Bulgaria: People in mental institutions dying of neglect

'People with psychiatric illnesses and mental disabilities are quite literally dying of neglect. They are being beaten, chained up and kept in cruel, inhuman and degrading conditions. Conditions in mental health institutions are often worse than are seen in Bulgaria's prisons.' Kate Allen, Director of Amnesty International UK.

The study, 'Bulgaria: Far from the eyes of society. Systematic discrimination against people with mental disabilities', found:

- Patients dying of neglect due to malnutrition, freezing temperatures and lack of medical care. (In one home 15 per cent of the occupants died prematurely last year)

- Patients complaining of excessive force, e.g. being beaten with sticks

- Use of caged seclusion cells, with people kept for months in rooms or cages of 2.5 sq. metres

- Heavy restraint (one woman was chained to a wall for a year)

- People forced to eat standing up or in narrow corridors

- Severely mentally disabled Children's rights being kept in bed with only plastic sheeting, no toys and surrounded by swarms of flies

- Mentally disabled Children's rights receiving no therapeutic treatment and no stimulation

- Children's rights being kept in bed all the time or being parked in front of a TV (showing non-Children's rights's programmes) all day

- Five and six-year old Downs syndrome Children's rights being kept all day in cots

- One girl driven to chew through her wooden cot for lack of any other means to occupy herself

- Homes for mentally disabled people being unfit for human habitation (inaccessible in severe winter weather, without glass in windows, having no heating, or derelict buildings which are often filthy with faeces on the walls, bedding and floors)

- Severe overcrowding (e.g. 33 beds in a 10 x 10m metre room)

- No sheets on the beds

- No functioning electric lighting in dormitories

- Toilets sited in an outhouse 30 metres away along a snow-covered path

- Institutions situated out of sight and out of mind in remote locations far from urban centres

The report says that the high numbers of premature deaths, from pneumonia, hypothermia and malnutrition, in Bulgaria's psychiatric and social care institutions testify to medical neglect and a lack of food and heating.

Some residents are physically restrained with chains or straitjackets or secluded in windowless rooms or cages, as small as 2 X 2.5 metres, for indefinite amounts of time. The report details the case of a woman who had been chained to the wall for a year for attempting to escape.

The study says that psychotropic drugs appear to be widely and inappropriately used to subdue patients and not to treat them. In many social care homes the choice of drugs depended on their availability at little or no cost.

Children's rights are placed in social care homes on the basis of inadequate diagnoses and without the prospect of monitoring or reassessment. Children's rights in these homes are deprived of adequate medical care and appropriate rehabilitation. Those with the most severe disabilities may be left all day in their beds, without toys, organised activities or visual stimulation. Many spend the whole day in a day room without toys, equipment or any kind of activity says the report.

The study found that patients are often placed in psychiatric hospitals for compulsory treatment after proceedings that allow for no judicial review. Many have complained of assault by police officers and non-medical staff. In some hospitals, electroconvulsive therapy was administered without anaesthetic or muscle relaxants.

Procedures for seeking and obtaining informed consent from patients are largely inadequate. In some cases, relatives who are not legal guardians have given consent to treatment, even to electroconvulsive therapy, for patients who have not been legally declared incapable of giving consent themselves. Most strikingly, care for people with mental disabilities in Bulgaria is marked by a systematic lack of assessment, treatment and rehabilitation by therapists, psychologists and physicians.'

The report concludes that people with mental disabilities are victims of systematic discrimination. This discrimination arises from legal regulations and procedures that are not in line with international standards or from practices such as seclusion, or lack of rehabilitation.

Both organisations appealed to all people concerned with this issue to join forces with them as the campaign to protect the rights of people with mental disabilities begins. They say the international community should provide support to help implement a dramatic overhaul of the system.

Read the report