“In State Psychiatric Hospitals in Bulgaria, One Doctor Takes Care of Ten Patients,” said Doctor Tsveteslava Galabova

A report by the European Committee for the Prevention of Torture has once again brought to the forefront the issues in Bulgaria and the way psychiatric hospitals operate in the country. Tsveteslava Galabova, Director of the State Psychiatric Hospital “St. Ivan Rilski,” told BNT on March 17 that the findings are severe, but not new.

Tsveteslava Galabova, Director of the State Psychiatric Hospital “St. Ivan Rilski”:
“I have witnessed all the reports; I have been working at Kurilo since 1994, roughly the time when monitoring of our work began. I have seen all the reports, and I dare say the conclusions are always the same: poor treatment of patients, inhumane practices, restraints, and there is always a significant staff shortage. And now, it is the same.”

Galabova explained that in Bulgaria, one doctor is responsible for ten patients in psychiatric hospitals, and most of the staff are nearing retirement age. While there is a national mental health strategy, it is not functioning effectively.

Tsveteslava Galabova, Director of the State Psychiatric Hospital “St. Ivan Rilski”:
“All measures outlined in the mental health strategy should be implemented. Day centres and community-based care need to be fully established, as non-medication-based care essentially does not exist. Well-organised psychiatric inpatient facilities are required. Legally regulated institutions should exist for treating patients who have committed serious crimes, with the possibility for longer-term care. Compensation must be appropriate. We need to consider why there are no clinical pathways in psychiatry and address this properly if necessary. And, of course, there should be a normal, non-stigmatising approach towards both the mentally ill and those of us who work with them.”

As a member of the Management Board of the Bulgarian Psychiatric Association, Dr Galabova noted that staff disagree with some of the recommendations in the European Committee’s report, including which medications should be used in hospitals and the requirement to provide patients with personal space.

Tsveteslava Galabova, Director of the State Psychiatric Hospital “St. Ivan Rilski”:
“The report criticises us for not taking patients on walks and for the lack of personal space. But it is impossible to take everyone out for a walk when there is one staff member taking care for ten patients. Each patient should have individual supervision.”

Galabova also highlighted that state psychiatric hospitals in practice also serve as shelters because social services do not function properly. She added that the Bulgarian Psychiatric Association has submitted a statement on the report, indicating readiness to strike:

Tsveteslava Galabova, Director of the State Psychiatric Hospital “St. Ivan Rilski”:
“I believe it will not come to a strike. For simple biological reasons, these hospitals would close themselves if things continue as they are.”

Galabova also commented on the tragic case of a young woman who died following a cosmetic procedure in Dupnitsa:

Tsveteslava Galabova, Director of the State Psychiatric Hospital “St. Ivan Rilski”:“This is truly taking on the proportions of a mass psychosis. Of course, thankfully, not psychosis in the clinical sense of the word, but we are certainly beginning to face problems with self-perception and the compulsion to be liked by everyone, everywhere, because we are flooded by social media; images and videos of physically attractive young—and not-so-young—people are everywhere. It is very easy to conclude that we too must become the same, without realising that this is unnecessary.

Of course, there is a great deal of institutional work to be done, meaning there must be clear regulations on what is done, where, by whom, how, why, and with what responsibility. But before that, we need to raise our health literacy so that we not only have information but truly understand what we can do to ourselves, how to do it safely, what the risks are, and with whom it should be done. As you rightly noted in the preliminary discussion, people spend more time researching a phone—its brand, specifications—than considering these procedures. Yet here, seemingly instinctively, we rush to try to become young. In essence, this represents a psychological issue even before any physical interventions take place.”