Patients in Bulgarian psychiatric hospitals are provided with nothing even approaching modern psychosocial treatments
Continued abuse and tying of patients, lack of therapy, understaffing. This is what a delegation of the Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) of the Council of Europe saw during their visit to state psychiatry centers in Bulgaria in March 2023, reports Free Europe – the service for Bulgaria of Radio Free Europe/Radio Liberty (RFE/RL).
Their observations were set out in a critical report, noting that the country “once again demonstrates the continuing serious failure of the Department of Health to prevent and eradicate such unacceptable behaviour”.
The news comes against the background of a case from the end of last year, when a patient of the psychiatry in Lovech died in a fire while being tied up for punishment. The case provoked a swift investigation by the ombudsman, which found numerous violations that led to the fatal outcome.
The National Assembly established a temporary commission to collect and analyze data on violations in psychiatry and to propose legislative solutions.
The Torture Committee has seen some progress in welfare institutions and hopes that actual deinstitutionalization will continue.
His report was published together with the response of the Bulgarian authorities. It does not differ significantly from the reports published after observations in Bulgarian psychiatry in recent years.
“Patients are hit and kicked”
The delegation visited the state psychiatric hospital “Tserova Koria”, the social care homes for persons with mental retardation in Draganovo and Tri Kladentsi, and the state psychiatric hospital in Byala.
She has received a number of claims from patients at both hospitals that, in addition to being shouted at by staff, orderlies also punch and kick patients, including in the groin.
It is common practice for patients to be tied, isolated, mechanically and chemically restrained.
As for the material conditions, the CPT sees overcrowded rooms and a “carceral” environment – with bars on the windows and a lack of decoration.
“As with previous visits, staff numbers are grossly inadequate to ensure adequate patient treatment and a safe environment,” the report said. The hospital in Byala continues to experience an acute shortage of psychiatrists.
There are limited opportunities for psychological, occupational and creative therapy. Most patients simply lie in bed or walk around idly.
CPT emphasizes that patients in Bulgarian psychiatric hospitals are not provided with anything that even comes close to modern psychosocial treatments.
Many patients were not informed of their rights as voluntary patients, including the right to be discharged at will. Thus, de facto, they were deprived of their freedom.
The Committee also requests the Bulgarian authorities to provide the conclusions of the audit of the clinical trials conducted at the Tserova Koria State Psychiatric Hospital, including the ethical approvals of these trials.
Calm atmosphere in care homes
The committee found the atmosphere in the care homes visited to be relaxed and most residents spoke positively of the staff.
In the homes visited, isolation and tying of the residents are not practiced.
Living conditions are relatively good, but the number of attendants and medical staff is “grossly inadequate” to provide adequate care for residents.
In their response, the Bulgarian authorities provide information on measures taken or planned to implement the recommendations made.
Note: Report to the Bulgarian Government on the ad hoc visit to Bulgaria carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 21 to 31 March 2023. The Government of Bulgaria has requested the publication of this report and of its response. The Government’s response is set out in document CPT/Inf (2024) 07.