Situation

One of the main overall impressions about the political and economic situation is the
growing sense of increasing stability. This is a real achievement given the short and
sometimes dramatic events that have taken place in the recent history of this newly
independent state. This territory was known previously as Bessarabia, which never
achieved the status of an independent state. Symptomatic of the endless upheavals
faced by people living in this part of Europe, its history is a catalogue of wars,
occupation and purges.

In the Middle Ages Bessarabia was a part of a Moldavian Princedom, and in 1812 it
became part of the Russian Empire as the Bessarabian province.

For a short period of time her territory was a part of the Romanian State (1918 - 1940)
and then Stalin annexed it, as the Russians drove the Germans back during the war.
This situation was confirmed as part of the Yalta agreement.

The Republic of Moldova obtained independence in 1990 and 10 years later, in 2001
chose to return to a Communist government. In the beginning, after the collapse of the
USSR, (1988 – 1991), the movements for national self-determination and
independence were very strong, but began to die away rapidly, in the face of a massive
deterioration in living standards and a high level of corruption of the leadership at that
time.

One of the most dramatic episodes of the last decade was the internal Transniestrian
confrontation in 1992 - between the official authority of Moldova and the separatist
government of the unrecognised Transniestrian Republic.

Until 2001 there had been two presidents and several parliaments and cabinets in the
country, the end results of which were a continuing deterioration in living standards and
a growth in corruption, particularly in the Transniestrian Republic, which is in effect run
by the mafia.

In the late nineties Moldova officially became the poorest country in Europe with
accompanying high levels of illegal immigration, criminality, prostitution and state
corruption.

Taking into consideration these factors it seems clear, why, in February 2001 the
Communist party won the national elections, and obtained an absolute majority in the
Parliament (71 seats from 101). The Presidency came under Vladimir Voronin, the
leader of the Communist party at that time.

It was my view that the hope that the former imaginary state of ‘Soviet well-being’ would
return, as suggested by the communists during the election campaign, led to their

4
success at the polls. It is of some credit to the Communist government that the general
situation in the country has gradually begun to improve. This included real
improvements in the economy. However one of the most important political problems,
the existence of the unrecognised Transniestrian Republic. remains unresolved, and
Moldova remains divided into two parts. The most recent elections at local level, held
on May 25th 2003, saw the communist party winning again, obtaining over half of the
mandates in the district elections.

As an outsider it is difficult for me to accurately judge events taking place in Moldova.

These events raise certain questions for Moldovans. These questions concern the real
and substantive orientation of the communist party in Parliament and the lack of
progress in solving the troubling questions of daily life - poverty, food, housing, health,
employment and education.

As one Moldovan put it, “One cannot but notice the difference between the former,
Soviet communism, and the present one, democratic enough and unobtrusive. For
example, the anniversary of Great October Revolution – is the only holiday reminding
from the communistic past - is celebrated rather modestly, not imposing it to the whole
society as it was before. At the same time, the tendency to take as much as possible
power, usual for any political structures of all countries, could put one on his/her guard,
taking into account the past of this country where the democratic forces are
insufficiently developed, and the transition to dictatorship in return for a satisfactory
minimum of existence can take place rather easily”.

Internal policies show a move towards “democratic socialism”, (my definition of this
regime), and the aspiration to market economy. (The Republic of Moldova is the only
country of CIS, which is a parliamentary and not a presidential Republic). Foreign
policy in contrast, is subject to rather inconsistent aspirations.

The priorities of foreign policy are based on the following regulations of the constitution
of the country:
- Strengthening of independence and sovereign maintenance of territorial integrity of
the country.
- Consolidation of the country as a factor of stability.
- Assistance to social and economic reforms for transition to the market economy.
- Becoming a lawful state.

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  Hunting and forestry economy
 Industry
 Construction
 Transport and communications
 Commerce
 Education
 Health and social assistance
 Other activities

Structure of the population occupied with the basic kinds of economic activities
for the year 2000

The real situation in Moldova, particularly the economic one, determines some of the
foreign policy priorities. Since the communists came to power, pro-Russian orientation
of the Government has become more obvious, though both the President and state
officials from the Government (the Minister for Foreign Affairs) have recently declared
interest in entering into the European Union as one of the key priorities of foreign policy.

It is currently an important time for the Republic of Moldova, being a chairman of the
cabinet of the Council of Europe. Friendly relations between Moldova and Russia, with
the increasing orientation to the establishment of good relations with the European
Union, put Moldova in a potentially special position. It is however possible that this is
more concerned with local election campaigns than a profound shift in policy.

Looking at the economic life of the country, a vital point is the almost total lack of
mineral resources (98% - are imported). There is a profound economic dependency on
agricultural production, especially since 45% of industrial production is situated in
Transniestria, which is not as yet under official Moldavian Government control.

At this juncture it is clear that the dependence of Moldova on countries delivering

energy, basically Russia, and the dependence of the export market on the CIS
countries, to which the products of the food industry are exported, causes problems.
This dependence explains the significant national debt (US$2,000,000,000), meaning
that for the most part the national gross revenue has to be delivered to debt repayment.

The national gross revenue has decreased during the decade of independence by 60%,
though some increase took place in 2001/2002 and real growth is taking place in 2003.

In 2001 Moldova registered economic growth of 4.5%, due to growth in industrial

outputs (14%). Foreign trade has grown, as a whole due to increases in exports (24%)
and imports (12%). The main exports (60%) consist of products from the agricultural
and tobacco industry. Trying to stimulate commercial activity, the Government has
reduced income tax from 28% to 25%, though it is felt that this level is still too high to
lead to real stimulation of the economy.

The following diagram presents the distribution of population, engaged in various fields
of activity, including public health services.

6
 Inflows of inward investments come mainly from Russia, Spain, USA, Germany,
France, and Great Britain.

The caution that foreign investors show to the Moldovan market can be explained by
fears of political instability and by the unhelpful legislative climate, with high levels of
bureaucratisation and endemic corruption. Moldova is on the list of 30 of the most
corrupt countries of the world. In the last meeting of the European Bank of
Reconstruction and Development, the Minister of Economy mentioned significant
growth in the economy of 5.5% - 7% (“Independent Moldova” newspaper of May 9,
2003).

My impression, overall, was not of continuing economic recession, especially in the

cities where there are literally thousands of small and medium sized businesses with
private construction and the winemaking industry prospering. This impression is
underlined by some figures that reflect these trends. From 1995 to 2001 the internal
gross output increased from 6480 million lei to 19019 million lei. The volume of
industrial production also increased from 4265.2 million lei to 10427.6 million lei. The
economic performance tables are below.

The main macroeconomic indices of the Republic of Moldova for 1995-2001

Internal gross Net taxes Internal gross

output output per capita
1995 6480 736 1798
1996 7798 972 2167
1997 8917 1252 2441
1998 9122 1403 2498
1999 12322 1323 3379
2000 16020 1998 4402
2001 19019 2415 5233
Volume of Volume of Capital
industrial agricultural investments
production production
1995 4265.2 4243 844.8
1996 4690.4 4639 987.4
1997 5889.4* 5100 1202.2
1998 5981.9* 4775 1444.4
1999 7190.8* 6396 1591.8
2000 8167.7* 8268 1759.3
2001 10427.6* 8646 2315.1

In construction Volume of retail Including

and mounting trade through Foodstuff
chains
1995 541.1 2757.1 1273.7
1996 522.4 3839.6 1653.3
1997 591.0 3970.5 2105.7
1998 649.8 3679.0 1991.3
1999 855.4 3601.7 1943.4
2000 755.6 6012.0 2741.5
2001 1056.8 7612.4 3419.3

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 Non-foodstuff Total amount of Total volume of
services rendered export
to the population
1995 1483.4 652.1 745.5
1996 2186.3 819.6 795.0
1997 1864.8 1237.3 874.1
1998 1687.7 1299.2 631.8
1999 1658.3 1896.8 463.4
2000 3270.5 2599.6 471.5
2001 4193.1 3404.4 570.1
Total volume of Monthly average Monthly average
import salary of an pension
employee engaged
in the economic
field
1995 840.7 143.2 64.3
1996 1072.3 187.1 78.7
1997 1171.2 219.8 82.8
1998 1023.6 250.4 83.9
1999 586.4 304.6 82.8
2000 776.4 407.9 85.1
2001 897.2 543.7 135.8
Living wage Number of
unemployed
persons
1995 310.6 -
1996 387.8 -
1997 439.5 -
1998 473.0 34918
1999 661.8 28873
2000 944.5 27646
2001 1053.0

Changes are noticeable. In comparison with the first term of 2002, the first term of 2003
saw an increase in agricultural production of 1.6%, and cattle breeding 3%. The volume
of transport services also increased by 3.5%. There has been a steady rise in retail
trade for the same period by 30.2%. It is especially important to point out the significant
increase in export 27.5%. In comparison with import 4.2%, as well as considerably
increased volume of crediting 63.5% and payment back of credits 39.4%.

These figures correlate with the increase of savings of citizens in the banks of the
country (on March 1, 2002 the total sum of savings made up 1740.9 million lei, and
already on March 1, 2003 the total sum reached 2618.1 million lei) This would indicate
a increased trust of citizens in the banking system of the country, which, after a number
of large bankruptcies, has entered into relative stability.

In January - February 2003 the monthly average salary in the Republic of Moldova was
749.9 lei, 34% more than in February 2002. There is increased purchasing power of
26.1%. The rise of economy correlates with decrease in the official unemployment
figure from 35600 on April 1, 2002 to 34800 on April 1, 2003. At the same time, the

8
living wage, which has increased from 1168 lei in February 2002 to 1232 lei in February
2003, still exceeds the level of monthly average salary. Probably, these positive
changes are linked with increase of private enterprises and market relations.

The data of Department of Statistics and Sociology of the Republic of Moldova show a
rise in consumer prices in February 2003. There is a 1.8% on January 2003. (Food
stuffs 0.9%, industrial goods 1.0% and for services rendered to the population the tariffs
the increase was 4.5%)

The greatest increase of prices for financial month registered was for food stuffs:
buckwheat 21.9%, wheat flour 9.4%, fresh fish 6.0%, sugar 3.3%, vegetables and fruit h
2.7% (including: onion 21.4%, apples 11.4%, grapes with 4.2%, carrot 3.7%, potato
2.2%) and alcoholic drinks 1.0% (liquor 5.0%, wine 2.5%).

The prices for tariffs and the services rendered to the population have essentially
increased for telephone use by 33.7%, for gas 3.0%. Other services rendered to the
population remained at the level of 2002.

In February 2003 the prices for foodstuffs decreased: eggs 11.0%, pork 8.0%, beef
5.0%.

The following tables illustrate the changes in structure of industrial manufacture

according to the form of ownership for the last years and the 1st term of 2003. By 2003
there is an increase in foreign enterprises and enterprises with mixed capital.

Structure of the population working at enterprises with various forms of

ownership

 Public
 Private
 Mixed without foreign investments
 Mixed with foreign capital

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Structure of industrial manufacture according to forms of ownership

Quarter I Trimestrul I
2003
24,0 31,0 15,8 20,5 8,7  Public
2003  Private
Trimestrul I 27,1 32,6 16,6 17,2 6,5
2002
 Mixed (public +
Quarter II 0% 20% 40% 60% 80% 100%
private)
2002 Publică
Privată
 Mixed enterprises
Mixtă (publică + privată)
Întreprinderilor mixte
Străină  Foreign

Number of economic agents according to forms of ownership on March 1, 2003

In In a
absolute percentage
units ratio
In all in the Republic 117531 100.0
State enterprises 4386 3.7%
Private 109754 93.4%
Enterprises with mixed property (state + private) without 538 0.5%
foreign investments
Mixed enterprises with foreign capital 1740 1.5%
Foreign 1113 0.9%

It was sad to read in one report that 80% of inhabitants live on less than US$2 a day. It
was especially difficult for me to approach the question of social protection after the
conversations I had with inhabitants of the country and visits to different institutions
(Especially in the rural areas) Certainly, the most socially vulnerable are children, old
people and those that experience mental health problems.

As with any country in such a transition period, many have faced deterioration in
conditions of life. Though recently there are notable improvements

The number of children between the ages of 6 - 12, suffering from anaemia (almost
50%) and at the age of 5 or younger (25%) struck me as very high.

The table presents the decrease in ration of an average inhabitant.

The consumption of food products per capita, kg/year

1990 1991 1992 1993 199 1995 1996 1997 1998

4
Meat and meat 58 56 46 35 30.1 23 25.3 25 26.7
products
Milk and dairy 303 258.6 198 174 163 165.2 161.4 154.5 155.5

10
products
Eggs, number 203 194 166 130 100 107.2 116 121 121
Sugar 48.9 41.2 30.5 30 22.3 21 22.5 21.2 21
Vegetal oil 14.1 11.6 8.5 7.8 8 8 8.2 7.6 7
Potatoes 69 68 66.5 95 84 67.8 71 68.8 65.1
Fruit, berries 79 78.9 63 80 68 59.7 59.3 77.5 47.7
and grapes

Despite visa obstacles, from 600000 to 1000000 citizens of Moldova are living abroad
countries including Russia, Italy, Greece, and Portugal.

Further reading based on the bibliography can describe, in more detail, other aspects of
political, economic and social life of the country. But the main conclusion I made is that
the focus should be made on social aspects with the aim of improving the life of the
citizens of Moldova. Certainly, one can only welcome the strategy of struggle against
poverty, recently started by the government. However the question always remains for
this country the same: what is the proportion which will reach the population and how
much will remain in the pockets of officials.

Situation in the field of public health services in the Republic of Moldova

The situation in the field of public health services is one of big troubles and small
successes. Possibly the logical impact of the economic, political and social situation.
Experiencing life in Moldova, I only too well know how difficult the abrupt changes were
for the population. The public health services in the Soviet period provided a relatively
developed network of all kinds of medical service, free-of-charge and accessible to
everyone. One can very well feel the profound disappointment during transitional
period when significant sections of the population lost the opportunity to receive
adequate medical service. In particular pensioners and people with chronic illnesses.
One can sympathise with this large group and their impossibility to provide themselves
with even the basic of medicines, let alone any complicated planned surgeries.

Meetings with the personnel of public health services have confirmed the fear that
people living in chronic, neglected conditions when faced with the necessity of payment
for medicines and services, tend to do nothing. Or try self-treatment. The degree of
extortion in the field of public health services is very high.

Low, unacceptably low salaries of doctors and medical staff means they search for a
way to survive in this country. Accepting unofficial payments and compelling patients to
pay for medical services. Ironically people with funds or power, have the possibility to
receive in full medical aid. Only 44.1% of the population positively speak of the
condition of public health services in the Republic of Moldova.

It is no wonder that the death rate is high (1456 per 100000 population) in comparison
with Central European figures (961 per 100000 population). The level of death rates is
also high among newborns (18.5 per 1000 population), in comparison with Europe (11
per 1000 population). Thus, the average lifetime has essential difference from the
European figures (67.6 and 73.6 accordingly). From the figures of death rate according
to diseases, are especially high the figures on: gastrointestinal tract (117 and 38 per
100000 population), cardiovascular diseases (830 and 476 per 100000 population), the

11
frequency of syphilis is also high (115 and 57.5 per 100000 population). More detailed
data on death rate are presented in the table below

Selected health indicators in the Republic of Moldova and European Region

Republic of Europe
Moldova 1998
1999
Life expectancy 67.6 73.6
Men 63.8 69.6
Women 71.4 77.6
Infant mortality per 1000 live birth 18.5 11.1
Maternal mortality per 1000 live birth 28.6 19.0
Standardized death rate (SDR) for all causes of death 1456 961
per 100000 population
SDR for cardiovascular diseases per 100000 population 830 476
SDR for malignant neoplasm per 100000 population 148 183
SDR for injuries and poisoning per 100000 population 105 84.7
SDR for diseases of the respiratory organs per 100000 89.5 60.6
population
SDR for diseases of the digestive system per 100000 117 38.0
population
SDR for infectious and parasitic diseases per 100000 19.9 13.2
population
New cases of tuberculosis per 100000 population 60.9 40.4
New cases of syphilis per 100000 population 115.9 57.5
New cases of AIDS per 100000 population 0.07 1.4

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On the diagram below I presented the dynamics of death rate for 2002 and 2003

2002
 Illnesses of intimately vascular system
1,3 6,2  Malignant tumours
6,6  Gastroenteric path
6,9  Accidents, intoxications, traumas
 Illnesses of respiratory ways
9,7  Infectious diseases
59,8  Others
9,5

Boli ale aparatului circulator

Tumori maligne
Boli ale aparatului diges tiv
Having compared the dynamics of parameters for 2000 and 2003, one can notice the
increase in numberAof ccidente,
deathsintoxicaţii şi traume of figures of increase in population,
with worsening
despite of increase inBoli
newborns.
ale aparatului respirator
Boli
Returning to the state ofinfecţioas
health ofe children, it is worth mentioning that the main causes
of infant mortality, is the pathology of prenatal period (34%), congenital defects of
A ltele
development (24.5%), infringements of respiratory system (22.1%). Vaccinations
recommended by WHO were made only to 86% of children. There are sanitary-and-
epidemiological problems in children’s health because about 50% have suffered from
pediculosis, 10% - from helminthosis.

From the problems of children’s health, is the disturbing the aspects of women’s health.
For example, maternal death rate still remains an unacceptable level (28.6 per 100000
population in year 2000). There is a very high level of abortions (725 per 1000 births in
1999). And it is not surprising, taking into account that only 50% of women adequately
use methods of contraception. Almost 38% of women do not use any methods of
contraception at all (UNICEF 2000).

All this makes an impression of gradual increase of stable degradation of health of the
population, both in provision of services to the population and the populations own
knowledge of health and self care. It is absolutely clear that this situation must be linked
with the economic state of the country and the funds allocated for public health
services. For example, for 2 years, from 1997 to 1999, the budget allocated for public
health services has decreased almost twice from 46.7% to 26.6%. In absolute figures it
is expressed in 480 million lei in 1998 and 247 million lei in 1999. At the same time, as I
have already mentioned, for a part of the population medical services are unaffordable,
and the part of additional individual expenses per capita make up US$20. It is evident
that the decrease of expenses for public health services by the state, inevitably results
in the fact that a part of these expenses have to be incurred by the population. The
situation is even more paradoxical due to the fact that only 20% of funds allocated for
public health services are spent for the aid to primary patients, providing out-patient
treatment, to the services of which resort 80% of the population. A positive feature of
the plan is the fact that 97.1% of the population lives at the distance less that 5 km from
13
the nearest medical aid post, though it takes more than one hour to 3.1% of city
inhabitants and 8.1% of countryside inhabitants to reach the medical institution. Partly it
is concerned with bad condition of roads, the fact I know from my own experience, an
underdeveloped network of transport services (especially in the rural areas)

Further is the data on the number of doctors in the country (only 17431), and the
doctors engaged in private medical practice (325). On average, per 100000 population
there are 40.6 doctors, the greatest number of them being in Chisinau (55 per 100000
population) and Balti (44 per 100000 population). In other regions these parameters do
not exceed the amount of 15-30 per 100000 population. The distribution of doctors
according to specialization is the following: therapists - 28%, surgeons - 12%,
stomatologists - 10%, paediatricians - 10%.

The following table presents the level of salaries, in the sector of public health
services.

Average monthly salaries of one employee

January 2003
Occupation January 2003 comparing to
January 2002,%
Permanent employees 773.2 135.0
Including: agricultural industry 319.1 130.4
Fishery 415.8 69.3
Industry 1052.9 125.2
Elaboration of career 658.3 126.6
Processing industry 1005.4 122.7
Electric power, gas and water 1272.3 134.9
Construction 778.0 127.7
wholesale and retail sale 632.7 122.1
Hotels and restaurants 644.0 127.7
Transport, storages and communications 1310.2 153.8
Financial activity 2248.0 115.0
Real estate 888.2 126.3
Public management and protection, compulsory 1059.4 113.5
social security
Education 537.5 151.8
From them teachers 740.4 160.0
Health and social security 500.4 157.7
From them physicians 798.5 170.7
Other activities of collective work, social and 556.8 148.9
personal

From the expenses of the sector of public health services for 31% are spent on salaries,
9% - on meal, 19% - on medicines, 30% - on public utilities.

In 1997 the WHO pointed out to a large number medical beds per 1000 population (11)
and recommended to reduce them to 6.1, including 2 social beds. With this purpose, for
example, it was suggested to reduce the number of hospitals in the city of Chisinau
from 30 to 15.
14
Absence of medical insurance is an important aspect, though the Government took a
relevant decision. Initially, the medical insurance should have started to function early in
2003, however, apparently, because of lack of funds necessary for the implementation
of this decision, it was postponed. The Government, nevertheless, is going to launch
the mechanism of medical insurance before the end of 2003.

As a summary for this part of the report, I ask myself how long it would take the
Republic of Moldova to develop the quality of care in the health service to a satisfactory
level for all of its citizens. Asking this question, I feel very pessimistic.

State of Mental Health in Moldova

What follows are my attempts to describe the conditions within a psychiatric hospital.
There are the faces of people, each an individual but each sharing an expression,
lifeless or anxious or pale and exhausted. Often black and blue because being beaten.
The suffocating smell of unwashed bodies, and urine. The worn–out clothes. The
density of living accommodation rooms with sleeping beds for 30–40 persons deprived
of any privacy.

I could say so much more. I feel we need to value life in all its forms. We need to
question what is madness. Have those who consider themselves healthy hidden their
madness deeply inside themselves and do not recognize it in others because they are
afraid of their own madness. We need to do these things in order to change the
appalling system that the so presumed ‘mad’ are trapped within. I could at see, feel, find
the germs of the future changes among new people whom I met in Moldova, both
working and living with them, among whom I felt well, understood and easily, on whom I
one could rely. It is such people that are needed to make the changes so desperately
needed.

Mental Health Services in Moldova

One of the most important characteristics of mental health in Moldova is the

centralization of services basically around psychiatric hospitals.
The structure of the help is simple: the ground of the help is psychiatric hospital, then
there is out–patient treatment provided in clinics by psychiatric hospitals and at district
polyclinics.

Today in the Republic of Moldova there are 2285 psychiatric beds, 110 less than in
2001. the number of beds per 10000 population makes up 6.3 (in comparison with 6.6
in 2001). The overwhelming majority of hospital beds are concentrated in 3 hospitals
(Chisinau, Balti – 130 km to the north from the capital, and Orhei – 60 km to the north
from Chisinau) The total number of beds in these cities at present is 2205. It is worth
mentioning that in stationary conditions the basic medical actions consist in prescription
of often out–of–date medicines with low efficiency and that often cause complications.
For example, from neuroleptics of last generation they have only Risperidoni. The price
is unaffordable for the majority of the population (30 tablets, 4 mg each cost more than
800 lei, – more than an average salary). This medicine is affordable for only a small part
of the population and only in private medical practice. Olanzapini (zyprexa) and
Serocvel (кетапридидин) are not registered in the country. The basis of treatment with
neuroleptics remains Haldol (Trifluorperazini), medicines of prolonged action are hardly

15
affordable. From anti–depressants one can list only 6–7 medicines present in the
market, the most used in hospital being Amitriptylini. Inhibitors of return capture
серотонина are presented only by Fluoxetini and recently appeared Paroxetini, the
prices for which are also absolutely disproportionate to the average salaries of the
population. Tranquilizers, mainly of benzodiazepini base (Diazepami, Valium, and
Xanax) are widely used. It is worth mentioning the rare use of electro–convulsive
therapy, probably, because of extremely outdated equipment. But even rare sessions of
electro–convulsive therapy are carried out without sufficient narcosis.

I think that the problem of occupation of patients is very important and insufficiently
solved. I mean occupation not in the sense of work in medical–labour workshops or
cleaning the territory (which usually takes place compulsively and not taking into
account the interests of the patients) Occupation not in the sense of helping the staff
with their duties. I mean occupation in all kinds of activity in the section with possibility
to communicate, to read, to paint, play table games. I have the impression that the
personnel did not understand fully the importance of creating an environment of
dialogue and creative occupation. Rather they involve medicines which they prescribe
as if a cure and the only way of aid.

It is interesting that the reduction of number of beds, has not resulted in the released
funds being used for the development of extra–hospital aid.
The largest psychiatric hospital located in Chisinau, during the period of its greatest
“prosperity” had more than 3000 beds. Halving of the number of beds (1430 beds) did
not result in opening of any extra–hospital centres. Halving of the number of beds did
not cause any fundamental changes in conditions in which the patients are kept, the
changes are limited to only redecoration. Probably linked with these conditions, as well
as of lack of development of private services in the field of mental health, the number of
hospitalisations in 2002 increased (14012) in comparison with 2001 (13031). At the
same time, the average duration of stay of patients in hospital decreased from 58 in
2001 to 47 in 2002, and the use of one bad accordingly decreased from 318 to 288
days.

On the one hand, it can be welcomed, as we see reduction in increase of

hospitalisation. On the other hand, the patients leaving the hospitals are not included in
the system of extra–hospital rehabilitation actions because they do not exist.

It is no surprise that there was an increase in the number of repeated hospitalisations

up to 48.8% in 2002 (46.7% in 2001). The increase of repeated hospitalisations at the
patients suffering from schizophrenia is especially noticeable. It seems to me that the
number of these hospitalisations could be considerably decreased if there was a well
developed structure of extra–hospital aid and if better medicines were affordable.

One can only welcome the reduction of death rate in psychiatric hospitals from 1.1 in
2001 to 0.8 in 2002.

One of very important aspects of quality of aid in the field of mental health is the
‘experts’ their training, and motivation of work and a motivation to raise their
professional standard. Here are presented some formal parameters concerning the
number and distribution of doctors. In 2002 the number of psychiatrists’ wages
decreased with 1.25 and makes up 225.5 wages (in 2001 there were 226.75 wages).
The complete staff makes up 89% (in 2001 – 94.6%) and in absolute figures: 200.75 in
2002 and 214.5 in 2001.

16
Thus, the number of psychiatrists is 0.5 per 10.000 population. From the general
number of 200.75 wages, the majority work in hospitals (115.25 or 57.6%) and only
85.5 (or 42.6%) in out–patient hospitals. Many people suffering from mental diseases
are in the community and not accessing help, because one of the only forms of help is
within hospital.

The data about the number of psychotherapists working under the jurisdiction of the
Ministry of Public Health are interesting and surprising: only 10.75 wages, and from
these wages only 8.25 work in out–patient hospitals.

In the country there is also a separate judicial – psychiatric examination in which 13.5
experts work. The university training of psychiatrists until recently lasted only one year,
and was focused basically on the training for work in stationary conditions. For quite
some time now the training has lasted 3 years, and more and more attention is paid to
non–stationary work and psychotherapy. However, very few young experts remain to
work in medicine/ psychiatry because of low salaries.

There is a very well organized procedure of post–graduate education, in which all

doctors, including psychiatrists, must attend a certain number of hours (450) of lectures
during 5 years in order to get the opportunity to confirm their medical category, or to get
a higher category (in all there are 3 medical categories giving a small rise in salary).

The number of visits of doctors to patients has increased with 33733 for the last 2 years
and makes 360944 (in 2001 in all there were 327211 visits). It is one of the figures
reflecting the activity of work of doctors, which can simultaneously be crossed with
some other legislative problems concerned with possible refusal of patients to see the
medical personnel in their house/apartment.

Many problems exist for children and teenagers. To present day there is no specialized
service for teenagers, neither in out–patient, nor in stationary conditions. Teenagers
requiring hospitalisation are admitted into children's sections but only rarely, if they are
mature enough, they can be hospitalised in adult sections. At the same time, this
category of patients apparently requires the development of a separate structure of aid,
especially taking into account the fact that the disease of mental pathology in 2002
increased up to 595.4 in comparison with 2001 (367.0) per 100.000 population.

Similar tendencies are noticed in children's pathology. The increase of number of

patients who repeatedly addressed the doctors up to 494.8 in 2002, in comparison with
391.2 in 2001, also per 100.000 population. In total, only 23.5 paedopsychiatrists work
with children and teenagers in extra–hospital field.

Special commissions of psychiatrists carry out the judicial psychiatric examination –

experts appointed by the court and according to the decision of the investigator. There
are only two definite positions concerning the committed crimes (sane or irresponsible),
and concerning the capability – capable or incapable. There is no legal definition of
reduced responsibility or limited capacity. In 2002, from all the persons who past the
examination, 118 persons were recognized irresponsible (8.4% from the number of all
examinations), that is higher, than in 2001 (106 deranged, or 7.6% from all
examinations). The majority of crimes committed with subsequent recognition of
diminished responsibility are committed by patients suffering from schizophrenia

17
(60.6%), in most cases they are subsequently sent for compulsory treatment. It
dismaying that during their stay for compulsory treatment there is a complete absence
of rehabilitation programs. These patients are not involved in psychotherapeutic or
generally therapeutic programs. The main thing that happens to them is being kept in
closed sections and taking medicines.

Psychiatric stationary institutions.

In Moldova there are three specialized psychiatric hospitals. The largest one is the
Clinical Psychiatric Hospital located in Chisinau and has 1430 beds, among which 75
are for children. The principle of placement into this or that section is territorial, however
there are specialized sections for epilepsy, gerontopsychiatry, somatopsychiatry for
transitional states, and a section for psychochronic patients.

The hospital serves the territory on which live about 2 million persons. My visit to this
institution made a rather contradictory impression. Bearable conditions were combined
with inadmissible density and keeping in basements. On the other hand, I cannot but
point out the aspiration of the personnel, even in such difficult conditions, to try to
facilitate and improve the conditions in which the patients are kept.

It is worth mentioning that five years ago, WHO in Moldova, having visiting the hospital,
recommended closing it, because of conditions in which the patients are kept.

The second largest hospital is situated in Balti and has 770 beds, 70 are for children,
150 narcological and 50 for a psychotuberculosis. This hospital serves the territory of
the north of Moldova with the population about 1 million inhabitants. In comparison with
the Chisinau hospital, my visit to this clinic made a much more favourable impression.
The rooms were both neat and clean. Also I want to mention the investment in
equipment. For example equipment for physiotherapy). Also there were basic attempts
to return people into the society.

The third hospital is in Orhei, and, since recent time, is situated in the building of the
former phthisiatric clinic. The hospital has 300 beds and serves 301800 inhabitants. It
seems to me that soon they will make some repair works of the building and the rooms,
which are really desirable.

Besides these institutions, in the Republic of Moldova there are 2 more sections with 60
beds each, in the north and in the south of the country.

In Transniestria there are psychiatric hospitals – in the village of Ekaterinovka (250

beds), in the village of Vihvatentsi (80 beds), and some psychiatric sections on Tiraspol
(70 beds) and in Tighina (30 beds).

I was surprised by the small number of daytime hospitals, they are situated on the
territory of psychiatric hospitals, and not in cities or districts near to consumers. There
are 4 daytime hospitals in the Chisinau hospital (2 for psychiatric conditions, 1 for
transitional and 1 for children and teenagers), each having 50 beds (in all 200). In Balti
hospital there are 30 beds and in Tighina with 15 beds. The work of daytime hospitals
does not differ essentially from the work of psychiatric hospitals where the main, and
often the only method of influence remains medicine. In this connection, apparently, the

18
duration of stay in daytime hospitals is rather short (the average stay – 36 days) in
comparison with similar structures in the countries of the European Union.

In hospitals in Chisinau and Balti there are medical–labour workshops accordingly for
250 and 50 persons

An important concern is the increase in number of patients who have a degree of

disablement. In 2001 there were 42.1 such patients per 100.000. There is insufficient
development of rehabilitation programs, inattention to other opportunities and kinds of
aid, except for medicines.

As a conclusion to this part, I would like to stress the rigidity of the whole system and
the lack of rehabilatation programmes. Also the concentration of aid in certain centres,
rather then being evenly spread throughout the country. Of course changes are blocked
by absence of the necessary funds, but I am not sure that this is the only reason. Sadly
I do not expect to see any serious changes in this field in the near future.

Prospects of Development of Mental Health in the Future

It happened so that our partner in Moldova, the nongovernmental organization

"Moldova – Philantropie", was invited for participation in elaboration of a long–term plan
of development of services of mental health in 2003 – 2008.

In the enclosure one can find the detailed project of development of mental health in the
country which is to be approved by the Board of Ministry of Public Health, and then will
be authorized by the Government.

As a project, some changes can be made to it, especially taking into account the fact
that the majority of items of the project at present have no financial support.

I will express my point of view only concerning certain items of this project and the
prospects of development of mental health the nearest future. It is important that the
project initially provides for clinical–epidemiological research of the real state of the
needs (р. 1.1.) Also I have several questions:

1. What method will be used to carry out this research in view of the fact that its
terms are rather short?

2. How will the real needs of our beneficiaries be investigated? How will the
relevant information on their needs be obtained?

A whole number of items will be devoted to the development of various instructions,

standards on rendering aid and efficiency of various aspects of aid in the field of mental
health, including legal and social aspects.

In the 2nd part there is an important item – creation of the Republican Scientific –
Clinical Centre of Mental Health for the development of aid rendered to the population.
In this sense, this institution, provided that it is well organized, could make for the
approach of services in the field of mental health and the best understanding of needs
of our beneficiaries.

19
Item 2.11 - in supposing the opening of a house for persons suffering from severe
consequences of mental disease. It would be reasonable not to limit the principle of
this house to simply meeting the basic needs of beneficiaries, but include a focus on
rehabilitation goals and individual programs of returning into the society. I insist on this
judgement as, having visited such institutions in Moldova, I faced the same conditions:
beneficiaries are kept in rooms, corridors, without any occupation and personnel are
engaged in their supervision.

I also have some questions concerning the reorganisation of the centres of mental
health. There needs to be teams of psychotherapist, psychologists, and social workers
etc. If they have no experts in the field of psychosomatics, they will carry on with the
practice of prescribing medicines, not including other possible methods of work.

I have no doubt that it is necessary to open a centre for urgent conditions, initially in the
capital of the Republic of Moldova, for example, for people, who tried to commit suicide
and people who try to harm themselves or others.

The opening of the psycho-neurology sanatorium for children and parents (р.2.16.) with
100 beds gives rise to rather serious questions. The main question arising is – How will
the opening of the sanatorium improve the level of services, aid and social
reintegration? I believe that the opening of centres of mental health for children with the
organisation of certain age appropriate activities, would be much more beneficial. The
opening of a sanatorium would inevitably cause separation of children from their home
and family, (including those who suffer from psychoses).

Perhaps the only real and necessary item is the opening of the psychosocial centres in
urban and rural areas (р. 2.15.). These centres would focus their attention primarily at
the needs of beneficiaries and provide all types of activity, in accordance with their
needs.

The third part, concerning prophylaxis does not give rise to many remarks, however, I
think that in this section it would be possible to provide for a certain work with the
population, for example, to use mass–media, to organize certain informational–
educational–training programs in secondary and infant schools etc.

The 4th part, concerning professional training, fails to include social workers. The 5th part
draws one’s attention to the medical provision (р. 5.24). The list of medicines that are
used nowadays, in the field of mental health in Moldova, needs to be reassessed.

It is very important, not only to update the hardware and software in the field of mental
health, but to create a national network in this field which would have access to the
World Wide Web and would be accessible for all users

Drawing a conclusion about the prospects of development, I have an impression of high

level of centralization of actions planned, with insufficient attention to real needs of the
individual beneficiaries. We need feedback from those individuals, their relatives and
close friends. I think that this information will be more objective if the beneficiaries and
their relatives will be able to create their own organisation.

20
Resources of NGO

During my visits to the Republic of Moldova, I paid particular attention to the NGOs.
Their development, efficiency, relationships with governmental & public organisations
and their prospects for the future. My view of NGOs in the field of mental health, is that
they could adapt better to the needs of the beneficiaries and listen more to them.

The non-governmental organisations that began their activity in 1989 have existed in
this young country for almost 15 years. Initially, during the first years of their functioning,
the state structures regarded them with some fear, as something that had come from
the West, from the capitalistic world having a shade of capitalistic ideology.

Gradually, with the increase in number and influence of NGOs, (In 1992 there were 37,
in 1996 163, and in 2000 1400), it became necessary to regulate their activity. This
resulted with the Law on Civil Associations in May 1996. In 1995 they adopted the Law
on Philanthropy, and in 1999, the Law on Funds Activity. Nowadays there are more
than 2500 NGOs in the country engaged in different fields. The majority of NGOs
activity is focused on culture, art, sports, education and training, economic
development, health and human rights protection. More than 50 NGOs are engaged in
women’s problems, more than 30 dealt with the problems of handicap, more than 70
with the problems of youth, more than 40 carry out their activity in the field of ethnic
relations and about 20 NGOs focus their attention on the protection of animals. In
addition 80 organisations are engaged in charity and social aid and have informal
relations with religious organizations.

Despite having such a large number of non-governmental organisations for such a

small country, only about 15–20% are actually capable, have sufficient material
resources and are able to carry out some activity in the chosen direction.

There are many difficulties which NGOs encounter. The following three are the main
ones.

1. Poor material resources

2. Lack of professional training

3. Insufficient co-operation with the state and local bodies

The overwhelming majority of NGOs are reliant in their activity on financial support from
abroad and get it for the development of various projects. Such a situation forces the
majority of actively working NGOs to constantly seek partners and offer new projects.
From time to time they face serious financial difficulties when the financing of one
project has ended and a new project has yet to be accepted for financing.

Only about 3% of NGOs get essential support from the state and, as a rule, these are
organisations that are managed by the relatives of the administrative board of the
country. From my point of view, this situation proves the inability of the state to
redistribute the funds for the needs of the population. The state prefers to allocate the
funds to local authorities and ministries, thus controlling their distribution. At local level
the majority of NGOs (80%) have very weak, undeveloped relationships with local
bodies, bodies which prefer to spend money directly on their functioning, often
competing with NGOs. Such a state of affairs is especially sad in rural areas proven by

21
the number of local NGOs (16.5%) in comparison with the national and regional NGOs
(83.5%).

My meetings with the represented NGO gave me the impression that the state policy on
the stimulation of work of NGOs has the effect of supervising and redistributing material
resources instead of allowing and supporting the activity of NGOs in those directions
which cannot be covered by public services.

On the other hand (I was interested in NGOs engaged in the social sector) NGOs suffer
from the tax pressing, as any other commercial organizations. They have to pay
customs duties for the imported materials irrespective of the fact whether these
materials are for charitable or for commercial purposes. In order to reimburse 20% of
the VAT, according to the contract signed with TASIS, it is necessary to receive the
status of a socially useful organization in the Ministry of Justice, and then to submit the
papers to the Ministry of Finance. These funds can be reimbursed to the NGO only if
the Ministry of Finance approves it This way is very difficult because of the abundance
of bureaucratic delays, but even a positive decision does not guarantee the
reimbursement of funds.

Despite the existing difficulties, the activity of NGOs gradually grows, including those
involved in the social sector.

The General Conference of the NGOs Alliance of the social sector took place in April,
2003, those present included Department for International Development (UK), the
European Commission, UNICEF, USAID, Eurasia, the World Bank as well as some
representatives of the Government and the Ministries (of Labour and Social Protection,
and of Education). The NGOs Alliance of the social sector was established on 1.8.
2002, and initially directed its activity toward four basic directions:

1. Consolidation of the network of NGOs of the social sector;

2. Exchange of information on the activity of NGOs and determination of the

directions of the further development;

3. Mutual professional training as an important factor for the increase of

professionalism of the employees of NGOs;

4. Lobbying of the interests for decision making at the national and local levels, in
order to change the legislation and the mechanisms of its implementation.

The network of NGOs of the social sector includes associations of NGOs in 8

directions:

1. NGOs Alliance in the field of social protection of Children and Family.

2. NGOs Alliance in the field of social protection of persons with handicap.

3. NGOs Alliance in the field of social protection of aged persons.

4. NGOs Alliance in the medical–social field.

5. NGOs Alliance in the field of maintenance of national values "Bastina".

22
6. NGOs Alliance of professional groups of professional sphere.

7. A forum of women’s organizations.

8. Network of NGOs working in the field of prevention of HIV/AIDS, sexually

transmitted diseases and toxicomania.

At present the greatest number of NGOs work in the protection of children and families
(more than 93), probably, because there is the opportunity of financial support.
One group is working with children with various physical and mental defects (convulsive
states, deafness, general physical abnormalities, Down’s disease, cerebral paralysis,
etc). Plus there are NGOs is engaged in protection of the rights of children who have
no parents. Another direction is the protection of rights of mothers and children in
difficult situations. There are many NGOs providing help in children’s development,
gaining of knowledge and skills, familiarizing with culture and art, in short-education.
The greatest number of NGOs of this Alliance is concentrated in Chisinau (30), in Balti
(20), in other cities of the Republic – (5).

The second according to representation is the forum of women’s organizations (25)

working mainly in the directions of protection of the rights of women. The main purpose
of this forum is to provide help to women in overcoming of those patriarchal, cultural
tendencies which in many extreme cases result in physical violence. They also exist for
lone women, especially those who in difficult financial conditions with dependent
children. From my point of view, the services and sources of support in this area are not
sufficient and have no opportunity to satisfy even basic requirements.

The third, according to the number of NGOs included in it, is the Alliance of
organizations engaged in protection of aged persons (22). They can be most effected
by difficult conditions of life in Moldova. The main direction on which the activity of
NGOs of this Alliance is concentrated, is to help these aged people to survive and to
provide them assistance in everyday life. It is absolutely clear that the meagre
pensions, which is several times lower than the living wage, does not allow these
people to eat and dress properly let alone pay for public utilities etc. Another severe
reality for the aged persons is their health care. Some NGOs try to solve this problem,
often with modest successes and in completely insufficient numbers. There is the
problem of loneliness. The considerable migratory wave which shows no sign of abating
and concerns young persons. Those young people who should be a support (not only
financial) for the aged persons. This state of affairs is especially sad, if one takes into
account the historical, way of life of Moldovan families where old people reached a
great age next to their sons and daughters surrounded by their care and attention.

It is absolutely clear that the network of NGOs developed for today is too small, does
not solve the numerous problems of the society, so that the voice of aged persons,
children and women not always sounds loudly enough to reach the ears and more
importantly, the hearts of people in power.

There are not many NGOs, involved in professional research at universities. Or who
have based their work on research (according to resources, rural development,
education and family, protection of children and families, development of social aid).
Where they do exist the activity of these NGOs is not limited only to research, they also
try to implement different projects aimed at the change of the existing state of affairs.

23
The main goal of the association of NGOs "Bastina" in order is to support national
values. It has a pro–Romanian orientation. It develops activity of a cultural and ethnic
nature between the two peoples, Moldova and Romania. Its actions are widely covered
in mass–media, as well as stimulation of publishing.

There are very few NGOs who deal solely with the prevention of HIV/AIDS and sexually
transmitted diseases. Taking into account the low level of education of the population
concerning these diseases and the lack of funds for the development of full scale
preventive measures. It can be assumed that in the near future the need for NGO’s in
this area will become extreme.

I am surprised by the disproportionately small number of NGOs working with drug

addiction and alcoholism. There may be several reasons one is the atmosphere of
condemnation and aversion of all layers of the society towards the dependent persons.
This does not acknowledge the need for help. The main idea feeding this position is
concerned with the necessity of refusal to use alcohol or drugs, which on belief of many
people will by itself lead to the substantial improvement of the social status of these
persons. Everything would be all right, if it was as true as it is desirable.

The last, the 8th Alliance including 8 NGOs, concerns medical and social sphere, and
this Alliance includes our organization – partner "Moldova–Philantropie". Besides
"Moldova–Philantropie" into this alliance enters the NGO "Memorie" providing aid to the
victims of violence, the team includes doctors of different specialities (including a
psychiatrist), a social worker, a psychologist and a lawyer.

Another NGO "Angelus–Moldova" is engaged in all kinds of aid to dying persons. At

present this organization functions as mobile brigades, assisting at home. In these
brigades work oncologists, therapists, psychiatrists–psychotherapists from "Moldova–
Philantropie" and social workers. Angelus–Moldova is the only NGO in this Alliance that
received a building from the municipality. However, this building is in a very bad
condition, and the NGO has no funds in respect of its repair.

The Medical Centre "Emanuil" is a medical–social structure with rather serious religious
orientation (the source of its finance), rendering assistance to different kinds of
beneficiaries. However, the emphasis is on persons of the same religion as the
founders of the centre.

The NGO "Oameni Generosi" structures its activity in the field of medical and social aid
to aged persons. The NGO "Ghipocrat" renders medical and social aid to children from
difficult families. The NGO "Environment and Health" focuses its attention on the
environmental problems.

At present representatives of the Alliance organize regular meetings, render mutual aid,
for example, "Moldova–Philantropie" consults, if necessary, the beneficiaries from
"Memorie", "Emanuil", "Angelus", "Oameni Generosi".
The carry out work on the development of strategic direction of the Alliance and
lobbying the Municipality and in turn the state structures.

Currently, the only NGO of the alliance dealing with the problems of mental health is
"Moldova–Philantropie", which, judging by the level of competence and efficiency of the
team is one of the leaders of the Alliance (presentation of "Moldova–Philantropie").

24
Summarising this part of the report there are two main points. First is the dependence
of the NGO’s for finance and the instability this can create and some level of
dependence on the state structures. The state has the aspiration to supervise the
activity and the budgets of these organisations. The second point is the potential of the
NGO’s for creative activity that meets the needs of neglected sections of the population.

No doubt that NGOs have a big future, though currently they are rather controlled.

Prospects of Social Aid

Prospects for the development of mental health services is depressing slow partly due
to financial reasons and partly or largely due to mentality. My own experience is of an
indifference of the majority of members of the society to problems that do not have the
aspect of personal. I understand very well that the conditions of difficult life result in an
individual focusing on personal survival and neglecting active inclusion in aid and
support of the others.

I will in detail describe the particularities of the social aid in Moldova to the persons
suffering from the consequences of mental diseases.

From the many conversations I had with the representatives of NGOs and beneficiaries
I have found that the aid rendered by the state as pensions, pays and privileges is
absolutely insufficient for survival. It does not cover the minimal expenses of the
citizens of this category. It is absolutely natural to raise the question about the ways that
allow them to survive. One way is through the support of the family, relatives who
assume a part of these expenses, sometimes the greater part. However, the person is
then at risk of be perceived as a burden by the members of family. Support can be
provided to the vulnerable person by, creating different kinds of centres, support, clubs
and any forms of leisure outside of the family or with the family, but not requiring the
participation of family in such a degrees as in everyday life.

There is the necessity of work with the members of family in order to create the minimal
environment of dialogue and support. If necessary, services of a medical, social
educational or legal nature, provided. Informational–educational work in various aspects
of aid and care and the consequences of mental diseases, is very important. This basic
work is absolutely undeveloped in the Republic of Moldova.

Another important aspect of the aid is complete and up to date treatment which should
follow a comprehensive assessment. This would reduce the weight of consequences of
mental disease of these persons and to prevent the complications concerned with long
treatment with less qualitative medicines. Currently this is not possible. A monthly dose
of Risperidoni is more than 4–6 months pensions. It is essential that NGOs working in
this field can and should continue their efforts to improve this situation.

However, The State, The Ministry of Public Health, Finance etc. are largely responsible
for the current situation and should be actively promoting positive changes for their
most vulnerable citizens.

Unfortunately, annual reduction of budget runs counter to this necessity, which,

alongside with delay of introduction of medical insurance brings bad prospects. The aid

25
that used to be active as humanitarian cargoes or aid provided by international
associations (Pharmacists Without Frontiers) has lost its influence for many reasons.
One is the illegal sale of the medicines. Another is the state rigid supervision of the
receipt of medicines resulting in commission on humanitarian aid brought into the
country.

Probably, such organisations as Pharmacists without Frontiers discontinued their

activity on the territory of Moldova because of competition, with representatives of
pharmaceutical business and the corruption of the officials.

The economic situation of the country in many respects determines the existing state of
affairs. There is much work to be done and always the question of who should pay for
it? Ideally it should be possible to provide a sufficient level of provision of medicines to
all persons in need. The role of the NGO’s should be increased to address the level of
reception and distribution of medicines and humanitarian aid.

An existing problem is that there is no definite legislative base to provide protection to

an employed or an employable person, protecting his or her employment rights when
faced with mental health issues. At the moment when the employer gets information or
a suspicion of mental defects in the employee, the destiny of this employee is
predetermined: very soon this person will be fired or, at best, will be transferred to
poorly paid post

What is needed to change the existing situation? First of all changes in the legislative
base and its implementation. NGOs may play an important role in lobbying of the
legislative acts and place a priority on this task. Secondly educational work on mental
health through mass–media and schools and universities etc. Thirdly, the creation of
special workplaces. NGOs could provide protected workshops, which would take into
account the wishes and interests of the beneficiaries, and also the unique features of
their work, can be a very important and prompt way of improving the situation. The
State needs to develop the policy of social service, which in turn could work in harmony
with the NGO’s and the mass media campaign and promote the legislative framework.

Social aid provided to the persons suffering from the consequences of mental diseases
is limited on many fronts for example living conditions and the protection of right of
habitation. Many live without utilities (water, gas, and electricity) because they get debts
and cannot pay the utilities bill. Often they are encouraged out of their properties and
subsequent placements are made in houses for mentally chronic patients, or psychiatric
hospitals. Relatives and other individuals can make gains. The paradoxical and the
cynicism of this situation consists in the fact that everybody knows about this fact but
the state structures do not organize the proper protection of the interests of
beneficiaries. Sadly legal services, from a lawyer to a judicial, prefer healthy
unscrupulous persons and their money, sometimes not even noticing the obvious
injustice of this event. I understand the gravity of this statement. This is the extent of
the problem, based on what I have seen and heard.

What prospects of change of the existing situation could be activated in the nearest
months, years?

Each person’s property and rights should be protected. Actions of all those involved
should be accountable. Perhaps if NGO’s had an individual’s circumstances and if
changes were then submitted to the NGO they could protect the rights of the individual

26
and exercise legal opportunities of protection and return possessions of those persons
which were illegally deprived. The NGO’s could create mobile services, which could, as
often as necessary, visit and help the beneficiaries and their everyday life. Isolation
would be decreased, knowledge of rights and sources of help increased.

For those who can live reasonably independently, protected apartments could be
provided. Again the potential project of an NGO.

I think that what I have described in this part, mostly based on what I felt and
understood, has greatly touched me and made me even more convinced in my will to
continue, at any price, the work in this country, supporting those who already try to do
something. The more interest that exists, the more determined individuals are the
sooner the state of affairs will change for the better, despite difficulties.

Legislative Base

In this part of my report I have decided to focus my attention on the only one law ‘About
Psychiatric Aid’, leaving out other legislative acts (About Philanthropic Activity, About
Funds and others) which have an indirect relation to mental health.

My interest namely to this law is clear, the legislative environment, is inevitably reflected
in protection of persons suffering from the consequences of chronic mental diseases.
However, beside the contents of the law, is the implementation of its articles. I observed
much during the days of working side by side with my Moldovan colleagues.

Evidently, this law was based on the principles of humane attitude to the beneficiaries,
which is mentioned in the first article. In practice such humanity is less visible, this was
clear during my visits to medical institutions. Humanity, in my opinion, means the
freedom and individuality of every person.

I think that the rules of international agreements marked in the 2 nd article is very
important, as well as the presence in art. 3 of the regulation about equality of all
persons before the legislation of this law irrespective of the citizenship.

As to art. 4 concerning the voluntary address for psychiatric aid, art. 22 on psychiatric
survey; 23 psychiatric survey without the consent, in some cases psychiatrists introduce
themselves as doctors of other specialities. This happens mainly at the request of the
relatives or other third party. For example when in the case of acute delirious condition
with expressed negative attitude to psychiatry. I think that here it is important to
understand the purpose of such infringement: if it results in earlier, adequate treatment,
should this be seen as an infringement? The situation is more serious with minors,
teenagers; the deviations in their behaviour are not concerned with mental diseases,
and the persistence in desire of their relatives to consult them is very high. According to
this law, a person under 18 is considered minor, and I think that in such situations more
often there are situations formally right from the point of view of the law when the
parents responsible for the teenager insist on consultation, and the teenager is
categorically against it.

In my opinion, namely the following arts. 5, 29, 36, 38, 42 can be infringed more often
than others. In psychiatric institutions the medical staff can be too quick to use brute
force. People are subjected to humiliation. The information on disease and treatment is
very seldom told, I have an impression the beneficiaries are put in position of a child,

27
and the adults (the personnel) decide on everything concerning his/her destiny. The
duration of stay in hospital is another delicate topic. It is clear that the average duration
of stay in hospital considerably exceeding the figures of the developed countries.
People are kept too long in hospitals for the several reasons. The main one is the lack
of development of services in the community. In addition there is an abundance of
unsolved social problems. For example, the number of hospitalised people rises in
wintertime when there is the problem of heating the dwelling and the cost of food rises.
I have some doubts about the effectiveness of the legislation to maintain sanitary and
Hygiene requirements. For example, one toilet for the whole section of 60–75 persons.
The implementation of article still remains in rudimentary state, because none of the
people whom I met, remembered the arrival to hospital of a lawyer which would come
especially to protect the interests of the hospitalised patients or to control the
observance of the rights or living conditions (art. 44 and 45).

The whole weight of the psychiatric diagnosis is inevitably made in art. 6, for, as I have
understood, the ascertainment of the diagnosis of a certain disease results
automatically in interdiction, in most cases proved, to certain occupations. It seems to
me that the fatality of restrictions is excessive. In order to restore the sanction to certain
kinds of works, the diagnosis should be cancelled, what is very uneasy. For this
purpose the person should address himself/herself to the Ministry of Public Health with
an application that has to be submitted to the chief not on the permanent staff
psychiatrist, and then the psychiatric commission has to be created which will confirm
or cancel the earlier revealed diagnosis. Apparently, I was touched by the fact that they
do not take into account the complication of disease and its dynamics, besides so many
bureaucratic delays. I have an impression that the person is strongly covered with «the
curtain of diagnosis» and almost does not exist for the society having an attitude to
psychiatry as the person at a certain stage can overpass the disease. And in this case
there will be a collision with lawlessness and inability to prove the restoration of
qualities and abilities of the beneficiary because of the domination and principle of
probable return of disease.

There is no doubt the art. 7, art.24 are very important, however I have an impression
that it does not work. One reason is the fear before the centralized state system of the
psychiatric aid. On the other hand, the institute of official representatives, trustees, is
rather formal as it has no mechanisms of control of the efficiency of aid and protection
of the beneficiaries.

Articles 8 and 9 about interdiction to provide information on the mental disease and
about medical secret as a whole are observed, though can be very easily infringed, for
example, for some payment. Officially the information on the diagnosis can be provided
as a reply to the inquiry of legal and other psychiatric establishments.

If the questions of diagnostics stated in art. 10 are close to the world standards; then,
the questions about treatment are rather far from the practice of the developed
countries. Also Moldova must look at models of rehabilitation. My concern is also that
medicine is used as punishments.

The protection of right on the consent to treatment (art. 11) also faces some difficulties.
As I have already mentioned, it is rather easy, under pressure, to get the consent to
treatment of people whose mental condition does not allow them to render sufficient
resistance to such influence. Significant others such as friends and family often cannot
represent their interests sufficiently. The state of affairs is even worse when it comes to

28
explanations of disease and treatment. As a rule, the beneficiaries remain passive
recipients, they are substantially deprived of the possibility to be heard, receiving in
reply to their questions and requests only rough answers.

I do not have an impression that there are rough infringements of the legislation in the
field of formal requirements to compulsory hospitalisation.

However, as I have understood, the rule of "phone call" from a higher officer or some
money can affect the duration of compulsory hospitalisation (including art. 13) or not
voluntary hospitalisation (art. 28), or hospitalisation of minors (art. 30), or not voluntary
prolongation of the period of hospitalisation (art. 35).

There can be no obstacles to keep the beneficiaries in hospital; despite of their

requirements to discontinue their guaranteed treatment art. 12. From the available
information I have found out that cases of submission of complaints about such abusing
are extremely rare.

The judicial–psychiatric examination is carried out according to art. 14 by special

commissions of doctors – psychiatrists – experts in out–patient or stationary conditions,
on the assignment of judicial instances on the basis of 2 largest psychiatric hospitals of
Chisinau and Balti.

The observance of art. 15 concerning military examination are still used in order to
escape from the obligatory military service. This is an infringement of another character,
when the doctor and the client have an arrangement in order to manipulate the
diagnosis.

From the aforesaid comes the understanding of difficulties in the maintenance of

observance of art. 16 concerning the state provision of kinds of psychiatric aid. The
infringement of the items of this article concerning the out–patient aid is that their simply
does not exist a sufficient out patient service. What does exist is not accessible to large
sections of the population. Similar infringement is the lack of provision of social aid,
assistance and employment to the persons suffering from the consequences of mental
diseases of any age.

Definitely there is no state program on creation of workplaces for this category of

citizens. This item is not implemented, inclusively, concerning the medical–labour
workshops.

Despite the presence in the law art. 18, allowing private practice, there is very few
private cabinets. In my opinion, this is because of the, high rates of taxation,
bureaucratic delays in providing the license, and limited possibility of obtaining a cash
flow either from the state or individual patients.
I do not have any special comments to a number of articles (19,20,21) that concern the
rights and duties of the personnel rendering psychiatric aid.

My attention drawn by arts. 25, 26, determining the particularities of the out–patient aid
and dispensary supervision. More emphasis should be on the consent and involvement
of the beneficiary

29
As a conclusion, my concern is not so much the law itself which could be improved but
its interpretation and implementation. In this direction, unfortunately, I cannot note any
progress neither from the state nor from other public organizations. I think that an
enormous progress would be made if practice was more transparent and made to be
accountable. Only then would there be improvements in the field of mental health. The
Republic of Moldova needs to reach towards international standards in this area.

Conclusion

Having once again read what I have written I realise there is so much to be done. There
is much to be done to provide services to, and help those who live, feel, and think
differently, owing to the temporary mental chaos in their heads.

No doubt that there is a big difference in forms of rendering assistance in Moldova and
in the countries of the European Union. The difference is especially noticeable when we
talk about the conditions in which the patients are kept and in attitude to the persons
suffering from the consequences of mental diseases. Both of these factors can only
improve if people change. I know that people can change, this has been demonstrated
during my time in Moldova.

Despite the work that lies ahead, I am optimistic that we are in the beginning of
considerable changes in the field of mental health. I view the activity of NGO’s and
public organisations as crucial. They are able to mobilise the society and make it
understand the importance of such changes. NGOs can co-ordinate their activities and
establish constructive relations with the state structures. They can work together with
different ministries and with public organizations. Often the staff members have
experienced different training, have a mature independence and most the desire to
unite and work together for change.

30
Bibliography used in the text
1.Berdaga, V., S. Stefanet, and O. Bivol, Access of the Population of the Republic of
Moldova to Health Services. 2001: Chisin
2.Cerbu, A., Public Health of the Nation as a Sum of Individual Health. Study carried
out in the frame of the project "UNDP NHDR: Moldova 2002". 2002, Scientific Practical
Center for Public Health.
2.Chiritoiu, B.M., An evaluation framework for health social insurance. Comparative
study on Romania, Hungary and the Czech Republic. 2001, Open Society Institute.
3.European Bank for Reconstruction and Development, Transition report 2000,
Employment, skills and transition: Economic transition in central and Eastern Europe,
the Baltic States and the CIS. 2000, European Bank.
3.European Commission, Civil Society Drug Demand Reduction. Phare networking
facility programme. Guidelines for applicants to call for proposals 2002. 2002, European
Commission.
4.Healy, J. and M. McKee, Implementing hospital reform in Central and Eastern
Europe. Health Policy, 2001. 61: p. 1-19.
5.Institute for Public Policy and C.E. Initiative, New Borders in South Eastern Europe.
The Republic of Moldova, Ukraine, Romania. 2002, Stiinta: Institute for Public Policy
4.Maclehose, L., Health Care Reform in the Republic of Moldova. Euro Observer, 2002.
4(4): p. a5-6.
6.Maclehose, L., Health Care Systems in Transition: Moldova (Draft). 2002,
Copenhagen: European Observatory on Health Care Systems.
7.Macovei, M. and A. Coman, Implications for HIV/AIDS of laws affecting men who
have sex with men in Romania ACCEPT (The Bucharest Acceptance Group). Med Law,
1999. 18(2-3): p. 335-49.
8.Michnea, A. and I. Gherhes, Impact of metals on the environment due to technical
accident
9.Ministry of Health, Public Health in Moldova 1999. 2000, Scientific and Practic Center
of Health and Health Management
10.UNICEF: Chisinau.
11.Ministry of Health, Health Status in Moldova 2000. 2000, Scientific and Practical
Center for Public Health and Management: Chisinau.
12.Ministry of Health Romania and WHO/Europe -Liaison office in Moldova, Direct
Support to the Molavian Ministry of health in the field of Healthcare reform 1998 - 2001.
2001, Ministry of Health Romania,
13.WHO/Europe -Liaison office in Moldova.
14.Moldova, R.o., Republic of Moldova 2001: National Environmental Health Action
Plan. 2001.
15.Moldova, R.o., PRSP Preparation Status Report - Republic of Moldova. 2002:
Chisinau..
16.Republic of Moldova Ministry of Health, Multi-year strategic plan for immunization
2002 - 2006. Draft. 2001.
17.UNDP, National Human Development Report, Republic of Moldova. 2000, UNDP.
18.UNICEF, The Situation of Children and Women in the Republic of Moldova 2000.
Assessment and analysis. 2000, UNICEF.
19.UNICEF, Multiple Indicator Cluster Survey. Republic of Moldova - 2000. 2000,
UNICEF.
20.UNICEF, Poverty and Welfare Trends in Moldova over the 1990s. Country paper.
Background paper prepared for the Social Monitor (2002). 2002, UNICEF Innocenti
Research Centre: Chisinau.

31
21.UNICEF, UNOHCHT, and OSCE-ODIHR, Trafficking in Human beings in
Southeastern Europe. Current situation and responses to trafficking in human beings in
Albania, Bosnia and Herzegovina, Bulgaria, Croatia, The Federal Republic of
Yugoslavia, The Former Yugoslav Republic of Macedonia, Moldova, Romania. 2002,
UNICEF,
22.United Nations, Republic of Moldova Common Country Assessment (draft). 2000,
United Nations.
23.WHO, Hospital Restructuring in Moldova. Mission Report. 1999, WHO:
Copenhagen.
24.WHO, Highlights on Health in the Republic of Moldova. 2001, WHO: Copenhagen.
25.World Bank and Government of Moldova, Moldova Health Sector Reform Project.
Restructuring Health Services in Central Judets. 1999, World Bank,
26.Government of Moldova.

32
 PROJECT

GOVERNMENT OF THE REPUBLIC OF MOLDOVA

DECISION no.________

From__________________2002
Kishinau

NATIONAL PROGRAM
For Mental Health Development
2003-2008

In conformity with the Law of the Republic of Moldova (RM) for psychiatric
assistance no. 44-46/310 from 21st of May 1998, for the population’ Mental Health
Research, Assistance and Protection, the National Program for Mental Health
Development 2003-2008 is approbated:

I. General positions

1. The National Program for Mental Health Development 2003-

2008 (further Program) ensures state policy in the sphere of Mental Health
Research, Protection and Assistance of Moldavian population.

2. Activities to be realized within the Program will be

harmonized with the statements of Constitution and fundamental Laws of
the RM, Parliament and President Decisions, Governmental ordinances,
and International Legislation.

3. Taking into consideration the Program originality, its

implementation depends on the profile of activities (medical, social,
psychological, educational and judicial), through collaboration between the
Ministries (Public Health, Labor and Family Protection, Education, Internal
Affairs and Justice).

II. Problem actuality

Mental Health is known as the main patrimony of the Nation and of the State and
ensures their stability, existence, and continuity.
European Community (EU) estimates Mental Health as medical, social,
multifactor phenomena, which includes mental disability and psychological factors that
often provoke and accompany Mental Health.
EU requests provide prevention, diminution, and annihilation of mental
disabilities through implementation of the Communitarian Psychiatry Concept.
This Concept assumes the development of hospital and extra-hospital services,
assisting Mental Health in these spheres in conformity with population’ demands.

33
 The real and objective estimation of Mental Health evolution of the population
and its conditions, and influence of the State can be obtained only through the creation
of The Scientist-Practical Center for Research, Assistance, and Protection of human
mentality.
Mental incapacities are an important source of disabilities that occupy the first 5
positions of 10 in the deceases hierarchy in dependence of predisposition to any type of
disability.
The importance of this problem consists in the fact that mental decease, in
contrast to the somatic deceases, presents a source to social micro-group (family,
profession) misbalance.
Exists negative public opinion referring to the mental deceases, mentally affected
people, specialized institutions, and those who take care.
Mental Health is the society major preoccupation and for every person it is
valueless. The prior attention should be paid to this problem. Such indicators as:
motivation for medical consultation, pathology, and nature of habilitation or handicap,
use of medicines puts mental incapacity in the first lines.
Mental disabilities can change person’s attitude to his life, to himself, to society,
as well as the attitude of society to the person.
The mental health and psychiatrists’ assistance are the complementary parts of
the necessary intervention to obtain good results. Both, are the essential elements of
multilateral strategy of mental health, and the balance should be maintained between
them. This balance will be based on: economical, ethical, historical, cultural and
structural factors and conditions (including accessibility for social and mental health
services).
During the last years, morbidity, invalidity and mortality of republic population
continuing to rise with predominance of schizophrenia, mental affections, mental
organic disabilities, mental retardations.
The number of family violence, stressful situations, and other tense positions,
caused by bad social economic state, increased in society. More affected are social
vulnerable people and in particular children. The number of suicides is raised.
Some of the causes that influence this process are: unemployment, alcoholism,
and drug addiction increase, especially among children and teenagers, reduction of free
of charge ambulatory treatment and support for mentally deceased people.
There is a need to generate hospital mental health services in the national
system of hospital health services.
Mental health should be located at the agenda of the state policy for sanitary and
the state should find possibilities for its practical promotion.

III. Program goals

• Consideration of mental health a scientific, fundamental, interdisciplinary

problem.
• Reduction of morbidity, mortality, and invalidity coursed by mental deceases and
amelioration of mental health on the society level.
• Increase of accessibility and efficiency of psychiatrist’s assistance.
• More ample integration in family and society for mentally disabled persons.
• Alteration of communitarian attitude to mental health and to people with mental
disabilities.

IV. Program objectives

• Reduction of risk and vulnerability factors for mental decease.

34
 • Implementation of superior location of mental health concept in the society
value system.
• Reformation of mental health assistance.
• Elaboration of primary, secondary, tertiary prophylactic strategies.
• Promotion of differential psychiatric assistance for mentally deceased
people, depending on evolutional stage of decease with possibility of treatment,
ergo-therapy, and socio-therapy.
• Priority development of extra-hospital mental health service for children,
teens, adults, and elderly persons.
• Harmonization of Research, Assistance, and Protection of Moldova mental
health with European Community standards and demands.

V. Program principles

The Program success depends on following factors:

• Recognition of Assistance, Protection, Research in the field of mental
health in RM to be one of the state development priorities.
• Appreciation of mental health as a state, multifactor, and inter-ministerial
problem.
• Coaching of public central, local, and communitarian administrative
authorities.
• Promotion of human rights of mentally disabled people is one of the
principle conditions of the Program fulfillment.
• Creation of a group for connection with fallowing systems:
a) General medical system;
b) University education and scientific research;
c) Educational system;
d) Institutions for correction and prevention of antisocial actions;
e) Mass-Media;
f) Associative communitarian systems.
• Monitoring of Program realization and its evaluation.

VI. System of mental health assistance and care

Reformation of the system of mental health assistance and care will be

implemented in accordance with international experience through the fallowing
principles:
1) Territory;
2) Therapeutic staff;
3) Care continuance;
4) Specialization (multifactor: age, pathology, therapeutic
intervention);
5) Communitarian orientation;
Psychiatry assistance system in RM will include:
• Republican Center of Research, Assistance, and Protection of human
mentality;
• Mental Health Centers;
• Psychiatric Hospitals;
• Departments (psychiatry as a compartment in general hospitals);
• Permanent hospitals;
• Interventional Centers for mental crisis cases;

35
• Psychiatry Assistance Emergency Service;
• Recuperation Centers;
• Centers for chronically mentally deceased and demented persons;
• Communitarian Services for Maintenance, Inclusion, and Integration of
mentally deceased persons in family and community.

36
 VII. Activities stipulated in the National Program for
Mental Health Development 2003-2008

No. Activities Executio Responsible Financing

o/n n period for execution
I. General organizational measures
Implementation of clinical-epidemiological
investigations, regarding “Mental deceases”, having
as object evaluation of Mental Health Evolution and
Conditions, people’ necessities in this field, Ministry of
contacting with Ministry of Public Health: Public Health,
2003-
1. • General information The University
2005
N.
• Information on children under 6 years old
Testimitianu
• Adults
• Capable and able people
• Disabled people
Estimation of competence and abilities of family
Ministry of
2. doctors to ensure Primary Assistance in the sphere 2004
Public Health
of Mental Health.
Ministry of
Elaboration of Standards, Regulations, Ordinances 2003- Public Health,
3.
in the field of Mental Health. 2005 Government
Departments
Elaboration of suggestions for completion and 2003-
Ministry of
modification of Moldavian legislation to promote 2006
Public Health,
4. human rights of mentally disabled people: Civic
Ministry of
Code, marriage and family legislation, housing
Justice
resources legislation, Labor and Pension Code.
Ministry of
Elaboration of necessary acts for juridical
2003- Public Health,
5. assistance, psychology, psychotherapy services in
2006 Ministry of
institutions of psychiatric assistance.
Justice
Vast implementation of nursing in activity of Permane Ministry of
6.
institutions of psychiatric assistance. nt Public Health
Evaluation and elaboration of 2 scientific-practical
themes in the field of mental deceases by the
University “N. Testimitanu”:
• “Psychiatric stationary assistance” – Ministry of
2003-
7. Psychiatry and Medical Psychology Public Health,
2005
Department USM
• “Extra-hospital psychiatric assistance” –
Psychiatry and Necrology Department of
FPM
Ministry of
Elaboration of improvement measures for legal 2003- Public Health,
8.
psychiatric assistance based on new conditions. 2004 Ministry of
Justice
Ministry of
Elaboration of construction, architectural, interior
Public Health,
9. and exterior equipment requirements for institutions 2004
Ministry of
of psychiatric assistance.
Construction

37
 Governmental
Organization of an Independent Governmental
Department of
Service to control and monitor efficiency of mental
10. 2004 Social and
health assistance and to respect rights of disabled
Judicial
people.
Assistance
No. Activities Executio Responsible Financing
o/n n period for execution
II. Organization, reorganization, reconstruction, and succession of specialized institutions
Proposed by Ministry of Public Health through
Governmental Decision is being established The
Republican Clinical – Scientific Centre for
Government
Investigation, Assistant, Implementation of 2003
11. of RM
Communitarian Services to assist Mental Health and
Ministry of
Promotion of mentally disabled people’ rights,
Public Health
Municipal Shelter for chronic mentally deceased
and demented people – 200 places.
Under support of Local Public Administration are
Ministry of
being organized centers of mental health with 2 2003-
Public Health
12. doctors – psychiatrists (for adults), 1 doctor – 2004
Local Public
psychiatrist (for children), 1 speech therapist, part
Administration
time jurist, 2 social assistants.
To introduce in a staff scheme of specialized
institutions a psychiatrist for children and Ministry of
adolescents: - 1,0 psychiatrist salary for 15000 2003- Public Health
13.
municipal infantile population, -1,0 psychiatrist salary 2004 Ministry of
for 50000 rural population, -1,0 psychiatrist salary for Finance
25 patients in daily hospital for children.
Ministry of
Chiefs of Municipal and Sector Departments for For the
Public Health
14. Health open sections for treatment of patients with program
Local Public
psychosomatic disabilities. period
Administration
Ministry of
Under support of Local Public Administration daily For the
Public Health
15. hospitals with 10-20 places are being organized in program
Local Public
local general-profile hospitals. period
Administration
Ministry of
To organize and register 3 consultative centers in
2006- Public Health
16. the field of mental health: North – Belts, Center –
2009 Local Public
SCP, South – Cahul, Comrat.
Administration
Restructuring of SCP sections on the basis of Permane Local Public
17.
mental morbidity structure in the republic. nt Administration
Ministry of
To organize in Kishinau Municipal Center of Crisis Public Health
18. 2007
Intervention. Health
Department
Ministry of
Public Health
Municipal
To organize Municipal Center for mentally retarded
19. 2005 Mayor Office
children with 5 days per week attendance.
Ministry of
Social
Protection

38
 Ministries of
Public Health,
To open in RM a psycho-neuralgic sanatorium (200 2005-
20. Education,
places) for children with mental disabilities. 2006
Finance
Syndicates
To organize the Republican and Municipal Center in Ministry of
Kishinau with subdivisions for children and Public Health,
2003-
21. adolescents, day hospitals on the basis of Ministry of
2004
Psychiatrically Health Center not on the territory of Finances
Costiujeni.
No. Activities Executio Responsible Financing
o/n n period for execution
Ministry of
Public Health
2003-
22. Reorganization of the epilepsy centers in SCP Psychiatry
2004
Clinical
Hospital
Ministries of
Organization of psycho-neuralgic sanatorium for
2006- Public Health,
23. mentally deceased children (4-16 years old)-100
2008 Education,
places.
Syndicates
III. Prophylaxis of mental deceases
Elaboration of measures in the direction of Ministries of
diminution of harmful actions, as the major factors Public Health,
provoking mental deceases, traumas, vascular 2006- Labour, and
24.
pathology, alcoholism, infections, stressful factors, 2008 other
negative psycho-social factors (unemployment), Ministries
financial dependence, negative family climate, etc.
Elaboration of methodical literature regarding mental
service activities in such directions as: early reveal
2005- Ministry of
25. of mental deceases, prophylaxes of socially perilous
2007 Public Health
actions among disabled people, rehabilitation of
mentally ill persons.
Early reveal of the mentally deceased with help of
Permane Ministry of
26. the family doctors, preventing measures for children,
nt Public Health
adolescence 15-17 years old.
Elaboration, edition, and publishing of an ABC-book
Ministries of
for children of under school age “The ABC of Human Permane
27. Public Health,
Mentality”, and of manual for alternative lessons nt
Education
“Mental Education”.
Implementation and carrying out of some training Ministries of
with children, adolescents, and adults on anti-social Permane Public Health,
28.
actions. nt Justice,
Internal Affairs
IV. Personnel training for psychiatric assistance institutions
Working out of suggestions regarding modification of Ministry of
training process and rotation of psychiatrists, Public Health,
Permane
29. psychotherapists, and family doctors, on the basis of State
nt
public health reform. University N.
Testimitanu
30. Initiation of teaching programs in the field of 2004- Ministry of
psychiatric assistance for children and adolescents. 2005 Public Health,

39
 State
University N.
Testimitanu
Evaluation and elaboration of training programs in Ministry of
the sphere of mental assistance and nursing through 2007- Public Health,
31.
rendering assistance to elderly people and chronic 2008 Medical
mentally deceased. College
Ministry of
Participating in international conferences and Permane Public Health,
32.
symposiums on mental assistance thematic. nt Hospitals,
NGO
Creation of professionals in this field at all levels Ministry of
(students, psychiatrists, psychologists, nurse, social For the Public Health,
33. assistants). program State
period University N.
Testimitanu
No. Activities Executio Responsible Financing
o/n n period for execution
Practical scientific investigations concerning
Ministry of
population necessities in mental health services and
Public Health,
implementation of new assistance forms within The Permane
34. State
Republican Center for Investigation, Assistance, and nt
University N.
Protection of Human Mentality, and Promotion of
Testimitanu
rights of people with mental dissability .
Achievement of recognition of Family and
For the
Communitarian Integration of mentally disabled as Ministry of
35. program
one of the interdisciplinary problem of fundamental Public Health
period
science.
V. Improvement of techno-material basis
Procurement and renewal of medical equipment for For the
Ministry of
36. Mental Health Centers and Mental Hospitals program
Public Health
according to needs and possibilities. period
Secure Mental Health Centers and Mental Hospitals For the
Ministry of
37. with medicines (tranquilizers, antidepressants, program
Public Health
anticonvulsive ) according to needs and possibilities. period
Multilevel computerization of institutions which
render assistance in the field of mental health For the Ministries of
38. (including creation of the Republican net in that field program Public Health,
and data base including information about period Finances
beneficiaries, latest scientific news, etc)

Prime Minister Vasile Tarlev

Countersigned

Minister of Public Health Andrei Gherman

Minister of Finances Zinaida Greceanai

40
Minister of Education Gheorghe Sima

Minister of Labour and Social Protection Valerian Revenco

Minister of Justice

PROJECT AUTHORS:

41