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1. National strategy(ies)

2. Improving the mental health of young people

National strategy(ies)

Official document and timeframe

A Strategy for the Mental Health of Children and Adolescents for 2016-2020 have been adopted by the Romanian Government in November 2016 through Government Decision.

Young people over 19 have not been among the target groups of the Strategy for the Mental Health of Children and Adolescents for 2016-2020, but have been targeted by the National Health Strategy 2023-2030, that includes a specific objective of promoting mental health.

Main elements and key objectives

The needs identified by the Strategy for the Mental Health of Children and Adolescents for 2016-2020 are:

• Developing services to promote the mental health of the child and adolescent and to prevent mental disorders of children and adolescents through partnership between the education system, the health system, the social services system and the justice system by developing parenting information and counselling services, implementation of mental health prevention programmes such as prevention of anxiety and depression, prevention of suicide, prevention of aggressive behaviours and development of social and emotional intelligence of children and adolescents;
• Developing and implementation of a comprehensive and complex database and establish methods and rules for collecting and processing target group data;
• Developing of child psychology modules in medical education curricula and programmes and in the training of teachers;
• Development of early identification and intervention services for children at risk of developing mental health disorders and children with a diagnosed mental health disorder by family doctors and school doctors;
• Improving the infrastructure and services of Mental Health Centres;
• Development of hospital services as specialized services for children and adolescents with mental health disorders by forming and training multidisciplinary teams in the hospitals;
• Continuous training of professionals.

The objectives targeting young people (adolescents) of the Strategy for the Mental Health of Children and Adolescents for 2016-2020 have been:

• Rising awareness of the population at national level on the well-being of children and adolescents and their mental health, through national campaigns and locally organised events;
• Promote and develop the mental health protection factors of children and their parents, through training of all involved professionals: teachers, family doctors, paediatric doctors etc.
• Early identification of children and adolescents at risk of developing mental health disorders, through developing and implementation of a comprehensive and complex database and establish methods and rules for collecting and processing target group data
• Early identification of socio-emotional and behavioural difficulties of children and adolescents
• Early interventions for children and adolescents at risk of developing mental health disorders and socio-emotional and behavioural difficulties
• Prevention of anxiety disorders and depression of children and adolescents at risk, through seminars
• Prevention and early interventions in aggressive physical and verbal behaviour of the child and adolescent
• Development of specialized services integrated into mental health centres
• Development within the mental health centres of evaluation and intervention services for the mental health of children and adolescents
• Development and implementation of educational interventions for children with mental health disorders in kindergartens, schools and detention centres (educational centres, detention centres) for juvenile delinquents
• Developing complex services and interventions for children with severe mental health disorders in institutions that hold children
• Development of specialized crisis intervention services in juvenile delinquency sections and detention facilities / probation services

The specific objective of promoting mental health in the National Health Strategy 2023-2030 proposes as main elements:

• Increasing the access to mental health services;
• Diversification of mental health available services;
• Development of mental health services at community level;
• Development of mental health preventive services;
• Improving monitoring and statistics on mental health.

Target groups

The target groups of the Strategy for the Strategy for the Mental Health of Children and Adolescents for 2016-2020 have been:

• Children and adolescents, their parents;
• Children and adolescents at risk of developing mental health disorders (children exposed to verbal and physical violence, alcohol abuse and psychotropic substance abuse, chronic somatic diseases of parents, disorganised families, extreme poverty, children with somatic diseases chronic children, children with parents working abroad) and their parents;
• Children and adolescents whose parents are diagnosed with mental health disorders;
• Children and adolescents diagnosed with mental health disorders and their parents;
• Children and adolescents with special protection measure;
• Children and adolescents from the units under the National Administration of Penitentiaries;
• Children and adolescents in probation services supervision;
• Children and adolescents with mental health disorders who have committed criminal offenses.

Government authority responsible for the implementation

The Ministry of Health is the main responsible authority for the implementation of the Strategy for the Mental Health of Children and Adolescents for 2016-2020, mainly through the National Centre for Mental Health and Anti-Drug Fighting under the Ministry of Health. Other authorities are also responsible for activities planned:

• the General Secretariat of the Government, for coordination of the other actors;
• the Ministry of Education, responsible for psiho-pedagogical assistance and first medical assistance for all students in schools;
• the National Authority for the Protection of Persons with Disability, Children and Adoptions, institution responsible for monitoring respect for the rights of the child in Romania;
• the National Prisons Administration at the Ministry of Justice, and the National Directorate of Probation, institutions responsible for monitoring and assisting young people in detention and probation;
• the Prosecution Office, institution responsible for the legal representation of all persons without legal capacity to exercise their rights, including persons (including children and young people) with mental health disorders;
• the Ministry of Internal Affairs and the National Police, responsible for intervening in situations of abuse, neglect and exploitation of the child and young people (including the one with mental health disorders), including those of domestic violence against the child, this specialized state institution having the powers to notify the local public administration authority provided by law to intervene in cases where the rights and interests the baby are endangered.

Monitoring/assessment/evaluation of the implementation of the strategy

The National Centre for Mental Health and Anti-Drug Fighting, subordinated to the Ministry of Health is responsible for the elaboration of an annual report on the implementation of the strategy but no report was made public.

Major revisions/updates

No updates have been made to the present Strategy for the Mental Health of Children and Adolescents for 2016-2020.

Improving the mental health of young people

Mental Health legislation was significantly changed in Romania in 2002 upon approval of the Mental Health and Protection of Persons with Mental Disorders Law - Law 487/2002. This law created a legal framework for actions in mental health. The law established responsibilities for promotion and prevention of mental health for multiple ministries, non- governmental associations, professional associations and others. This law protects the rights of mental health service users and establishes the criteria for admission to a psychiatric unit, including the criteria for compulsory admission.

The National Programme of Mental Health has 2 sub-programmes: one for psychiatric and psycho-social pathology and another for sub-programmes for prevention and treatment of drug dependence. The sub-programmes are delivered in psychiatric hospitals and psychiatric departments of the General Hospitals and Mental Health Centres.

The major activities, coordinated under the sub-programmes for prevention and treatment of drug dependence, are: substitution treatment with opioid agonists, testing the drugs metabolites in specialised units and treatment of intoxication with drugs. The objectives of this sub-programme are to increase social rehabilitation of the patients and the decrease the relapse rate of patients with drug dependence.

The National Programme of Mental Health is funded by the state budget through the budget of the Ministry of Health and its implementation is coordinated by the National Centre for Mental Health and Anti-Drug Fighting.

The number and types of mental health services targeting all patients (including young people), according to the National Programme of Mental Health, include:

• psychiatric hospitals: (i) acute psychiatric departments in general hospitals (75), (ii) psychiatric hospitals (34 acute and chronic).
• 20 Day Care Centres
• 52 Mental Health Centres (36 for adults and 29 for children)
• 4 specialised addiction units and forensic psychiatric hospitals
• 150 private ambulatory offices, authorized by the Ministry of Health

The National Centre for Mental Health and Anti-Drug Fighting can develop policies/programmes/projects/initiatives especially targeting young people. According to the institutions annual reports, representing the main monitoring tool, activities included the training of school and family doctors for early detection of mental health problems among children and young people.

In 2020 the National Centre for Mental Health and Anti-Drug Fighting started the project “Support for the development of community mental health services for children and adolescents”, with support from the EEA Financial Mechanism 2014-2021, European Public Health Challenges Program. The project is not youth specific, but targets children and adolescents up to 18 years old, aiming at developing appropriate community mental health services for children with mental health disorders. It was not planned in the context of COVID-19 pandemic, but answers the needs generated by the pandemic. The project includes a national awareness campaign on  the stigma attached to the diagnosis of mental health disorder as the main barrier to accessing support services.

Within the context of the COVID-19 pandemic, the Ministry of Health, in partnership with Babes Bolyai University, started to operate in 2021 a helpline (by phone) psychological and emotional support for people affected by COVID-19. The helpline is not youth specific, but young people are among the target groups.

In 2021, the Ministry of Education launched the National Child Support Program, in the context of the COVID-19 pandemic - "Caring for children", based on the Emergency Ordinance of the Government no. 105/2021. The programme has the following objectives (among others):

• informing and providing resources for the recognition and prevention of risks to child safety, as well as on the possibilities of managing the psycho-emotional health of children, in the context of the COVID-19 pandemic;
• adapting the psycho-emotional education of children according to age categories and school cycles;
• the development of the digital infrastructure for alerting, identifying and intervening in cases of child abuse and crime, for situations that do not require the immediate intervention of the specialized structures within the 112 Emergency Service;
• facilitating access to psychological and psychotherapeutic intervention services for children;
• the development of the competencies of the specialists who come into contact with the children and the use by them of unitary and applied tools and working procedures;
• developing the capacity of institutions working with children to carry out prevention, intervention, support, monitoring and evaluation activities from the psycho-emotional and child safety perspective.

The programme is not youth specific, but targets children and adolescents up to 18 years old (and can benefit young people beyond this age). The funding for the programme is not planned in detail. According to the programme document (Emergency Ordinance of the Government no. 105/2021): "Funding related to the Program is provided from the state budget, through the budget of the central public administration authorities, including reimbursable and non-reimbursable external funds, in accordance with the law, through the budgets of the line ministries."