Bulgaria鈥檚 mentally ill battling for their dignity
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At the psychiatric hospital in Kurilo in the mountainous countryside near the Bulgarian capital Sofia, around 100 patients languish on their beds in dilapidated surroundings.
For hospital director Tsveteslava Galabova, the facility is 鈥渞epresentative鈥 of the state of psychiatric hospitals across the country.
Of the 12 public hospitals treating people with psychiatric disorders, 11 are in remote locations like Kurilo.
Bulgaria 鈥 with a population just over 7 million 鈥 remains the European Union鈥檚 poorest country and still struggles to provide adequate mental health care.
The country鈥檚 psychiatric hospitals have 2,300 beds in total, while another 13 asylums offer space for around 1,000 patients 鈥 with another 900 on a waiting list.
Built in the early 20th century, Kurilo鈥檚 hospital is the biggest in the Sofia region, but the facility offers little respite from the bitterly cold winters or from the sweltering heat of summer.
It may be situated in a lush green park but, as Galabova drily notes, that alone 鈥渃an鈥檛 treat schizophrenia.鈥
Inside, the conditions are dire, with two toilets for every 20 patients, three patients per room and the metal beds they sleep on are their only personal space.
As well as material privation, those suffering from mental health issues also have to deal with widespread prejudice.
Interior Minister Valentin Radev recently sparked controversy after a high-profile murder case by saying 鈥渢he mentally ill should be brought under control and locked up.鈥
鈥淭he attitude of stigmatization is pervasive in society, even among doctors,鈥 said Professor Drozdstoy Stoyanov, a senior adviser on psychiatry to the ministry of health, who invited experts from the European Psychiatric Association to Bulgaria to advise on reforming the system.
In a 2017 report, the UN鈥檚 Committee Against Torture expressed concern over 鈥渢he high incidence of inappropriate or unnecessary non-consensual institutionalization鈥 in Bulgaria while noting a lack of 鈥渋ndependent inspection or monitoring mechanism for mental health institutions.鈥
It also noted the ongoing problem of isolation, saying such institutions 鈥渃ontinue to be located in remote locations鈥 鈥 a fact not lost on Galabova.
鈥淲e asked for the hospital to be transferred to Sofia but the city authorities said that a referendum would have to be held first,鈥 she said, indicating that the idea was eventually dropped.
鈥淚t is extremely dangerous for physical and mental health to spend hours and hours doing nothing,鈥 said visiting EPA president Silvana Galderisi .
One of the main problems in Bulgaria is the fact that 鈥渢his kind of institution (still) exists: They are very isolated, are very large and very understaffed for the number of people they have.鈥
With few facilities located near the patients鈥 communities, their families tend to leave them at the mercy of such institutions, often for years on end.
In the past, there was a farm at Kurilo where the patients could work but it didn鈥檛 survive the transition to a market economy.
And now there are no funds for any form of rehabilitation.
鈥淥ur budget is ridiculous and absurd,鈥 said Professor Maya Stoimenova, director of the psychiatric clinic at the Medical University of Pleven in northern Bulgaria.
Like many others, her clinic struggles to afford the wages of basic personnel to supervise patients and distribute medicine, let alone provide any further therapy.
The average wage of a health worker specialized in rehabilitation is 630 leva (US$370) a month, compared with 450 leva for a psychiatrist and 490 leva for a nurse.
In other European countries 鈥渢hey can earn at least two-and-a-half times as much,鈥 Galderisi said.
It will remain difficult for Bulgaria to compete with other EU states in terms of salaries for specialist workers, with only around 2 percent of the country鈥檚 health budget earmarked for mental health.
The EPA recommends this portion should rise to 10 percent.
As for reforming the sector, experts note that Bulgaria lags behind other countries such as Poland and the Czech Republic.
Under pressure from the EU and the United Nations, the government has outlined some steps to improve care for those suffering from mental disorders and disabilities.
This year, it launched a three-year action plan which includes the closure of 10 understaffed and inadequate institutions and replacing them with day centers offering care within the community, as well as a smaller number of residential homes. But there is still a long way to go, and as Galderisi said, 鈥減olitical will is crucial.鈥
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