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Illegal immigrants with a mild form of COVID-19, suspected of being ill or in contact with sick people, should soon be taken to the Rokiškis Psychiatric Hospital.
August 12 Gintaras Kacevičius, director of the State Health Insurance Fund (VLK) under the Ministry of Health, signed an order in which the migrant isolation service drops after long-term treatment services.
Service code 3906 is provided for self-isolation service for migrants, the title reads as follows: “Long-term treatment of patients with mental illness (isolation of foreigners who have crossed the state border of the Republic of Lithuania illegally due to COVID -19 disease) ”.
This decision soon caused a storm among mental health experts.
There is a risk of confrontation with the courts
Nijolė Goštautaitė, a board member of the Lithuanian Psychiatric Association, assesses the situation in Midttun in two ways. On the one hand, it is understandable that the country faces a special situation in which atypical decisions must be made, but according to her, the decision to equate isolation services with long-term psychiatric treatment services is inappropriate. This decision has many underestimated risks.
One of them is that Lithuania may face courts as a result. In this case, the service paid for by the state is a treatment that is provided on a mandatory basis. Migrants can claim to be infected with COVID-19, but have received psychiatric treatment in a hospital, which has been paid for by the Republic of Lithuania.
They may start claiming damages and then have to prove that the migrant was not actually treated for a mental illness.
“Treatment has been done and a diagnosis has not been made. On what basis is a person given involuntary treatment? Will they be treated under the Mental Health Act or will it be a different court decision? A person cannot be treated in a psychiatric hospital to receive psychiatric services illegally. Lithuania is a state governed by the rule of law, so the law must be respected. Compulsory treatment according to the Law on Mental Health Care cannot be applied to people who do not suffer from a mental illness ”, comments N. Goštautaitė Midttun on tv3.lt.
It is strange to the specialist that VLK, by closely monitoring whether the institution has actually provided the services for which VLK pays, allows itself to pay what will not be provided. It is not clear how the quality requirements for a different treatment service will be determined, who will decide on its content.
Distorting the statistics can have a negative impact on the hospital.
Another problem that can be caused by using the code for this service is distorted statistics.
“When we cover one service with another, then we have misleading statistics on the treatment of mental disorders. Will these cases be included in the treatment statistics, or will they just not be reported or will there be an additional code? There are no answers to these questions yet.
When paying for long-term psychiatric treatment, if not provided, statistical codes will still be assigned to a specific institution. This means that there will be an excess of additional false cases of long-term treatment, ”says N. Goštautaitė Midttun.
The decision may also have a negative impact on Rokiškis Psychiatric Hospital. N. Goštautaitė Midttun says that long-term treatment is an indicator of poorer work: it means that the institution has not been able to deliver effective treatment and patients stay in hospital for too long.
“SAM has established certain indicators, it requires the number of days in bed to be up to 18 days, and this is considered good practice. With the addition of more long-term treatments, the performance of the hospital should decrease. And the manager’s salary already depends on it. If this is not taken into account, it is not yet clear exactly how to do it, ”says N. Goštautaitė Midttun.
Possible provocations from hostile states
Another risk is that the decision to combine two different services in one code may have a negative impact on Lithuania in the international community. The document can be used by countries hostile to Lithuania and may start to create misinformation about Lithuania.
“It just came to our attention then. Apparently, we forcibly placed migrants in psychiatric hospitals and treated them there. Just like in Soviet times,” notes N. Goštautaitė Midttun.
The interlocutor states that Lithuania does not lack experience in handling similar situations. The summer hospital had provided a separate building and isolation facility during the first quarantine.
“There are institutions that have similar service experience, it is not necessary to pretend that we provide services that are not provided. At that time, the system worked quite well, paid for by the Vilnius municipality, that is, as an isolation service.
Now it has been chosen to pay for a bogus service out of the mandatory health insurance budget when it is constantly short of funds, simply at a similar rate per bed day. This is contrary to legal and ethical principles. It is obvious that this can lead to many problems, the risk of which has been underestimated ”, concludes N. Goštautaitė Midttun.
Former Health Minister, who worked as a psychiatrist, MP Aurelijus Veryga shared a post on his social media on Wednesday about VLK’s decision to include the migrant isolation service under the long-term treatment code.
On the portal tv3.lt, the parliamentarian says that the choice of a psychiatric hospital as a place to isolate migrants is strange.
According to the MP, if a service code was needed to allow the hospital to pay for services, it was necessary to create a new code instead of putting the isolation service under another code.
The MP also sees the actions of states hostile to Lithuania as one of the biggest threats.
“Knowing how many provocations there are from our hostile neighbors, all we need is for all of us to start psychiatric services, almost to write diagnoses. In general, how does it look? Psychiatry is not some kind of toy to write those things down. If you want to pay, the Government can really do it without delaying such service codes “, – TV3.lt comments A. Veryga.
According to Veryga, this decision was “a bureaucratic attempt to evade, to find a way to pay.” This, according to the parliamentarian, is an unexpected step.
“Without a mind-blowing shape, I’m surprised how close to fantasy it spreads. Soon we will begin to write everything in medicine. After all, these are not psychiatric problems at all. And anyway, psychiatry is stigmatized, it has problems, I think it is completely wrong to stigmatize it even more ”, says A. Veryga.
Psychiatry and the coronavirus are two incomparable things
Ramunė Mazaliauskienė, president of the Lithuanian Psychiatric Association, psychiatrist and psychotherapist, says she understands why it was decided to include migrant isolation services in the long-term treatment code. According to the specialist, after deciding that the migrants would be isolated in the Rokiškis Psychiatric Hospital, it was necessary to find a way to pay for the services provided.
“A service code has been created to reimburse the hospital for the services that will be provided to these people. It sounds strange to me that a psychiatric code has been given, which in principle means that there is a mental disorder ”, observes R. Mazaliauskienė on tv3.lt.
According to the expert, people isolated from the coronavirus should not be equated in any way with people with mental health problems.
“There is no medical logic. If a patient is suspected of having a COVID-19 infection, then it is an infectious disorder. Psychiatry is a completely different field of medicine. Infectious diseases and psychiatry are completely different things, since a wood processing plant and a metallurgical plant seem to belong to the industry, but they are completely different areas and cannot be mixed ”, says R. Mazaliauskienė.
SAM explained the solutions
The Deputy Minister of Health Danguolė Jankauskienė commented to the news portal tv3.lt that there is currently a really unusual and extraordinary situation in Lithuania: two emergencies have been announced (due to the Covid-19 disease and due to the influx of illegal immigrants), which they require rapid, extraordinary and non-systematic solutions, involving the various medical institutions of the country and awaiting cooperation.
“The isolation of migrants is a municipal competence. In the absence of such opportunities, government agencies came to the rescue. For these reasons, the decision was made to isolate the migrants in the Republic Psychiatric Hospital, because, unlike other Lithuanian hospitals, it has protection, otherwise it would have been necessary to organize additional protection in the hospitals.
We also had to work out the procedure for paying the hospital for services, that is, paying the mental hospital for services that were unusual for him. In order not to require an additional license for the institution, a new service fee code 3906 was approved in lieu of sickness.
There will be no mental illness codes in medical records, only the Covid code. The service code used for payment will be used only for this specific purpose: to pay for the services provided, and will not be included in any statistics on mental illness ”, responded Mr. Jankauskienė, Vice Minister of SAM.
Dust: Migrants with COVID-19 to be housed at Rokiškis Hospital next week
Migrants with COVID-19 at Rokiškis Psychiatric Hospital will start accommodation starting next week, says Health Minister Arūnas Dulkys.
“Approximately, if I remember correctly, the speech starts on the 23rd. But these are new solutions in which we continue to work and collaborate. There is such an organism alive here, every day the emergency commissions and people work there every day 24 hours. per day recently. These solutions can still be diverse depending on the situation, ”A. Dulkys told LRT radio on Tuesday.
According to Lietuvos Rytas television on Monday, Rokiškis Psychiatric Hospital managers confirmed that the facility is preparing around 60 places for migrants with mild or asymptomatic COVID-19. They would be housed in a separate fenced hospital area.
A. Dulkys told LRT radio that these decisions were necessary in the event of an emergency situation in the state, and emphasized that the migrants would not be housed in a medical institution subordinate to the municipality, but to the ministry.
This year, more than 4.1 thousand people illegally crossed the border between Lithuania and Belarus. migrants. The increase in illegal migration has been declared an emergency. The country’s officials take the position that the increase in migratory flows is an organized action of the Minsk regime against Lithuania.
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