The invisible sick people of Bulgaria
A few days ago, the meteorologists striker from Murgash Peak Stoyan Stoyanov, placed with a court decision for home treatment at St. Ivan Rilski Psychiatric Hospital, left the clinic arbitrarily and was returned by two police officers. These are the current news on the case with the « naked man of the mountain », which in a visibly inadequate state dawn on March 9 beaten Rumyana and Georgi Zlatanov and entered all news emissions.
Neither money nor support: where does psychiatric assistance fail in Bulgaria
This can happen to any of us
| Behind the public attitude « this one is crazywhat we will do with him, he will be crazy all his life! « There is a rejection of this disease state, the stigma and the prevents that this can happen to any of us. |
| « The world is very uncertain at the moment. We live with the sense of lack of rules, lack of rights, lack of rule of law, breakup. And we tend to ignore everything that adds additional anxiety, and these are people with severe psychiatric disorders. As if we cannot bear it as a society, » says Valentina Hristakeva. |
From the diagnosis to treatment: How to get to a psychiatric hospital and what follows
One of the big reasons for poor outpatient treatment, according to Dr. Velinov, is the elimination of the dispensary system, including compulsory meetings of the patient with his / her treatment team. Some time ago, even patients living in inaccessible edges were visited by the doctor and sister who went periodically with an ambulance to examine the patients in place. « Because these people need permanent continuous monitoring. And this must be a state policy, » the psychiatrist says. However, state policy is different.
No concern did not come from anywhere. The mentally ill are not in the sight of politicians. They are not active voters, often they have no relatives or relatives to stand behind their backs. Mental illness is not represented. They have no national advocates.
Valentina Hristakeva runs enterprises where people with severe mental disorders are hired. They work, contribute to the social economic growth of the country, pay taxes, insurance. This is a working practice worldwide. Such are the results in Bulgaria. Those who have started work do not fall into crises can recover so that they live with dignity and when there is care and support, the results are visible. GIP-Sofia is also a social service provider.
« The municipality has a leading role in this process, » says Valentina Hristakeva. « It should launch a procedure with the Ministry of Labor and Social Policy, with which to seek funding for this activity. When the municipality argues the need for disclosure of these services, it should be included in the financing for the next calendar year. The activity is funded by the state and is delegated to our management organization. »
| But it happens hard. Because of the stigma, because of the negative public attitudes, because of the unpopular target group that is not politically « interesting ». |
« Last year, a map of social services was accepted, but we do not see our target group well represented in the municipalities. We see family -type accommodation centers, protected housing. It is as if this is the maximum for the people of this community – to be separated, to be accommodated, however. is in the center of Sofia, if it can be somewhere in the suburbs, if it can not be in the suburbs, because even there live people, it should not be to school, it should be nothing. About this is the expectation, « says Hristakieva.
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She adds that the Ministry of Labor and Social Policy is the only one that recognizes the need for this type of service – unlike the Ministry of Health, in which she has no figure to which this topic is important to her, there is no competent professional to advocate for the care of the mentally ill.
The lack of competence, leadership, literacy regarding good world practices, and lack of respect for the profession by society is expressed in the anecdote: psychiatry is not a profession but a diagnosis. This contains both misunderstanding and the undervaluation of the work of psychiatrists. In the literal and in the figurative sense of the word.
No money – act!
Psychiatry is not one of the desired students’ specialties. The state does not spend money. The hospitals are municipal. The payment is miserable and the conditions meet the pay. This directly affects the training of staff in medicine and in clinical psychology.
| « The clinical psychological practice works with methodologies that were standardized in the 1970s. This is a shame, » says Georgi Kirilov, a teacher of clinical and consultative psychology at Sofia University « St. Kliment Ohridski ». |
And he continues: « When colleagues go to work and ask the hospital to provide them with newer methodologies, they are laughing there and telling them: we have no money to pay you wages, repair the roof from which it runs over patients, and you want to give you money for tests. You have these tests – work with them. »
The problem of training training is also reflected in the work of experts. For their expert work, for which they are criminal liability (imprisonment of up to 5 years for false conclusion or incorrect protection), they receive less than BGN 30 per hour – nearly three times less than the fees in private practice. Thus, in the court proceedings, either the « Mohicans » remain – committed to the profession or poorly prepared, which has a negative impact on the quality of expertise. Competent clinical psychologists have been working for some time and leaving.
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Georgi Kirilov is an expert in the Sofia Court of Appeal, Supervisor is in the field he works, there is a doctorate in clinical psychology. Since 2008, together with Assoc. Prof. Velinov, they have made regular proposals for the creation of a register of experts and the register of expertise that these experts defend. « This will immediately give information about the quality of the experts, and it will be useful so that future staff can be trained. Because the requirement for experts to maintain their professional qualification is only formal. There is no body to make me enhance my professional qualification, nor does there be an authority for me. The subsequent appraisal of the professional competence of the experts, but there is no such interest.
The stigmatized Bulgarian
There is no binding discipline in the legal education of magistrates, Prof. Velinov continues the topic. « Well, how prosecutors, investigators, judges understand what happens when they meet such cases. »
| Thus, we come to one of the saddest finding that all three interlocutors share: abuses of patients’ rights, marginalization, rejection. Because stigma necessarily leads to rejection. |
Poor practices are not only provoked by the fact that someone neglects the fact that the mental illness has rights, but also that it does not have the instrument to take adequate care for that person.
There are not enough staff, there is not enough security in the workplace, no procedures to secure this person right now. There is no external support, no public understanding of what is happening in psychiatry, explains Valya Hristakeva.
Evil Conditions: In psychiatry, they continue to tie patients without clear rules
And according to Assoc. Prof. Velinov, the total trouble is that there is no desire among young specialists to go to psychiatry. Because – apart from miserable conditions – there they will communicate with patients who are surprising, incomprehensible, sometimes frightening, and the professional, especially in the first years of his adaptation, wonders where he has fallen, says the psychiatrist.
Valya Hristakieva emphasizes that the low rewards of workers in psychiatric units are a terribly important topic. But the conditions in which the patients are treated are stunning – this is an absolute fact. And it is important that the topic be addressed in an adequate manner. But this is in no case enough.
Raising wages will not change quality. And that’s what we’re just talking about – about psychiatrists and their salaries. And there is not a word for those who live at 15-20 years locked in this place. «
Victim of his mental illness
We are deeply unenlightened people with regard to mental health and we have no high emotional intelligence as a society.
| We are not civilized enough and do not accept that the person who suffers is the victim of his mental illness. |
But does anyone teach the children of empathy, compassion?
