Bulgarian psychiatric and social care institutions: ill-treatment, acute understaffing, mechanical restraint misuse

In a new report the Council of Europe’s anti-torture Committee (CPT) has expressed grave concern that many of its long-standing recommendations concerning the treatment, conditions and legal safeguards offered to psychiatric patients and residents of social care institutions remain unimplemented. (see the report’s executive summary) In August 2020, the CPT delegation visited St Ivan Rilski State Psychiatric Hospital and Tsarev Brod State Psychiatric Hospital for the first time, as well as Byala State Psychiatric Hospital which was visited by the CPT in 2006. The delegation also visited, for the first time, social care homes for persons with learning disabilities in Kudelin and Samuil and the social care home for persons with psychiatric disorders in Govezhda.

In all hospitals and social care homes visited, the delegation received allegations of ill-treatment of patients and residents by staff – orderlies (‘sanitars’) were verbally rude to patients and residents, pushed or slapped them, punched, kicked, and hit with sticks. Gate guards in Kudelin and Govezhda social homes carried and would occasionally hit residents with wooden sticks (sticks matching descriptions given by residents were found by the delegation in staff offices in all three establishments). As regards living conditions, the Committee notes that some renovation has occurred in all three psychiatric hospitals, particularly in Tsarev Brod, and that material conditions in Byala had improved since the CPT’s last visit in 2006. However, there was a clear scope for further general material improvement and personalisation of dormitories. As for the social homes visited, Samuil provided for satisfactory internal décor and even en-suite sanitary facilities in many rooms but living conditions and sanitary facilities in Kudelin and Govezhda required major improvement.

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In all three hospitals visited, inadequate, and often grossly insufficient numbers of ward-based staff were found. The number of multi-disciplinary clinical staff, too, was totally inadequate to meet the many psycho-social treatment and rehabilitation needs of patients. “Unfortunately, the findings of the 2020 visit suggest that the Bulgarian authorities still fail to fully grasp the importance of adequate numbers of staff and the need to assertively act to rectify that deficiency,” the Committee stated. “The persistent staff shortages give the impression that, in the Ministry of Health, mental health care is not sufficiently valued; it clearly needs to be given a higher priority for investment and development.” In social homes, too, the numbers of nurses and orderlies were totally insufficient. Seemingly due to low salaries and the difficulties in attracting and retaining staff to work in the rather remote establishments, the professional quality of staff, especially orderlies, appeared to be poor; this, combined with inadequate training and supervision, undoubtedly increased the risk of ill-treatment of residents. The numbers of staff who could provide psycho-social, occupational and recreational input to residents were also inadequate, particularly in Kudelin and Govezhda.

Council of Europe

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