12 years after the beginning of the deinstitutionalization process, there is still no progress


Twelve years ago Bulgaria pledged to begin deinstitutionalizing people with mental health disabilities. The aim was to reduce the placement capacity of institutions (homes) for adults with mental health and intellectual disabilities, suspend admission of new people, and gradually close these institutions while returning their residents back into the community, where supported by specialists, they could lead independent lives.

The Bulgarian Helsinki Committee (BHC) presented a new report last week that comes to the conclusion that the process of deinstitutionalization has not even started. Evidence suggests that over the last 12 years the number of specialized institutions remains unchanged. Some of them were successfully closed down, only to have new ones open in their place. Today the number of specialized institutions is 54. In 15 years, the number of residents has dropped from 5000 in 1998 to 4000 in early 2015. Given the general negative demographic trends in Bulgaria during this period, the 20% decrease is insignificant and is a retreat from the set targets in a number of strategic documents.

Almost all specialized institutions are isolated, located far from larger cities, in inaccessible mountain areas, or, in some cases, along border areas. The isolated location of these institutions prevents residents from receiving adequate medical care and access to social services. The material conditions are extremely depreciated and in need of urgent repair. Finding qualified personnel is also a challenge not only in small towns but in larger cities too, due to extremely low salaries.

BHC’s report nootes that the authorities understand deinstitutionalization as a process of taking people out of institutions and moving them into alternative community-based social services that essentially replicate the institutional model on a smaller scale. By April 2016 in Bulgaria there are 128 protected homes for adults with mental health disabilities, 11 transitional homes and 54 family-type housing centres (24 for people with mental health disabilities; 22 for people with intellectual disabilities and 8 for people with dementia). These services have become micro-institutions and a final destination for their residents. They recreate the atmosphere of the large state institutions and do not have the capacity to develop residents’ skills for an independent life and social inclusion.

All this further propagates the institutional model of care and confirms the lack of political will for quality and cardinal reform. Alarming is also the fact that in spite of improved material conditions in some institutions, care for residents and the institutional culture has not improved over the last 15-20 years.

BHC recommends a comprehensive rethinking of social policies affecting people with mental health and intellectual disabilities. One of the most important steps that the state must immediately take to launch the process of deinstitutionalization is to suspend the admission of new residents in specialized institutions. Potential residents should be offered a system of alternative services for individual expert support. A uniform standard for non-residential social services should also be introduced and their availability should be guaranteed through long-term programs.