MDAC News Bulletin

BULGARIA: European Committee for the Prevention of Torture urges reform within mental health and social care institutions

29 February 2008, Budapest (Hungary) and Strasbourg (France): The European Committee for the Prevention of Torture (CPT) has raised serious concerns about guardianship, admission procedures and conditions within mental health and social care institutions in Bulgaria. It seeks prompt reforms. 

Following its visit to places of detention, which include mental health and social care institutions, the CPT has raised a number of concerns that warrant urgent and detailed attention by the Bulgarian government. Many of these concerns mirror those already raised by MDAC by way of legal complaint before the European Court of Human Rights.

The most serious concerns relating to mental health institutions relate to lack of staff, staff training and resources. This has led to incidences of violence, very limited therapeutic options and insufficient provision of rehabilitation programmes as preparation for independent life in society. In addition, despite previous recommendations of the CPT in 2002 that attention be given to improving living conditions, these remain inadequate. In one institution there had for instance been no hot water for some months, ‘the general level of hygiene was unworthy of a hospital facility’, and nutrition insufficient.

As MDAC has previously noted, practice, rhetoric and legislative provision in Bulgaria often diverge. This has been re-iterated by the CPT which points out in its Report, that procedures for compulsory admission and treatment are not necessarily followed, legal representation sometimes overlooked and ‘consent’ to treatment, so as to avoid the need for court proceedings, obtained through pressure. The importance of regular monitoring of institutions repeatedly raised by MDAC, was also commented upon by the CPT. It recommends that the government ‘develop mechanisms for regular visits to psychiatric establishments by independent bodies’ and also to homes for ‘persons of mental retardation’.

Although some welcome efforts to reorganise the care of persons with mental health disabilities were evident to the CPT, so too were their deficiencies. It noted, as has MDAC, insufficient progress in de-institutionalisation programmes which has resulted in many residents remaining within institutions for their entire lives. Of utmost continued concern in this respect is the failure of the government to introduce judicial review of both initial and continued admissions. To deprive a person of their liberty without adequate legal oversight offers huge potential for abuse. It is for this reason that MDAC particularly endorses and welcomes the CPT’s forceful recommendation that such reviews are provided.

Perhaps of equal concern however is when legal oversight is openly mocked. The CPT describes in its report one incident where 55 residents were deprived, legally, of their legal capacity in the course of a single court hearing. In turn the Director of the institution in which they were housed was appointed their legal guardian. The ease at which legal capacity is removed, guardianship imposed and abuses perpetuated, has formed a major focus of MDAC’s recent work. So too do they form the basis of complaints currently before the European Court of Human Rights, the judgments of which are enforceable under international law.