According to specialists, psychiatry is the part of the health-care system facing the biggest problems.  It’s not that there aren’t examples of good care.  But overall they say that the psychiatric care system, “is badly organised, lacks funding and doesn’t take a sufficiently up-to-date approach to its organisation and to using the latest treatments”.  Better funding for state-run psychiatric hospitals, upgrading of aging buildings, and the introduction of IT systems or other ways of recording past treatments have to be the first steps in a reform which unfortunately still hasn’t begun, despite being charted in numerous official documents.  And it’s why carers are ringing alarm bells.

“Without a single IT system in place we just don’t know how many people came to hospital for psychiatric care last year, for example,” says Dr. Katsarov from the Centre for Patients’ Rights.  All the health service knows is how many people overall received in-patient psychiatric care – about fifty thousand over the year.  But they’ve no idea what proportion of them were repeat admissions.  So the question is how many patients actually came for and received in-patient psychiatric care, points out Dr. Katsarov.

For five years now, Dr. Tsveteslava Galabova has been the director of one of Bulgaria’s twelve psychiatric hospitals, St. Ivan Rilski, in Novi Iskar near Sofia.  She’s actually worked there for twenty years and says that there are very serious problems with psychiatric care in hospitals.
 
“Just one problem is the poor equipment that most psychiatric hospitals have.  But there is one shining example which shows that things can change if you want them to.  That’s Pazardzhik psychiatric hospital, which looks like a hospital should, it’s in the right place and provides high quality European standard psychiatric care.  Unfortunately the situation elsewhere isn’t good.  The twelve state-run psychiatric hospitals have been open for many years.  Ours was opened 70 years ago but the one in Karlukovo is a hundred and ten years old.  In the past it was thought that people with mental illnesses had to be kept in isolation, far away from society for long periods of time.  That’s how it was, but thinking has changed.  For thirty years now, no-one in Europe has treated patients by institutionalising them.  But we still do that in Bulgaria.  Sadly, nothing, or almost nothing, included in the mental health reform, which was part of the national mental health plan for 2004 to 2014, has been put into practice.”

Dr. Galabova points out that one major problem is the difference in funding between state-run psychiatric hospitals and the other care structures like mental health care centres.  Psychiatric hospitals have a fixed annual budget, but health centres are funded according to how many patients they treat.  They also receive subsidies from the Ministry of Health to treat patients for thirty days, but once they’ve used up the subsidy, they send the patients to state-run hospitals for treatment after barely a fortnight.  The centres say they’re only doing, “what the court said.”  But the court only said that because that was what the health centre’s expert proposed, explains Dr. Galabova, adding: 

“So far this year, seventy-nine patients have been transferred to St. Ivan Rilski hospital from psychiatric care centres.  At the moment, for example, we’ve got more patients from Dupnica.  It affects the patients badly.  How can we say that we’re socialising patients and modernising psychiatric care if patients are treated so far away from their families and loved ones?”, asks Dr. Glabova.  On that same point, Stoicho Katsarov notes:

“The most important thing at the moment is to rethink how psychiatric hospital care is funded.  We’ve got to make changes that take account of the specific nature of these diseases.  It’s not a question of more money, but of allocating funds more effectively so the system works properly.  For example, if we decide that state-run psychiatric hospitals and mental health care centres are separate, then we need to treat them as such.  If they have the same functions and do the same job, then they should be funded in the same way.”

When it comes to the position of the mentally ill in society, they’re mostly at the bottom of the social ladder, quite simply because serious mental illness starts at a young age.  Very early and very quickly it turns patients into invalids.  They can’t get work experience so they’re put on welfare benefits and lead pretty unhappy lives.

English:  Christopher Pavis