Institutions Remain Dumping Grounds for Forgotten People

Reform is coming too slowly to institutions for adults with intellectual and mental health disabilities in Bulgaria, Romania and Serbia, where chronic neglect, filthy conditions, and the use of physical restraints and high-dosage drugs to control behaviour remain routine.

Read the article in Bulgarian

Yana's Photo Gallery: Dumping Grounds for People

Someone is screaming her head off in what seems a desolate part of the yard. There is a fence surrounding some shacks and, with each step taken towards it, the shrieks get louder. Ten more steps and there’s a gate in the fence. Another ten and all hell is let loose.

There is the screaming woman – barefoot, skinny and dressed in rags. There is another woman, unable to walk, rolling around on the ground, covered in flies – hundreds of them. In her filthy hands she clutches two chunks of bread. There is a girl dipping her dry bread in the dirty puddle in front of the outside toilets. Then she eats it. No-one pays attention.

It is lunchtime in Goren Chiflik, an institution in eastern Bulgaria, housing 90 women with intellectual and mental health disabilities. It was renovated recently, but the place of horrors, the shacks for the ‘most disabled’ residents, was left untouched. It is well hidden; so well hidden, in fact, that the head of the regional directorate for social protection says she has never seen it, despite having paid numerous visits to the institution. The 30 women here are not allowed to eat with the others. Instead, they are given their food behind the fence that is usually locked, effectively turning it into a cage.

This investigation, mostly conducted undercover in institutions for adults with intellectual and mental health disabilities in Bulgaria, Romania and Serbia, uncovered evidence of human rights abuses, inhuman and degrading treatment and appalling neglect. It showed that reform in this field remains patchy and slow, and too often leaves the most vulnerable behind.

 People in institutions3,700 in Bulgaria’s institutions for adults with intellectual and mental health disabilities.
5,700 in institutions under Serbia’s social ministry.
4,800 in the chronic wards of Romania’s mental hospitals.



Tied up with drugs

In the institution for adults with mental illnesses in Radovets, I meet 76 unusually lethargic men. Too many hands are trembling, faces stiff and movements heavy. I am about to find out why.

Radovets is a tiny village in southeast Bulgaria and, like most institutions, it is as remote as can be. Attracting qualified personnel here is practically impossible.

Officially, I am in Radovets as a researcher for the Bulgarian Helsinki Committee, BHC, the country’s most influential human rights NGO. This was the way I chose to gather most information for this investigation, as journalists make institutions nervous.

Although almost all the residents are diagnosed with schizophrenia, Radovets does not have a full-time psychiatrist. The director of the institution, Krayo Kraev, says just one such specialist works within a radius of 50km, and he only visits once a month.

One consequence of this neglect is that all the men in Radovets are on the same therapy, haloperidol, in every medical record we see. The director confirms this. “All residents have been prescribed haloperidol by the psychiatrist,” he says. He sees nothing wrong with this state of affairs.

Medical experts maintain that haloperidol, an old antipsychotic drug, has extremely strong side effects, including tardive dyskinesia – involuntary movements of the face, hands and feet; akathisia – manifested in repeated rocking movements; lethargy and sleepiness.

The men in Radovets have taken haloperidol every day, sometimes for years. Records show that doses are high and the drug is given without consent. This means tranquil residents and untroubled staff. It also results in blurred minds and harmed bodies.

“This is not treatment, but taking control of people,” Krasimir Kunev, head of the BHC, says. “I’ve never seen side effects so widespread.”

During our visit, the men either sleep or sit in the yard doing nothing. Hristo is one. This 32-year-old, once an award-winning chess-player, describes his day: “I wake up, have breakfast, take my pills, but they suck all my energy out and I fall asleep. I wake up, go to lunch, thankfully we are not given pills then, so I play some chess; dinner comes, I take my pills, I am exhausted, I go to sleep.”

As this applies for all the residents, it becomes clear why the old isolation unit – a tiny closet under the stairs – no longer has to be used. Drug-based restraint has become a substitute for physical restraint.

Challenged about the therapy, the director of Radovets says he will look into the issue.

 DeinstitutionalisationExperts have been urging “deinstitutionalisation” for years. This involves the development of a network of community-based services, such as day-care centres and sheltered housing to prevent people from entering institutions or help them when leaving. However, according to the Open Society Mental Health Initiative, “none of the new EU member states have concrete plans or financing mechanisms to develop networks of community-based alternatives.”

For example, according to the Bulgarian social ministry, in 2009, ten people were taken out of institutions and placed in protected houses. However, 1,300 are on a waiting list for admission to institutions. The Bulgarian Helsinki Committee calls this policy an “imitation of deinstitutionalisation”.












Read the article in Bulgarian

This article was produced as part of the Balkan Fellowship for Journalistic Excellence, an initiative of the Robert Bosch Stiftung and ERSTE Foundation, in cooperation with the Balkan Investigative Reporting Network, BIRN.