Beyond our Borders: Mental Illness in Romania

Personal story updates include: case management team change; possible medication change; need for employment, and support to get there. (first 5 minutes of podcast)

Then, a  conversation with Amedeea Enache, Exec. Director of Estuar Foundation in Romania, Board Member of Mental Health Europe

We talk about:

1. Deinstitutionalization, esp. After break from communism in 1989, then joining European Union in 2007 - where do patients go once discharged?
2. Disparities between the urban and rural area in terms of services provided
3. Stigma/secrecy - people diagnosed, and their families
4. Employment for those with SMI -importance, availability
5. Awareness in the field, who are the main actors, and what is the families and members involvement
6. What our countries can learn from each other

Links: https://estuar.org/ (it’s in Romanian, though) - facewbook page: https://www.facebook.com/estuarclubhouse

Estuar Foundation was established in 1993 by Penumbra Association from Scotland and Romanian League of Mental Health and it is the first Romanian organization created for adults with mental health challenges. It's a network of day community care centers and accommodation services that were certified and recognized at local and national level.

They work with:

• Families and friends of people with mental
• health problems
• Community membres
• Adults with mental health problems
• Representatives of local and central authorities
• Adults with temporary problems of adjustment
• and communication
• Mental health specialists

About our guest:

A passionate professional, focused on achieving results, with eighteen years activity in serving communities and vulnerable groups. Ten years as director of social services provider NGO. Experience in organizational and project management, mental health services development, national and international partnerships development, human rights, and advocacy in mental health field.

EDUCATION in US (current) 2020-21

Humphrey School of Public Affairs, University of Minnesota

Humphrey International Fellow, Affiliated with Fulbright Program

Transcript

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Advocacy in Romania

SPEAKER_01 0:01

Welcome to our podcast, Schizophrenia. Three Moms in the Trenches. From the place where schizophrenia and real life collide. East Coast, West Coast, Middle America. With Miriam Feldman, Mindy Gryling, and Randy Kaye. So something we don't often talk about here on Schizophrenia Three Moms in the Trenches is that we are three American moms. And mostly we deal with the mental health system here in the United States. So today, thanks to a connection that Mindy made, we're going to widen our perspective because this is a worldwide problem. Schizophrenia rates are one in 100, regardless of the country. And so we're delighted to have a very special guest on today. And we'll introduce Amadea officially in a second, but we can wave. Hello. Hello. Hello, everybody.

3 sons updates

SPEAKER_01 0:58

So uh Randy and Mimi and Mindy, we generally just start for our regular listeners with a 60-second update of how our sons are doing today. And then we're going to get right to we have so many questions for you. We're so excited. So since I'm here, I will say my son Ben is we've saved him from falling off a cliff in the last week. He uh nearly was hospitalized again. And I wrote a blog post about it on Ben Behind His Voices.com. But basically still getting used to a new medication that's time released, and it was pretty much wearing off. And he was beginning to isolate and gesture and do those things when we know they're slipping. Meanwhile, his case management team that he has been with for 17 years, although I've done most of the work, they were suddenly disbanded. This is just what happens in the mental health system in America. His case manager came into his office and somebody else was sitting in the office and they went, Oh, your team is being disbanded. So now my son's team is gone and he's being transferred elsewhere, which I think will be a blessing in disguise. But now it's a whole bunch of new people to train to get them to listen to me and get them to hear the history. But I think it might turn out okay. There was a whole thing with my son is currently receiving an injection every so often, and it was way too late. And the night we were supposed to get it, the pharmacist said, Hey, he doesn't have any benefits, which we've been struggling for. So I was like, just I'll give I'll give you my credit card number. Just I felt like Shirley McLean in terms of endearment. Give my son the shot. But anyway, we straightened it all out. He had the injection the next day and avoided hospitalization. But this is the roller coaster that never ends. So that's my update. Uh, Mimi, you are in Los Angeles right now. So what's going on with you and Nick?

SPEAKER_03 2:55

Well, I spent a lot of time with him in the last week getting everything in order. And I'm slightly nervous to be here and not be up there, but he's got good caregivers now, and his dad's up there, and so far, so good. He's kind of on a status quo right now until I come back. There's a new medication that the doctor wants to add to his regimen, and I asked him to wait till I get back because this is it's very it's weird, it's interesting. This is a narcolepsy medication, and he combines it with the closipine because it counteracts the sleepiness of the closopene. But it's kind of experimental, and I just felt like anything that's gonna activate him, I want to be around because you never know what can happen. So for right now, we're just gonna stay with the status quo and hopefully things will be okay. And then when I get back up there, we're gonna try this new med.

SPEAKER_01 3:57

Okay. Sounds familiar and interesting. Mindy, you give your update, and then I'm gonna turn it over to you to introduce our guest officially. Sounds good.

SPEAKER_02 4:07

And I just wrote down what Mimi just said because Jim is also on clozepine and he sleeps a heck of a lot, like 16 hours a day sometimes.

SPEAKER_03 4:15

You know, Mindy, I think I'm gonna have to hook you up with Dr. Leitman in New York, and you should talk with him because he he's got all the protocols that work and he knows things that most other doctors don't. So I'm gonna do that.

SPEAKER_02 4:29

I really would love that. We should have him as a guest on this show, too, because no, we're going to definitely. He might like to know what uh what we are learning.

SPEAKER_01 4:38

So anyway, Jenna is um and just disclaimer generally, families don't give each other advice and prescribe things for other families. So we're not setting a protocol here, but we all are friends and we do take suggestions from each other and then ask our doctors about it. So we don't want to get in trouble. Okay, Mindy. I appreciate that disclaimer.

SPEAKER_02 5:00

Um, so Jim is doing really well. He's uh living with us right now most of the time. He has his own apartment, but he saw a friend today, he's still on the waiting list to get employment with an employment service. Um, that is against evidence-based practice, which says if someone with schizophrenia wants to work, they should get to work fairly fast. But that is not happening. But outside of that, he's sober and he's working a little bit, and we're pleased with

Who is Amedeea

SPEAKER_02 5:30

that. So, with that, um, we do want to welcome Amadea Anake. And we're in for a real treat, I think, because we are going to learn about another mental health system, Romania, tonight. Um, I met Amadea through the dean at the University of Minnesota Humphrey Institute. She's been a longtime friend of mine, and in fact, um, my book launch was there at the institute last October. So she knew of my interest in mental health, and then she knew that Amadea was trying to hook up with people, but with COVID, it's really hard to do. So we're having these virtual events and we had a conversation, and I thought this would be a perfect chance for not just me to learn about Romania, but all the people who listen to this podcast. So we're so pleased that you're here, Amadea. And um she's a passionate professional who's focused on achieving results for people with mental illness. She's been with the Estuar, I hope I'm pronouncing that right. Okay. The foundation in Romania for 18 years, and she's been the director for the last decade. This is the first and I think only mental health organization for adults in Romania. You can correct me if I'm wrong.

SPEAKER_00 6:51

We are the only services provider for adults.

SPEAKER_02 6:55

Yeah, that's really amazing. And so she also has vast experience in this field with national partnerships, international partnerships, and has advocated for human rights and is a current board member of mental health Europe. So your information goes beyond just Romania. So welcome.

DI: Deinstitutionalization in Romania

SPEAKER_02 7:17

And I'm going to start with the first question because we do have so many that we hope we can get through them all. And the first one is a little background on the mental health system in Romania. So we understand that because of the communists, deinstitutionalization took a longer time to happen in your country. So could you tell us about the mental health systems since the communists left the leadership?

SPEAKER_00 7:44

Thank you so much, Mindy, for this uh presentation and thank you for this opportunity of uh sharing what I know and also learning from you. I didn't participate in my life in too many podcasts, so I'm really happy and uh really excited. Uh, returning to your first question, until 1981 uh Romania was under dictatorship and under communist uh times. So we started to try first signs of democracy from January 1990, and since 2007, we are members of European Union. And uh the first sign of DI started in uh let's say early 2000, but still the process is uh ongoing. In communist time, we really had uh big, big hospitals with over 500 patients with chronical illness, persons who were locked there for maybe decades and uh abandoned by their families. Uh, step by step they lost all their abilities. When we uh started as a country to prepare for joining EU, Romania was forced, and that was a very good sign, to take a lot of measures in order to reach EU. And one of the the most important measures was to rebuild the mental health system and to make steps in order to destroy and close the big institutions. And uh indeed they were closed uh but not entirely. We still have small institutions with uh 50 persons, but with the same concept of an institution, uh, with only treatment, no um other uh therapies, no other real involvement of the people, and not focused on uh on patient. Uh, still uh people are treated as without abilities as they are not fitting in the communities, they are not taken into serious, and uh the system really needs to be rebuilt and transformed into services, into communities with the involvement of a lot of stakeholders. So we really have a lot of steps to be taken, and indeed now things are much better than 10 years ago, than 20 years ago, but we cannot fool ourselves that we are in an ideal situation, not at all.

SPEAKER_02 10:40

And we still have a ways to go here in the United States too. But you've gone from 500 people, it sounds like in an institution down to 50. What would you say is the status of how many people are still in those larger places with 50 compared to how many are getting their according with statistics?

SPEAKER_00 11:03

Uh we have I think 17,000 adults institutionalized currently in in Romania. And uh for you to have an idea, Romania has a population of around 90 million people. Yeah.

Community Services for SMI

SPEAKER_03 11:22

Interesting. You know, what I would like to know is now that you're going through this process, what is the balance in Romania between people who are taking inpatient care and what are they offering in terms of care in the community?

SPEAKER_00 11:40

What I can tell you is that in Romania we don't have a mental health strategy and we don't have a plan to follow. So um the institutions and we have uh we are uh divided in regions. Some hospitals belong to the Ministry of Health, some hospitals belong to the uh local municipalities, this only in terms of hospitals, but the services are divided on every region. So if the leaders of those uh these regions consider that they need to do something, they do something, but we do not have a coherency, we do not have a long-term strategy and not even a small strategy. So uh it's very difficult to make a comparison between what is in hospitals and what is in community because we don't really have service in communities, unfortunately, except for S2R. We have small projects which I wouldn't call services because they are not ongoing and they are not authorized by the Ministry of Labor. And um, yes, the balance is in uh the de favor of services in in community, and we really have to work a lot to convince the public authorities to pay and to provide these kind of services or to work in partnerships with private or with NGOs when they do not have the capacity.

SPEAKER_03 13:22

I see. You know, here also we

Rural v Urban

SPEAKER_03 13:25

see a lot of disparities between urban areas and rural areas in terms of what is available for services. You know, a lot of times in in rural areas, there just aren't doctors, there aren't psychiatrists. How does that work in Romania? Is there a big difference between the cities and the country?

SPEAKER_00 13:44

Yes, the situation is exactly as the one you described here. Uh, the main hospitals, and I start with this, although we we are active in um uh promoting the social services and not the hospitals. Um the hospitals are only in the big cities, and in terms of uh services or access to a psychologist, also persons need to go uh from rural to urban area, sometimes over 50 kilometers or over 100 kilometers, and sometimes it's not only about traveling, it's about the mentality. They don't know that they need this kind of support, and they don't know where to ask and how to ask this kind of support. And uh also today you will find in a very rural area persons with different mental illnesses who accept for some periodical treatment, they never accessed any other service because they don't know that these services exist in the urban area, unfortunately.

SPEAKER_01 15:03

Wow, I've I've got to say at the moment it doesn't sound very different. I was thinking that too, from the United States. It's like universal problems. And in a moment, I do want to shift a little bit and talk about stigma, but before we leave this general overview, so can you help me to understand this from the point of view of someone like our sons who has a mental illness? So it sounds like during communism, they were pretty much in an institution for their whole life and just treated with medication, but not treated as a person, not treated as someone with potential. So now where the institutions are smaller or there are fewer beds, what

What happens after hospital discharge?

SPEAKER_01 15:47

happens to someone when they're discharged if there are no services? Or do they become homeless? Like what happens to your average person with schizophrenia in Romania when they're discharged?

SPEAKER_00 15:58

Um they count a lot of on the support of the families, on the support of uh large families. Sometimes neighbors provide help, sometimes friends provide help. Some of them they end up in uh in street, those who do not have a family to support. And uh, in our foundation, we had a lot of cases with persons who uh didn't have a family, and unfortunately, they were absolutely fooled to sell the house to somebody else on a very small amount of money, and they ended up in the street.

SPEAKER_01 16:43

Okay, so now these families are they allowed to have the right to administer medication? As I'm sure No. So there they go to the families, but the families like here in America, we don't we're not are not given the right to have them take medication. And then do they wind up back in the hospital if their families just can't handle it?

SPEAKER_00 17:08

If the family cannot handle, it depends, but usually uh it depends on the status of the persons. Sometimes it's not necessary to go in the hospital because there's in the hospitals in Romania only people who are in a crisis, and after two weeks, most of them they go home with unfortunately no support from and no monitorization from the hospitals. If the person is not taking the medicine, the doctors most of the time they don't know anything, and according to the legislation, it's okay like this. So we do not have a mobile system to with a social worker or with a psychologist to go from time to time to check the status. And unfortunately, the situation is very, very, very bad with this approach. And um, for persons who who can prove that they not take care of themselves, they can register in this institutionalization process, and they can get a place in a small institution, or maybe if they are lucky, in a

Protected Apartments and Estuar Support Services

SPEAKER_00 18:28

protected apartment with maybe two or three colleagues. But they need to find support from the social services to pay for this kind of service, which of course is not cheap, it's quite expensive. Right.

SPEAKER_01 18:45

So it it actually sounds quite familiar, it's very similar here. What does S2R do?

SPEAKER_00 18:53

In this uh position, we have three apartments in Bucharest and we provide 24 hours a day services for persons with mental health illness. Uh, usually they are sent to us by the psychiatrist doctors, or sometimes they found out on the internet that uh we provide the services. And if in that moment we have an empty place, we uh have them in our apartments, and we provide all the necessary support in order to have a decent life in the community. We support them to get a job, to go to job, to maintain their jobs, to keep the connection with the family in case they want this, and uh sometimes to continue their studies if they are uh at a very uh young age, or even if they are at, let's say, 40, we we push them to continue their studies. We um support them to stay in touch with their psychologist and psychiatrist, and we organize a lot of events in order to engage them in in community. And some of them stay with us for uh a few years, some of them for more years. It depends because uh although we always say that it will be good to engage many people, sometimes we discover that if we cut the service, these persons wouldn't have a place to live. So we keep them as long as is necessary in order to continue a good life. But unfortunately, we do not have too many apartments. We have only three apartments and with three places in each apartment. And um, except for this, we have community centers. We have four community centers in Romania in four different cities, and we offer uh services for uh at least 100 persons in every community center, uh, eight hours per day. We are users-oriented. Everybody who steps in uh in our centers is uh receiving services customized to the personal needs. We sometimes we offer psychological counseling, sometimes juridical counseling for uh those who have some juridical problems and sometimes vocational in order to have a job, and all our services are free.

SPEAKER_02 21:36

Wow, it sounds like there's some things better in Romania, quite a few things, but it sounds like it's a very small number of people. Yes. You have really good services, but a very small number of people.

SPEAKER_00 21:50

And unfortunately, we do not have the capacity to extend our services because when you extend a service, you have to think Thinking on long term, you cannot uh open a center or an apartment for a few months. You have to do it for a lot of years because it's very difficult to engage with people and then to say, I'm sorry, we do not have funding.

SPEAKER_01 22:17

Right. Who funds you, the government or private or both?

SPEAKER_00 22:21

Uh most of them is uh public. We uh write projects and we get grants either from the government, from the ministry of um of labor, because we are recognized as a social service and not as a medical service. So we do not have anything related with the Ministry of Health, but with the Ministry of Work and Social Protection in Romania, with some local municipalities because we uh take care of the persons for which the local municipality doesn't have the capacity to take care, and some of the grants are coming directly from European Union, of course, writing projects. Uh, we also had grants uh from uh Norway.

SPEAKER_01 23:07

Really? Wow. Yeah. Wow. So thank you for the work you're doing. I'm sure there are many families thanking you as well. And and now I understand what you do, and sounds wonderful. So

Stigma and Discrimination with SMI

SPEAKER_01 23:22

let's just talk a little bit about stigma now. You know, we have a group, and you're currently in the United States doing some work and some study. And so the National Alliance on Mental Illness, NAMI, they're trying to pivot from calling discrimination against people with mental illness stigma to just plain calling it discrimination. But no matter what you call it, can you talk about discrimination or stigma against people with mental illness and their families? Like how are they treated in Romania?

SPEAKER_00 23:53

It was for the first time here in the US when I um heard about the discrimination concept to replace the stigma concept. As you said, whatever we are calling in Romania, of course, persons are facing a big and important stigma. And most of the families are hiding the fact that their children have a mental health illness. Only the close friends know these uh aspects, only some neighbors maybe know these aspects, but usually the families don't want to share this aspect because they consider that is uh is shameful, it's something uh maybe embarrassing, and they don't want to have problems with anybody else. They consider that this shared information will bring problems sooner or later. And uh, I have to admit that stigma is less and less in the last decade, and uh we we felt this people are more open. Uh, once the social media exploded, and once everybody has access to Facebook, Instagram, or other channels, everybody has access to a lot of information. So um there were a lot of campaigns, not only Romanian, but also international campaigns who made people uh more willing to share and to be open with uh with this. In S2R, we have uh a group of our uh users who participated. I almost said last year, but no, it was not last year because last year was quite difficult and quite close. It was at uh the end of 2019. We did an in-person event, and five persons with uh mental illness showed in front of everybody telling in 15 minutes a short story. They received themselves, they received uh training how to react, how to be one man or one woman show, and uh the show the show is not a show. The event was fantastic, but unfortunately, we were not able to find any parent to participate. We had only uh adults, and we had a teacher with a parent and who dropped in the last moment saying, I'm sorry, I don't want anybody to take pictures and to appear later. I don't know in in which medium. So she she dropped. Yes, unfortunately, that is the situation.

SPEAKER_01 26:52

Yeah, it's it's not that different. Okay, Mindy.

SPEAKER_02 26:56

So they're they're not appearing on podcasts, the parents in Romania, it sounds like like like we three mothers are doing well we are, but our sons, you know, my son is not public, his name is different.

SPEAKER_01 27:11

He had a job for a long time when he was really stable on his medication, and they had no idea he had schizophrenia because he would not say it. He would probably have been fired. Yeah, so it it's still there. I'm open, but at my son's request, I don't say his real name anywhere in the book. And his last name is different from mine. So if you were to look for Ben Kay on the internet, I don't know who you would find, but it wouldn't be my son. Anyway, go ahead.

SPEAKER_02 27:40

Yeah, and that, you know, this reminds me of my early days when I was in the Minnesota House of Representatives and I was asked to speak at a NAMI event at the Capitol, and they had it at night outside, not in the Capitol, and there was just a few people that huddled around and they held candles, and and it was a very hush-hush, and that was oh 25 years ago, and now when NAMI has events at the Capitol, they get hundreds of people. People are bust in from all over the state, and there's parents and professionals and a lot of people with mental illness, including serious mental illness. And so our son has grown up, I think, uh, in a bit more open environment, maybe in Minnesota than Connecticut, but still there's a lot of families that are active themselves here too, that they don't want to out their children. But since I was a public official, our son has always been outed and he participates in programs, but he's very shy with his schizophrenia. So I was going to ask you then what families advocate for and what barriers keep them from speaking up. But it sounds like you're not there yet with even getting them to speak up. Will they write their stories if they didn't have to like anonymously and share that way so you could use stories when you're talking to funders and elected officials?

SPEAKER_00 29:16

We do not have active

Family Secrecy

SPEAKER_00 29:18

parents to share their experience. So uh when we are uh looking for maybe funding, or maybe we are invited to a TV show to say what we are doing, we can always count on some of our users who are uh willing to expose themselves. And we have a group of users who participated several years to a marathon, and they ran for 42 kilometers, they were shown in media, uh, on Facebook, they told their stories, but from the parents, we have to work more in order to show them the benefits and uh and to to tell their stories. But of course, it's an individual and personal decision.

SPEAKER_02 30:13

Interesting that it's more people with mental illness who speak up than families because it's more the other way around here in a lot of respects.

SPEAKER_03 30:23

Yeah. You know, I

Support for Families

SPEAKER_03 30:25

read here that your organization has a parents' school. Is that similar to what NAMI is here? Is that something where parents do communicate with each other and learn?

SPEAKER_00 30:36

It's a support group that uh we organize and uh we are aware and everybody is aware that having a family, a person with schizophrenia or bifolar disorder, uh this uh affects the entire family, and the parents really need the support. So they can come to this group, which sometimes is happening every week, sometimes every two weeks, because of the pandemic. Uh, we really had uh problems in continuing the the group. But uh parent school has, I think, at least 15 years and provides support under confidentiality to the parents of our users, and not only to the parents of our users, because sometimes parents of persons for whom we do not provide services come to participation.

SPEAKER_03 31:35

You know, here in this country, because we have pretty strict medical confidentiality laws, there are a

Confidentiality

SPEAKER_03 31:43

lot of problems here for families who want to be involved with their adult children's cares, but those family members have the adult children have anagnosia and don't recognize their illness. And so the families are sort of kept out of it. How do you communicate with the families when the the patient, the person with mental illness isn't even aware of their mental illness?

SPEAKER_00 32:10

Uh well, um uh first I can tell you that we are not um a medical institution, so uh not providing the treatment is an unusual approach from ourselves. Provided only counseling, and we as an institution have the obligation, especially after two or three years ago, the European Union introduced the GDPR uh legislation which uh forces us to maintain confidentiality for a lot of information. So mainly if the users of our services do not want to sign and do not want us to communicate with their parents, we cannot communicate.

SPEAKER_03 32:59

So it's the same like it is here, yeah.

SPEAKER_00 33:01

Yeah, yeah. 28 years ago, when S2R was uh was born, we didn't have this legislation. So the parents were able to come and uh our uh staff was able to speak with them without even thinking about uh this uh these aspects, but now the legislation is very, very strict and we have to follow it. Right.

SPEAKER_01 33:27

In a way, we had something very similar in this country. Further back, though, in the 1950s, many people like our sons would just be in institutions. And so even though the staff, I don't really know what the confidentiality laws were back in the 50s, but when you're talking about under communism, you didn't have these restrictions, but you also didn't have the chance that your child was going to be dismissed, discharged. I think with every political system brings its challenges and pendulums that swing all the way. Just FYI, we only have about 10 minutes left and a lot to cover. And so I want to make sure that we we touch on everything. This is just so fascinating, but I am surprised at how many similarities there are that you're running through a lot of the same challenges that we are here in the States. When we talk about better treatment of people with mental illness, an improved mental health system, who

Advocacy in Romania

SPEAKER_01 34:24

are the people that are advocating for better treatment and what are the human rights considered in the mental health field in Romania?

SPEAKER_00 34:32

Usually there are the NGOs who are advocating in Romania. There are some very strong human rights NGOs who advocate for uh respecting the human rights or for changing the legislation. NGOs.

SPEAKER_02 34:51

NGOs, net government organizations, yes, government organizations, yeah.

SPEAKER_00 34:58

But um most of the NGOs are um uh not focused directly on mental health, they are focused on keeping uh on maintaining human rights and together with S2R, which are services providers, sometimes together with some public authorities. And uh we have also an NGO, which is an NGO for users, and all the members are uh persons with mental health uh disabilities, and also the president, they are quite active in advocating.

SPEAKER_01 35:32

For which rights? For like what particular human rights are they advocating for?

SPEAKER_00 35:36

Uh, for example, for closing the rest of the institution, this is an issue in Romania, or for a better condition in the psychiatrical hospitals, this is another issue. What else? For better funding and for creating more social services in the community, this is another advocating uh reason.

Jobs, SMI, dignity, benefits

SPEAKER_02 36:05

You mentioned that Estuar does work with people with mental illness getting jobs. And um, here when we had the institutions in the United States, often people like my grandmother, who was in one, worked, and that I saw as very healthy. I saw my grandmother doing the best when she was working, and then there was a rights group here that actually thought that was slave labor, people shouldn't have to work in state hospitals. So then the pendulum that Randy mentioned swung over to people with mental illness, serious mental illness, maybe shouldn't work. It was too stressful, they shouldn't be made to do it. And they were even counseled that they wouldn't ever work again if they were going to get government benefits. And so now the pendulum is swinging again, and um, people with mental illness want to work like anybody else. They want money, they want self-respect. And over 80% of the people in the United States who have a serious mental illness want to work, but yet it's something like 16% actually have jobs. So, what's like in Romania as far as employment? People with serious mental illness?

SPEAKER_00 37:21

The legislation is very bureaucratical. Of course, people can work, but they have to go previously to an expertise commission, and the doctors speak with them, they uh note their entire files and uh their history, and the doctors decide which is the capacity of working, and after they receive a capacity certificate, they can work either uh 50% of their time, either 100%, or they cannot work at all. There are also this situation. And what is the worst part goes from now on? For example, if some of them uh will have a job and will have a mental health crisis and will go to hospitals, most of the employers want to want to engage with them and to wait for them to come back. Although the legislation is very clear, this is discrimination. You have to wait for the person to be back from the hospital, but most of the employers do whatever they can not to continue the job or hiring them because they found out that they have in their organization or in their company person with mental health illness, and they don't know how to react or how to work with them. So uh most of our users, because I know their situation, sometimes decide even they have the right not to work because they think if I will work for six months and then maybe I will have a crisis, I will go to hospital, then I will have to find another job. But if they work, they will they will lose the benefits, the pension. So they say maybe it's better to stay home and to have this certain pension, or uh then to go to work and lose the pension, because after they do not work, it's very difficult to have again the pension. They have to wait for several months to go again to the commission. So it's this circle of bureaucracy who really doesn't help uh the person to stay engaged in having a job. So after a lot of disappointments and bad situations, most of them say, I think it's more good for me to stay at home than have all these challenges, especially that the salaries are not quite uh quite big. So um a lot of our users are in this situation of choosing not to work because it's quite complicated the system. And also the employers in Romania, um 99% of them they do not know how to accommodate a person with uh mental illness, they don't have a program to support them, and uh they consider that they will have a lot of problems if they will hire them.

SPEAKER_02 40:48

It sounds like this is an area where where the United States could help because we are better than

Lighting Round QA

SPEAKER_02 40:55

that, and and we have just about five minutes left, so we have a lot of questions.

SPEAKER_01 40:59

I think we're gonna have to just give short answers to the next to the next few.

SPEAKER_03 41:04

It's the lightning round.

SPEAKER_01 41:06

It's the lightning round. Okay, so Mimi, you're up, you're up.

SPEAKER_03 41:10

Let's talk about homelessness. Yeah, here, you know, we have a huge homeless population, and it is largely comprised of people with mental illness andor substance abuse issues. Is it the same in Romania? And also, if it is, what efforts are being made to offer affordable and supported housing there?

SPEAKER_00 41:33

In my opinion, although it's very, I don't know how accurate it is, I think we do not have a lot of homelessness population. But in Bucharest for 20 for uh for two million and a half population, we have uh around 4,000 persons who are living in the in the street, and I have to admit that there are no services for them, and the authorities don't do too much, they almost do nothing, they have only some shelters who provide overnight sitting, and that's all, unfortunately. But we this is almost nothing.

SPEAKER_01 42:21

We have uh a lot to learn from each other. So I almost hesitate to ask this because I because it it could be a very long answer, and we could do a whole show on this, but I'm just curious, maybe a yes or no or a short phrase to say when people are in school, like the equivalent of our high school. Yeah. Do you have school social workers and counselors to help kids and families get early detection, or could you use more of those?

SPEAKER_00 42:50

We have psychologists uh in uh in high schools. We have one psychologist to many high schools, so they don't really have proper time. I don't know if the psychologists are properly trained to serve uh the young population. Everybody is very unhappy about a very inefficient psychological service support service in our educational institutions.

SPEAKER_02 43:21

And this one could be a yes or no. Do you have enough psychiatrists?

SPEAKER_00 43:25

Uh definitely do not. Uh yes, we have enough. Oh yeah.

SPEAKER_01 43:32

Okay, that's that is different from this. Very much. So maybe your question, you can have a longer answer to your question, Mimi. This is the we're getting to the crux.

SPEAKER_00 43:49

Oh, I'll need to explore more. What I what is very well developed here is the advocacy system, which we don't really have back in Romania. Designing public policy here involves a lot of stakeholders and is very it's a very important process back in Romania. Designing public policies belongs to the politicians who do not really involve the main important stakeholders. So at the end, we will have inefficient public policies.

SPEAKER_01 44:28

So you you're learning some things here that you can take back there. The opposite question what do you think you do better than we do here in the United States? What could we learn from you?

SPEAKER_00 44:41

Oh, so this is such a difficult question. Can I not answer? I don't know.

SPEAKER_01 44:47

Okay, that's perfectly fine.

SPEAKER_02 44:49

One thing you have enough psychiatrists. We don't. Yeah, that's a big deal.

SPEAKER_01 44:54

Yeah, that's that's huge. And it sounds like if they were more foundations like yours, is there a website where people can find out more about Estuar Foundation?

SPEAKER_00 45:04

We have uh, but it's not in English, it's in Romanian, www.estuar.org.

SPEAKER_01 45:11

Okay. Thank you so much. So our guest today has been the wonderful Amadea Enake.

SPEAKER_00 45:18

Thank you so much for inviting and for sharing with me.

SPEAKER_01 45:22

Thank you so much. It's it's learning that it's sort of a universal issue, and hopefully we can all learn from each other and make the world a better place for those with mental illness and their families as well.

Upcoming episodes

SPEAKER_01 45:35

A little preview of what's coming up, our next episode. We will actually talk to a young woman who is managing her schizophrenia quite well. She has quite a story to tell, and she's very open. I have met her once, but we're Facebook friends. Her name is Rebecca, and she's going to tell us about her schizophrenia and what she does. And coming up, we'll be talking to the NAMI education director about family to family and their other programs, and also uh a probate judge who's going to talk about conservatorship and what it's like from her side of the bench. So we hope you'll subscribe on YouTube, follow our podcast wherever you get your podcasts, and thank you for listening. Hey, thanks for joining us for this episode of Schizophrenia Three Moms in the Trenches with Randy Kay, Mindy Gryling, and Miriam Feldman. To get in touch with us or to learn more about our books, please visit our websites at Miriamfeldman.com, MindyGryling.com, or RandyK.com.