Mental Health Care in Bulgaria since World War II

Abstract

The beginnings of mental health care in Bulgaria go back a very long time; but systematic, planned, and multifaceted development did not occur until after World War II. For the People's Republic of Bulgaria, this has been a period of fundamental change in the state and the social system. At the outset of the period under discussion, Bulgaria was in a very inauspicious situation with regard to care of the mentally ill. At the time, care by the state was limited to a single university neuropsychiatrie clinic and a few hospitals and hospices for the chronically ill, with a total of 1,135 beds (150 of which were in the university neuropsychiatrie clinic). The two disciplines neurology and psychiatry were not separated, as they are now. All told, there were only about forty doctors throughout the entire country who were working in these two areas of specialization during the war. Care in the private sector took place in only three private hospitals with fewer than a hundred beds. Outpatient care by the state was provided mainly in the university clinic in Sofia; there were a few facilities in other cities, where such care was predominantly part of private practice. The quality of care before and during the war was very unsatisfactory, and in some hospitals this continued to be the case in the early postwar years as well. Gradually, with much effort and in parallel with the development of a single, integral state network encompassing the entire country, the conditions of hospitalization, medical care in hospitals, follow-up care, and rehabilitation have steadily improved. In a number of places, hospital care has now reached optimal levels; in a few cases, it has even achieved quite comfortable conditions (e.g., in the cities of Radnevo, Varna, and others). Most of the older psychiatric hospitals were located in whatever buildings were available (monasteries, schools, and even former prisons); hence, conditions for the patients confined therein were bound to be unsatisfactory. In some