site.btaParliamentary Committee Discusses Psychiatric Care System Issues and Challenges

Lack of personnel, lack of young doctors, low pay, poor equipment are part of the problems in the psychiatric care system, and Bulgaria is in last place in Europe in terms of number of psychiatrists, said Dr. Vladimir Nakov from the National Centre for Public Health and Analysis during a meeting of the Temporary Parliamentary Committee to Protect the Rights of Mentally Ill Patients and to Draft Legislative Changes to Safeguard Them. Nakov cited data from a monitoring of psychiatric care in the country carried out in 2023, the purpose of which is to establish the structure of psychiatric treatment facilities, as well as the needs for psychiatric care.

The data showed normative problems and problems in psychiatric care structures. In terms of regulatory issues, violations of the Health Act have been found, with instances of courts in some cities sending patients to forced treatment for six months, while the legal term is three months, Nakov pointed out. Some of the other problems are related to taking the study of psychiatry, a new postgraduate training programme is currently being developed. There is a lack of a legal framework that would allow the development of certain activities in medical facilities, and there are also no incentives for continuing training of specialists in inpatient treatment. Nakov  said that in other countries there is a targeted financial mechanism for the active participation of doctors in congresses and conferences on psychiatry.

There is a lack of staff at all levels in the psychiatric care system, low pay, poor material base, insufficient equipment, poor transport communication, poor organization between psychiatric care units at the regional level, Nakov also noted.

The average age of psychiatrists in Bulgaria as of August 2022 is around 60 years old. It is expected that by 2015 there will be a severe crisis, as the number of people entering the system is extremely small.. There are twice as many women in psychiatry as men, the monitoring data also show. Those entering the specialty are mainly women, which means that the profession is becoming feminized, and there are studies that this leads to reduced pay, Nakov added.

One of the serious problems that must be solved is the increase in the salaries of nurses and doctors working in state psychiatric hospitals, said Health Minister  Hristo Hinkov. In the budget of the Ministry of Health for this year, no funds are provided for increasing these remunerations, he also pointed out.

“In our efforts to return mentally ill patients to the community, we made an attempt to create clinical pathways in psychiatry, which was met with traditional resistance, which is inexplicable to me, considering that until now there was no regime to control what happens in psychiatric hospitals,” Minister Hinkov also said.

“If we build mental health centers in regional cities, real deinstitutionalization can begin,” he added. The Ministry of Health has asked the Ministry of Finance to make an adjustment to the funds earmarked for the construction of 300 outpatient clinics and that they be earmarked for the construction of mental health centers. The answer from the Ministry of Finance was that there are no funds planned so far, Minister Hinkov added.

In Bulgaria, mental illness is equal to social death, because people know that all doors close for and there is stigma attached, said psychiatrist Dr. Tsveteslava Galabova.

Lawyer Marieta Dimitrova indicated that an analysis should be made of the forms of detention and the order for the accommodation of nearly 200 people who are long-term residents of state psychiatric hospitals.

The members of the Committee agreed that the Ministry of Health should monitor the state psychiatric hospitals and establish the exact number of long-term residents, as well as a named list of the persons and their place of residence. It was also voted that the Ministry of Finance would propose to provide funds for targeted funding until the end of this year for state mental hospitals, providing funds for the maintenance of the hospitals.