Migration, mental health and costs consequences in Romania.

BACKGROUND: Legal and illegal circulatory migration from Romania reached huge proportions after 2000, following the lifting of the visa requirements for EU Shengen countries. So far, the impact of migration on health has received scarce attention from Romanian authorities.

AIMS OF THE STUDY: To describe the socio-demographic and clinical profile of the migrants who have developed mental illness, estimate their services use in terms of hospitalization and to analyze the cost impact on the Romanian health system and on the migrants' co-payments, to discuss the possible relationships between migration and mental health.

METHODS: A semi-structured interview, designed by the authors, has been administered to 50 migrants admitted to the Second Psychiatric Clinic Cluj-Napoca, Romania, to investigate the following areas: immigration status, working conditions, income, housing, insurance and social bonds. The clinical symptomatology of these patients was assessed using the Brief Psychiatric Rating Scale (BPRS). The average cost of hospitalization per day per patient, the total costs of hospitalization and the migrants' co-payment through personal contribution to the insurance system were estimated.

RESULTS: Most of the patients were young, single, with no previous experience abroad and with few social ties in the host country, with unqualified and insecure jobs. In this group, 45 out of 50 had schizophrenia spectrum disorders diagnoses. The hospitalization length of these patients was slightly shorter than the hospitalization of non-migrant patients with the same diagnosis. Individuals from rural areas had longer hospitalisation than those coming from urban areas. Those who left the country illegally and those who worked illegally had shorter hospitalisations. The average costs of hospitalization per day per patient were Euro 15.56; and the total costs were Euro 14,054.92. In order to cover the costs of hospitalization in the native country due to an illness with the onset abroad, a patient should work and contribute 4.65 years (on the basis of minimum salary) as a co-payment for the hospitalization in the native country.

DISCUSSION: The patients considered in the present study fit the general profile of the emigrants. Discrimination, social isolation, insecurity may increase the risk for mental illness. A relevant role in the length of hospitalization may be due to the urban/rural dimension: patients from rural areas have less access to mental health care, therefore when they are finally hospitalised, they may remain longer because, in case of relapse, rapid readmission may not be possible. The shorter stay in hospital for those who left the country and worked illegally may be due to better resistance to stress and flexibility, to an illness that was not in an advanced phase, or to inability to afford higher personal co-payment for longer hospitalizaton.

IMPLICATIONS FOR HEALTH POLICIES: More accurate and careful screening for mental illness should be applied at least for legal emigrants. Cultural adjustment programs should be organized prior to departure. Contact and counseling points in the host country would be important for prevention and treatment of mental illnesses. Programs focused on circulatory migrants and aimed at developing work opportunities in the native country would increase their self confidence and enable them to perceive their return as success and not as failure.