The CPT is highly critical of the lack of implementation of many of the Committee’s long-standing recommendations regarding the treatment, conditions and legal safeguards offered to patients in psychiatric hospitals. However, the CPT notes that some progress appears to be being made as regards the treatment of persons in social care institutions, especially with the help of dedicated managers and staff. The Committee hopes that genuine deinstitutionalisation of social care will continue, with proper community facilities and care being provided for service users.
In the report, the CPT again received a number of allegations of ill-treatment by staff (shouting, slapping, punching, and kicking) from patients in the psychiatric hospitals visited. The CPT concludes that such a situation demonstrates the continued failure by the Ministry of Health to prevent all forms of ill-treatment of patients and to convey a clear message to staff that ill-treatment will not be tolerated and will be the subject of appropriate sanctions.
The Committee notes that staff numbers in psychiatric hospitals continue to be grossly insufficient to provide the necessary treatment for patients and to ensure a safe environment on the wards. Opportunities for psychological, occupational, and creative therapies also continue to be very limited. The CPT therefore reiterates that patients in Bulgarian psychiatric hospitals are not provided with anything approaching the full range of modern psychosocial treatments required, which is both neglectful and harmful to patients.
As during previous CPT visits to Bulgaria, a number of patients deemed de jure voluntary were not truly consenting to their hospitalisation and were de facto deprived of their liberty. The majority of such patients did not seem to be informed of their rights as voluntary patients, including the right to be discharged upon their request.
The Committee also requests that the Bulgarian authorities provide the conclusions of the audit into the clinical trials ongoing in Tserova Koria State Psychiatric Hospital (including the copies of the ethical approvals of such trials) following the CPT’s concerns during the visit to the hospital regarding informed consent, proper documentation, and remuneration of participants.
Turning to social care homes, the CPT commends the kind and warm attitude of staff towards the residents in Draganovo Social Care Home for Persons with learning disabilities. The staff’s high level of commitment is especially commendable considering the challenges faced by the extremely low numbers of staff caring for many residents requiring personal assistance.
The Committee further notes the recent adoption of the Ordinance on the Quality of Social Services, which has increased the coefficient of the number of employees in each social service in relation to the number of residents. It is hoped that social care homes across the country will be able to strengthen their staffing numbers.
Finally, the CPT is pleased to observe that the seclusion and mechanical restraint of residents are not practiced in the two homes visited, thus respecting the provisions of the Bulgarian legislation.
In their response, the Bulgarian authorities provide information on various measures, taken or envisaged, to implement the recommendations made by the Committee in the visit report, notably through the implementation of the National Strategy for Mental Health of the Citizens of the Republic of Bulgaria and the National Long-Term Care Strategy.