Public amnesty international Bulgaria Far from the eyes of society Systematic discrimination against people with mental disabilities
November 2002

Summary AI Index: EUR 15/005/2002

Amnesty International is concerned about the grave lack of respect for basic human rights of people with mental health disorders or developmental disabilities (hereafter referred to as people with mental disabilities) in Bulgaria. Some of their basic rights are systematically violated when being subjected to treatment against their will in psychiatric hospitals, or when placed for residential care in social care homes for children or adults with mental disabilities. Many of the violations of basic human rights, arising from legal regulations and procedures which are not in line with international standards, or from the observed, widespread practices, such as the enforcement of seclusion or lack of rehabilitation and active therapy, amount to systematic discrimination against people with mental disabilities.

In October 2001 and January 2002, representatives of Amnesty International, the Bulgarian Helsinki Committee (BHC) and Mental Disability Rights International (MDRI) visited a number of these institutions. The delegation uncovered a broad range of violations of basic human rights which concerned issues such as legal provisions and practices regarding compulsory treatment in psychiatric hospitals which result in arbitrary detention and violations of fair trial rights; lack of adequate rehabilitation for mentally disabled children; and shocking living conditions and inadequate treatment available in social care homes for adults.

Placing many of these institutions in very remote locations, some of which are unsuitable for all-year residential accommodations, appeared to be the result of a deliberate policy of isolating those with disabilities. Far from the eyes of society, these people are not an unpleasant reminder of society=s failure to accept the responsibility to treat all human beings as equal and to assist those who are at a disadvantage.

The living conditions in hospitals visited by AI's representatives were inadequate and did not meet international human rights standards. There was a notable lack of opportunities for rehabilitation and therapy, and electroconvulsive therapy was reportedly administered in some institutions in its unmodified form (i.e. without the use of anaesthetic or muscle relaxant). Restraint and seclusion practices in psychiatric hospitals were not in line with international standards and in some instances amounted to cruel, inhuman and degrading treatment or punishment. Legal regulations regarding placement for compulsory psychiatric treatment in Bulgaria did not provide sufficient guarantees of independence and impartiality. Furthermore, the Bulgarian authorities have failed to bring the legislation concerning placement for compulsory psychiatric treatment into line with the decision of the European Court of Human Rights in the case Varbanov vs. Bulgaria.

The placement of children into institutions is frequently based on unscientific diagnoses, and without a genuine assessment of the level of support which they require. There are no rules, or procedures, or practice which would impose consistent monitoring and reassessment of diagnoses by teams of specialists. Poor living conditions prevailed in all social homes for children visited. State-allocated resources were reportedly inadequate for even basic maintenance of the facilities, provision of food, heat and clothing. None of the institutions visited were staffed or attended (even on an irregular basis) by the range of specialists required to conduct an appropriate rehabilitation program for children with developmental disorders. Medical care was inadequate and general practitioners were often far away from the social care home. Treatment by specialists, including psychiatrists, rehabilitation and reassessment, were not standard practice.

Adults with mental disabilities are placed into social care homes in a procedure which blatantly fails to meet requirements of international human rights standards and violates the rights to due process and freedom from arbitrary detention. The living conditions in seven of the eight social care homes for adults visited by AI amounted to inhuman and degrading conditions in violation of international law. The level of neglect in some facilities rendered some buildings derelict, filthy, and, in places, dangerous for the residents. Dormitories frequently contained large numbers of residents and few institutions had any space, even toilets, which afforded privacy. Residents were dressed in ragged clothing or old army uniforms. All the homes were providing three meals a day, but many residents appeared malnourished and complained that the food was of poor quality and insufficient quantity. In some places heating in winter months was severely inadequate. Residents in most institutions visited complained that they were sometimes ill-treated by certain orderlies. Methods of restraint and seclusion in all homes visited, in the opinion of the delegation, amounted to cruel, inhuman or degrading treatment or punishment.

Psychotropic medication was openly used to subdue behaviours which may well not have a psychiatric basis, but may be due to distress and/or anger arising from the environment. Medication was the only therapy in most of the social care homes visited and occupational therapy, where available, consisted only of residents doing the menial work of the staff without any recompense.

In some institutions the mortality rates were high, particularly in years that had colder and longer winters. In most of the homes post-mortem examinations had never been performed nor had police or other authorities investigated the circumstances of deaths of residents. Records on deaths in social care homes are not reliably kept and apparently this data is not systematically collected and published at the national level.

Supervision by national and local authorities of all institutions visited was sporadic and inadequate and underlines the urgency for an independent oversight mechanism to be established.

This report is divided into two parts. The first deals with psychiatric hospitals visited and the provisions for compulsory psychiatric treatment. The second part, which deals with social care homes, is divided into two sections, one for children's institutions and the other for institutions caring for adults with mental disabilities. The report also contains a summary of AI's concerns and a list of recommendations to the Bulgarian authorities.

This report summarizes a 71-page document (36822 words): Bulgaria: Far from the eyes of society, Systematic discrimination against people with mental disabilities (AI Index: EUR 15/005/2002) issued by AI in October 2002. Anyone wishing further details or to take action on this issue should consult the full document. An extensive range of our materials on this and other subjects is available at Amnesty International and the news releases can be received by email.

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