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30 May 2025 | Policy Analysis
Better national anti-drug policies
5.11. Mental health care
Mental health care in Romania has traditionally been provided in institutional settings and although policies seeking to shift care into the community have been introduced since 2000 (WHO, 2015a), their full implementation has as yet to be achieved.
For example, there was only a small decline in the number of psychiatric hospitals, from 38 in 2006 to 35 in 2014 (Ministry of Health, 2015a; WHO, 2015a), while the number of psychiatric beds, including beds for neuro-psycho-motor rehabilitation, increased from 17 097 in 2008 to 17 337 in 2013 (National Institute of Statistics, 2015a). The mental health workforce is low compared to other EU countries, with, for example, the number of psychiatric nurses at 16.8 per 100 000 population in 2014 compared to 31.9 per 100 000 in high-income countries, according to the World Bank income categories (WHO, 2015a).
There has been a decline in bed occupancy between 2006 and 2013, from 91.4% to 88.1%, and a very small decline in the ALOS in psychiatric hospitals, from 19.9 to 19.4 days over the same period (National Centre for Health Statistics and Information, 2014). In 2006, following the EC Evaluation Mission on Mental Health in Romania, the authorities developed new legislation and released funding for the development of mental health community services and mobile intervention teams (EC, 2006). This also involved the establishment of mental health centres, which operate within the structure of hospitals. The transformation further envisaged the introduction of additional activities to ensure continuity of care and interventions at the community level, and hospitals were provided with additional funding for the refurbishment of facilities and for employing staff.
In 2009, the National Centre for Mental Health (now the National Centre for Mental Health and Anti-drug Fight) was reorganized, although the scope of activities did not change substantially. Further legislation concerning specialized health, education and social integrated services for persons with autism and associated mental health disorders was issued in 2010 (Law 151/2010), while Law 194/2011 targeted the control of operations with products likely to have psychoactive effects to improve the control of substance abuse. More recently, the Mental Health Law 487/2002 was revised in 2012 to adapt it to the European Convention for Human Rights and Fundamental Freedoms.
Overall, there is little evidence about the impacts of changes introduced to enhance mental health care services on population health indicators. There are plans to improve mental health care services further through the development of clinical guidelines and community care standards, as well as for information, education and communication campaigns to reduce the social stigma attached to mental ill health (Ministry of Health, 2014).
Context
Despite the implementation of the National Anti-Drug Strategy for 2022–2026, illicit drug use, measured in terms of lifetime consumption, increased among adult Romanians aged 15–64, from 10.7% in 2019 to 12.8% in 2024. The consumption is even higher among people aged 15–34, increasing from 16.9% lifetime users in 2019 to 18.2% in 2024.
The strategy is implemented under the coordination and supervision of the National Anti-Drug Agency, subordinated to the Ministry of Internal Affairs, that had been in charge also of the anti-drug policy development, monitoring consumption and assisting consumers through 47 anti-drug prevention, evaluation and counselling centres.
Impetus for the reform (what prompted it)
The existing anti-drug policies, as the previous ones, were highly criticized. Critics argue that they are mainly prone to punishing drug users, who are often declared to be dealers, instead of focusing on prevention and treatment.
In December 2024, the government decided to reorganize the Anti-drug Agency as the National Agency for Policies and Coordination in the Field of Drugs and Addictions, under the subordination and coordination of the Prime Minister. In addition, mental health and addiction prevention centres were developed under the coordination of the National Centre for Mental Health and Drug Control of the Ministry of Health.
Main purpose of the reform
The main purpose of this reform was to attain a better and integrated coordination of the anti-drug policies. Also, the reform will support the Mental Health Action Plan 2024–2029 and in the long run is expected to contribute to the decrease of illicit drug use in Romania.
Content/characteristics
Besides the reorganization of the National Anti-drug Agency that under the direct subordination of the Prime Minister will guarantee better coordination among different sectors and resource pooling, mental health and addiction prevention centres will be created with specific roles in prevention, treatment and rehabilitation of drug users. Further, hospitals will be allowed to establish inpatient wards for the treatment of substance-related addictions.
Implementation steps taken (or scheduled)
The National Agency for Policies and Coordination in the Field of Drugs and Addictions became functional in March 2025 through Government Decision no. 186 that details the roles of the institution, including of the focal point for the European networks and rapid warning system. It also lays out the internal structure, financing and external collaboration.
In May 2025, the MoH published Order no. 1562 on the organization and operating of the mental health and addiction prevention centres, setting their roles, structure and staffing. They are expected to be fully functional in two years.
Outcomes to date and any evaluation
It is too early to evaluate the outcomes. An up-to-date legal framework has been created for better intersectoral collaboration, strengthening governance in the area and ensuring a more preventive and medical approach to the addictions, rather than a corrective one. It is expected that the new approach, guided by the examples of best practices in other countries, will decrease the use of illicit drugs in Romania and improve the mental health of the population.